Diagnosis And Staging Of Inflammatory Breast Cancer
Because inflammatory breast cancer forms in layers, your doctor may not feel a distinct lump during a breast exam and a mammogram may not detect one either. However, it is possible to see and feel the skin thickening that often happens with IBC. This skin thickening can also be detected on a mammogram.
In most cases, inflammatory breast cancer is diagnosed after you or your doctor can see or feel breast changes such as redness, swelling, warmth, or an orange-peel look to the skin. Because IBC grows quickly, it is usually found at a locally advanced stage, meaning that cancer cells have spread into nearby breast tissue or lymph nodes. Just about all people with IBC have evidence of cancer in the lymph nodes. In approximately 1 out of 3 people with IBC, the cancer has spread from the breast to other areas of the body.
If youve been diagnosed with inflammatory breast cancer, its completely understandable if youre feeling overwhelmed. Keep in mind, though, that there are a variety of treatment options available for IBC.
How Is Ibc Treated
Treatment for IBC usually starts out with chemotherapy, followed by surgery and breast cancer radiation therapy.
- Recommendations for chemotherapy cycles average six cycles over a span of four to six months.
- Radiation therapy is generally given five days a week for five to six weeks.
The goal of chemotherapy for breast cancer is to shrink the tumor or tumors as much as possible before surgery so the oncologist can surgically remove as much cancer as possible. If your cancer is HER2-positive, you may also undergo a targeted therapy. If your hormone receptor status was positive, your provider may suggest hormone therapy.
A mastectomy is usually indicated for people with IBC, and if your provider finds cancer in the lymph nodes, these organs may be surgically removed as well. Many people with IBC have radiation therapy following surgery. Its possible to have breast reconstruction, but because radiation therapy is so important in IBC, its recommended to wait until after your radiation is finished.
Consider getting a second opinion or even several opinions to be sure youre comfortable with your surgical team and that youre getting the information you need to make a decision thats right for you.
What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
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Signs And Symptoms Of Inflammatory Breast Cancer
Inflammatory breast cancer causes a number of signs and symptoms, most of which develop quickly , including:
- Swelling of the skin of the breast
- Redness involving more than one-third of the breast
- Pitting or thickening of the skin of the breast so that it may look and feel like an orange peel
- A retracted or inverted nipple
- One breast looking larger than the other because of swelling
- One breast feeling warmer and heavier than the other
- A breast that may be tender, painful or itchy
- Swelling of the lymph nodes under the arms or near the collarbone
Tenderness, redness, warmth, and itching are also common symptoms of a breast infection or inflammation, such as mastitis if youre pregnant or breastfeeding. Because these problems are much more common than IBC, your doctor might suspect infection at first as a cause and treat you with antibiotics.
This may be a good first step, but if your symptoms dont get better in 7 to 10 days, more tests need to be done to look for cancer. The possibility of IBC should be considered more strongly if you have these symptoms and are not pregnant or breastfeeding, or have been through menopause.
IBC grows and spreads quickly, so the cancer may have already spread to nearby lymph nodes by the time symptoms are noticed. This spread can cause swollen lymph nodes under your arm or above your collar bone. If the diagnosis is delayed, the cancer can spread to distant sites.
When To Consider Joining A Clinical Trial
If youre newly diagnosed with IBC, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after youve been diagnosed. So, theres time to look for a clinical trial.
Once youve begun treatment for IBC, it can be hard to join a clinical trial.
Susan G. Komen® Breast Care Helpline
If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN or email .
The Helpline offers breast cancer clinical trial education and support, such as:
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service to help find clinical trials that fit your health needs, including trials for people with IBC.
Learn more about clinical trials.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.
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Surviving Stage 4 Breast Cancer: Is It Possible
Understanding survival rates of stage 4 breast cancer
According to the National Cancer Institute , an estimated 27 percent of people in the United States live at least 5 years after being diagnosed with stage 4 breast cancer.
Many factors can affect your longevity and quality of life. Different subtypes of breast cancer behave differently. Some are more aggressive than others, and some have far fewer treatment options than others. For this reason, your subtype may affect your outlook.
Higher survival rates are also associated with the extent and location of metastasis. In other words, your long-term outlook may be better if your cancer has only spread to your bones than if its found in your bones and lungs.
Immediately seeking treatment, like chemotherapy, surgery, or hormone therapy, can help improve your outlook. Making healthy lifestyle choices might also improve your chances of survival.
