Inflammatory breast cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 28, 2016
StartDiseasesInflammatory breast cancer

Inflammatory breast cancer IBC is an uncommon but deadly form of breast cancer, accounting for 1-5 percent of all breast cancers. This type of breast cancer spreads rapidly and makes the affected breast swell, red, and tender.

Contents

Definition & Facts

Most cases of inflammatory breast cancer involve cells that line the milk ducts and then spread beyond the ducts. The cancer cells often don't form lumps and may not appear on a mammogram, hindering diagnosis and early detection. They block the lymphatic vessels, resulting in symptoms that appear similar to a breast infection that might affect a breastfeeding or pregnant mother.

Women who have inflammatory breast cancer experience delayed diagnosis. Inflammatory breast cancer is commonly diagnosed at stage 3 or 4, depending on if it has metastasized or spread to the lymph nodes or the rest of the tissues. Inflammatory breast cancer is more likely than other cancers to recur. Less common than other forms of breast cancer, it is responsible for a disproportionate amount of deaths from breast cancer.

Symptoms & Complaints

Some of the signs and symptoms include:

  • A breast’s appearance changing over the course of some weeks
  • Heaviness, thickness or a visible enlargement of the affected breast
  • A discoloration that makes the breast look bruised, purple, red or pink
  • Feeling unusual warmth in the affected breast
  • Ridges or dimpling on the affected breast’s skin making it look like an orange peel
  • Breast pain, tenderness or aching
  • Turning inward or flattening of the nipple
  • Swollen lymph nodes above the collarbone, under the arm, or below the collarbone

These symptoms are similar to symptoms of an infection incurred during pregnancy or breastfeeding. It is important for women who are not breastfeeding or pregnant to seek prompt medical attention because these symptoms are otherwise unusual.

Causes

To date, scientists are not sure about the causes of inflammatory breast cancer. However, like all cancers, it results from cells dividing uncontrollably. The abnormally growing cells are usually located in the milk ducts. These cells accumulate and obstruct the lymphatic vessels in the breast. The lymphatic vessel blockage causes swollen, dimpled and red skin, which appears to be the result of inflammation.

Inflammatory breast cancer is diagnosed in different frequencies in various parts of the world. For instance, in Sub-Saharan Africa and northern Africa, there are higher rates of inflammatory breast cancer compared to Western Europe and Northern America. Obesity is a known risk factor. The average age of diagnosis is 52.

Diagnosis & Tests

Doctors will visually inspect the breast as part of their diagnostic process, but imaging and laboratory tests are required to make a definitive diagnosis. Some of the tests include:

  • Mammogram. This is an X-ray of a patient’s breast tissue. Each breast is photographed and checked on the X-ray machine. The breast has to be firmly but gently compressed using a clear plastic plate. Two mammograms have to be taken for each breast but from different angles.
  • Biopsy. The doctor takes samples of tissue from the infected breast. These samples are then examined using a microscope to check for cancer cells. The doctor may take samples from lymph nodes as well to determine whether or not the cancer has metastasized.
  • Ultrasound scan. This test makes use of sound waves so as to provide a photo of the breast tissue. A gel has to be applied on the breast to assist in moving the device around the required area. These sound waves are then converted into photos using a computer. The main advantage of this test is that it takes about ten minutes or less and it is painless.

Breast cancer is staged according to the tumor's characteristics (T), whether or not it has spread to the lymph nodes (N), and whether or not it has spread to other organs (M). All cases of inflammatory breast cancers are staged as T4, the highest stage for that metric; all cases are staged overall at either stage 3 or stage 4. The survival rate for stage 4 cancer is 21 months.

Treatment & Therapy

Because this type of cancer spreads quickly, treatment has to be started straight away. Treatment options include:

  • Chemotherapy – this kind of treatment makes use of anti-cancer drugs to destroy the cancer cells. One can have chemotherapy after surgery (adjuvant chemotherapy) to reduce the chances of recurrence. Other women can have it before their surgery (neoadjuvant chemotherapy) mainly to reduce the cancer size. Chemotherapy can be delivered orally or intravenously.
  • Surgery – the type of surgery a cancer patient undergoes depends on the cancer stage and the health of the patient. It may be possible to perform breast-conserving surgery that only removes the tumor if a lump is present (a lumpectomy) or only removes the cancer cells (partial mastectomy). In other cases, the entire breast has to be removed (mastectomy) as well as all the lymph nodes under the arm near the affected breast (radical mastectomy).
  • Radiotherapy – in this kind of treatment, high-energy rays are used to destroy the cancer cells. One may be given radiotherapy to minimize the risk of cancer coming back to the chest, lymph nodes, and breast.
  • Hormonal therapyProgesterone and estrogen hormones may encourage the growth of cancer cells. Hormonal therapies are offered to reduce the amount of the hormone in the body. This may delay the growth and spread of cancer.
  • Targeted therapy. This form of therapy attacks specific genes or proteins in the cancer cells with antibodies. It is important to first determine which abnormal protein or gene that the cancer cells contain. In some cases of inflammatory breast cancer, the cancer cells have a protein HER2 that functions abnormally. If this abnormality is present, it may be treated with trastuzumab, a type of antibody.

Prevention & Prophylaxis

Although there isn’t a way of preventing inflammatory breast cancer, women should get breast cancer screenings. It is also important to live a healthy lifestyle that includes consuming a balanced diet, getting regular exercise and limiting alcohol intake. Women also should remain vigilant about any irregularities they notice in their breasts and seek medical attention. Early detection is crucial in the treatment of breast cancers.