What Makes Ibc Different
Inflammatory breast cancer accounts for only a tiny fraction of breast cancers, so its symptoms are less well known and the disease has received less attention from researchers. It also has different physical signs than other types of breast cancer instead of a lump, IBC causes swelling and visible changes in the skin around the breast including redness and a dimpling of the skin called peau d’orange, which is French for the skin of an orange.
IBC also tends to show up in women at a younger age and spread more quickly than other types of cancer. And because the cancer cells have already grown into the skin by the time symptoms appear, its typically diagnosed at stage 3 or stage 4.
Unlike strides made against other types of breast cancer, there arent yet any targeted therapies against IBC.
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How Quickly Breast Cancer Develops
You may have heard remarks that cancer has been present for five years before it is diagnosed, and this may sometimes be true.
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown, as estimates based on doubling time assume that this is constant throughout the duration of tumor growth.
If doubling time were constant, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor, and a doubling time of 100 days would take 10 years to be evident on exam.
In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Since the majority of studies have found the average doubling time to be between 50 days and 200 days, itâs likely that most breast cancers that are diagnosed began at least 5 years earlier .
Finding Social And Emotional Support
Its critical to find a strong source of social support, whether its your friends and family, or a support group with other people with breast cancer. While the journey is challenging, you dont have to navigate stage 4 breast cancer alone.
Ask your healthcare provider if theres an in-person support group where you receive treatments. You can also find online and social media groups to join.
Your healthcare provider can also provide more information about the specifics of your cancer, treatment options, and support programs in your area. If youre not sure where to look for an in-person group, a counselor or social worker can also help.
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Has Anyone Survived Stage 4 Inflammatory Breast Cancer After It Went Into The Bones
Asked byTopazcat on Tuesday, June 4, 2013
Has anyone survived stage 4 Inflammatory Breast Cancer after it went into the bones?
I was diagnosed with IBC stage IIIB November 2010. Received 16 weeks of chemo, double mastectomy, 22 lymph nodes removed from under left arm, and 30 radiation treatments. was cancer free for almost 2 years. Friday I found out cancer is back and is in my spine and pelvic bones. I am now stage 4 metastatic cancer. Will have more tests to see if it is any place else. I am scared and feel like this is a recurring nightmare. Has anyone survived once the cancer is in the spine?
Hormone Receptor Status And Her2 Status
Triple negative IBC are hormone receptor-negative and HER2-negative. Triple negative IBC and IBC that are hormone receptor-positive and HER2-negative tend to have a worse prognosis than other IBC .
Hormone receptor-negative breast cancers, such as triple negative IBC, can be treated with chemotherapy, but they cant be treated with hormone therapy.
HER2-positive breast cancers can be treated with chemotherapy and with trastuzumab and other HER2-targeted therapies. So, women with HER2-positive IBC tend to have better survival than women with HER2-negative IBC .
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Antibodies And Cell Staining For Flow Cytometry
The staining panel, monoclonal antibody clones, and sources are shown in Supplementary Table S. Antibodies in direct surface staining tubes were directly conjugated with fluorophores. Staining for perforin and granzyme B was done after samples were fixed with 2% paraformaldehyde and permeabilized with PBS containing 0.1% saponin, 1% BSA, and 0.1% sodium azide. Staining for FoxP3 was performed after cells were fixed and permeabilized with the Biolegend FOXP3 Fix/Perm Buffer Set . One million cells were stained in each sample on ice for 20min in approximately 200l of staining buffer and rinsed twice. Staining tubes that were not fixed/permeabilized were subjected to 100ng/ml propidium iodide in the second rinsing step to mark dead cells. The BD IMK kit was used to determine the percentages and absolute counts in whole blood of the following mature lymphocytes: T lymphocytes , B lymphocytes , helper/inducer T lymphocytes , cytotoxic T lymphocytes , and natural killer lymphocytes . BD Trucount tubes were used for determining absolute counts.
Breast Cancer Symptoms & Signs
Breast cancer does not always produce symptoms, but when symptoms do occur, a lump or mass in the breast is the most common symptom. Other possible symptoms include nipple discharge or redness, changes in the skin such as puckering or dimpling, and swelling of part of the breast. Certain types of cancers known as inflammatory breast cancers may produce redness and warmth of the affected breast, but these are not common symptoms of breast cancer.
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Patients And Study Variables
Patients, diagnosed from 2005 to 2016, with clinical T4dN03M0 breast cancer were identified: diffuse erythema and edema involving a third or more of the skin of the breast. Patients with only a pathological T4d status without clinical T4d status were excluded. Patients were classified into four breast cancer subtypes, based on HR/HER2-status: HR+ /HER2, HR+/HER2+, HR /HER2+, and HR /HER2. Patients were excluded when data on HR and/or HER2 status were missing.
According to Dutch guidelines, ER/PR status had been determined with immunohistochemistry . At least 10% positive tumor nuclei were considered as a positive result. In the Netherlands, HER2 status was considered positive with an immunohistochemical score of 3+ or amplification of the HER2 gene diagnosed with in situ hybridization or with other amplification-based techniques, such as multiplex ligation-dependent probe amplification . In case of an immunohistochemical score of 2+ , ISH or MLPA was performed. If in this case HER2 was found to be amplified, HER2 was considered positive. HER2 status was considered negative with an immunohistochemical score of 0 or 1+ or if ISH or MLPA showed no amplification of the HER2 gene. In the Netherlands, some variation in determining the HER2 status existed in the period 20052016 in the double probe ISH test). For this study, the HER2 status as was registered in the NCR was used.
Availability Of Data And Materials
The data that support the findings of this study are available from the NCR but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the NCR.
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How Is Invasive Ductal Carcinoma Diagnosed
Same Day Results
At the Johns Hopkins Breast Center, we know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. We follow strict guidelines for biopsies and pathology reports. Most of our patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.
Learn more about the steps of diagnosis, including:
- Digital mammography
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How Early Can Ibc Be Diagnosed
Because of IBCs quick-growing and aggressive nature, combined with its tendency to be misdiagnosed, its commonly diagnosed at an advanced stage.
- IBC tends to grow in layers, which is why it can be missed during exams.
- On imaging, these sheets of tissue can resemble nests.
- Your doctor may be able to feel these areas of thickening on your skin, as well as possibly see areas of higher density on a mammogram.
At CTCA®, our doctors determine a diagnosis based not just on the breast’s appearance, but on the results further testing, which may include:
- A biopsy that removes a small sample of affected tissue in your breast to be examined in a lab
- Biopsy results that show whether you have the HER2 protein, which is present in about 20 percent of breast cancer cases
- The determination of hormone receptor status, or whether you have more hormone receptors than usual within the cancer cells
Knowing whether your cancer has any of these characteristics will help you and your care team make informed treatment decisions.
If the biopsy results in an inflammatory breast cancer diagnosis, your doctor will likely order a breast magnetic resonance imaging to find out how much of the breast and lymph tissue is affected, and whether the other breast has been affected . You may have other tests performed, including positron emission tomography scan, computed tomography scan and bone scan, to also see whether the cancer has spread to any other parts of the body.
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Lymphocytes In Metastatic Ibc
We performed comprehensive immune phenotyping by multi-parameter flow cytometry on fresh peripheral blood samples from each of the IBC patients and healthy controls. Seventy-two immune parameters were compared between IBC and healthy donors by Wilcoxon rank-sum test. The absolute counts of T cells , B cells , helper T cells , cytotoxic T cells , and natural killer cells in blood were also determined, and median values are shown in Table . IBC patients with metastatic disease had a significantly lower absolute lymphocyte count than healthy female donors . The absolute number of total NK cells in the peripheral blood of IBC patients was also lower than in healthy donors , which paralleled reductions in absolute numbers of B cells and T cells . The five IBC patients with TN disease exhibited some of the most extreme lymphopenia with particularly low levels of T cells . It is also worth noting that lymphocyte counts from the two patients that did not receive chemotherapy treatment were similar to other IBC patients .
Table 2 The median number±standard deviation of lymphocytes per l is indicated for 14 stage IV metastatic IBC patients and 11 healthy donors as assessed using BD Trucount assays
Survival Rates For Metastatic Breast Cancer
According to the American Cancer Society , the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 28 percent. This percentage is considerably lower than earlier stages. For all stages, the overall 5-year survival rate is 90 percent.
Because survival rates are higher in the early stages of breast cancer, early diagnosis and treatment is crucial. But remember: The right treatment for stage 4 breast cancer can improve quality of life and longevity.
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