How Is Inflammatory Breast Cancer Diagnosed

Differential Diagnosis And Work

Other issues to consider are those that delay the diagnosis at presentation before a malignancy is identified. The differential diagnosis in a patient with signs or symptoms of inflammation of the breast without a diagnosis, i.e., those with inflammatory breast or inflammatory breast syndrome, includes both lactation-related and non-puerperal causes, and very few reports have been published that define the incidence of malignancy among patients presenting with inflammatory breast symptoms aside from lactation-related mastitis . This means that little literature is available to assist the generalist faced with a patient with an inflammatory breast to optimize the work-up and to distinguish malignant from non-malignant etiologies. The most common diagnosis causing inflammatory breast syndrome is infectious mastitis, which is most common during lactation and typically responds quickly to antibiotics. The crucial diagnosis to rule out is IBC, as IBC is always stage III at diagnosis and progresses rapidly to stage IV breast cancer when the diagnosis is delayed . Also important to recognize is that IBC can occur in pregnant and lactating women, making the diagnosis in such patients especially challenging.

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How Is Inflammatory Breast Cancer Diagnosed And Staged

Inflammatory breast cancer is rare, with symptoms similar to a more common condition breast infections . Your healthcare provider may prescribe antibiotics and see if it resolves your symptoms to rule out an infection. If they suspect IBC, theyll order a biopsy to confirm the diagnosis and additional tests to see if the cancers spread beyond your breast.

Diagnosing inflammatory breast cancer

Diagnosis involves a physical examination, imaging studies and a biopsy.

Staging inflammatory breast cancer

Biopsy results can help your healthcare provider stage the cancer, or determine whether its spread outside of your breast tissue. By the time IBC is diagnosed, its either stage III or stage IV. Stage III cancer has only spread to your breast tissue skin. Stage IV cancer has spread to other organs.

Your healthcare provider may order any of the following tests to determine if your cancers spread:

What Is The Prognosis For People With Inflammatory Breast Cancer

IBC usually develops quickly and spreads to other tissues outside of your breast. It often returns after treatment. Early diagnosis and treatment are vital to managing the condition as effectively as possible.

Because IBC spreads quickly and is found later than other cancers, the outlook for people with this condition is generally not as good as for different types of breast cancer. Still, some people live many years after an IBC diagnosis. Your healthcare provider can explain your prognosis to you.

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How Is Inflammatory Breast Cancer Different From Other Types Of Breast Cancer

When compared to other forms of the disease, inflammatory breast cancer:

• Looks different — often there are no lumps, but your breast might appear red, swollen, or inflamed
• Is harder to diagnose — it doesnât show up well on a mammogram
• Is more aggressive and spreads more quickly than other types
• Tends to be diagnosed at a younger age, especially among African-American women
• Is more likely to affect overweight women
• Is often further along when itâs diagnosed
• Sometimes has spread past the breast when itâs diagnosed, which makes it harder to treat

Change In Nipple Appearance

A change in the shape of the nipple is another possible early sign of IBC. Your nipple may become flat or retract inside the breast.

A pinch test can help determine if your nipples are flat or inverted. Place your thumb and index finger around your areola and gently squeeze. A normal nipple moves forward after pinching. A flat nipple doesnt move forward or backward. A pinch causes an inverted nipple to retract into the breast.

Having flat or inverted nipples does not necessarily mean you have IBC. These types of nipples are normal for some women and are no cause for concern. On the other hand, if your nipples change, speak with a doctor immediately.

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How Is Ibc Different From Other Types Of Breast Cancer

Unlike with other types of breast cancers, only 15 percent of people diagnosed with IBC have a lump. Thats why it can be mistaken for breast infections or injuries because of the redness and swelling it causes. While its possible to detect IBC on a mammogram, the imaging device may not recognize evidence of disease because the cancer forms in layers.

More women than men are affected by IBC, and it tends to be seen in younger women than other breast cancers. Black women are also at a slightly higher risk of the disease than white women, and being overweight or obese is also known risk factor for IBC.

Treatment For Inflammatory Breast Cancer

The treatment for inflammatory breast cancer can be slightly different to other types of breast cancer.

Chemotherapy

You usually have chemotherapy as your first treatment. This is called neo adjuvant chemotherapy. It helps to control the cancer cells in the breast and reduces the swelling. It also aims to destroy any cancer cells that might have spread elsewhere in the body.

Surgery

After chemotherapy you have surgery unless there is a reason why this isn’t suitable for you. You are most likely to have your whole breast removed .

Some women might be able to have breast conserving surgery. For this type of surgery, the surgeon removes the area of cancer and a surrounding area of healthy tissue. But for most women, mastectomy is the best option.

The surgeon usually removes the lymph nodes under your armpit.

Radiotherapy

After surgery you have radiotherapy to the remaining breast tissue. This is to help stop the cancer coming back.

Other drug treatment you may have

You have hormone therapy tablets for some years if your breast cancer has hormone receptors. Your doctor might recommend that you also have targeted cancer therapy, such as trastuzumab and pertuzumab, if your cancer has receptors for those drugs.

Breast reconstruction

You may be able to have breast reconstruction after you have finished your treatment . Do ask your surgeon, they can tell you whether this is suitable for you.

• Find out about breast cancer treatments

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When Should I Call My Doctor If I Am Concerned About Inflammatory Breast Cancer

Contact your healthcare provider immediately if you notice any changes to your breast, even if you dont feel a lump. With further testing, your provider can determine whether IBC may be a concern.

Contact your provider if youre taking antibiotics for a breast infection especially if you have the symptoms of IBC and your symptoms dont improve within a week.

What Causes Inflammatory Breast Cancer

Most inflammatory breast cancer is considered invasive ductal carcinoma. Ductal carcinoma is cancer that forms from cells lining your milk ducts. An invasive ductal carcinoma is cancer that spreads beyond your milk ducts, invading healthy tissue. Researchers dont know what causes these cells to become malignant .

Inflammatory breast cancer develops when cancer cells block lymph vessels. Lymph vessels are hollow tubes in your lymphatic system that allow lymph fluid to drain out of your breast. The blockage causes your breast to become red, swollen and inflamed. In most cases of IBC, cancer cells spread outward from your lymph vessels. Cancer that has metastasized affects your other organs and is harder to treat.

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Can Ibc Be Diagnosed Early

Early diagnosis of inflammatory breast cancer greatly increases your chances for successful treatment. Since symptoms of IBC often are similar to those of breast infection , your doctor first may prescribe antibiotics. If the symptoms do not improve or grow worse, you should have diagnostic tests as soon as possible.

Diagnosing Inflammatory Breast Cancer

It can be difficult to diagnose inflammatory breast cancer because there is usually no lump to feel during a physical exam or to see in a mammogram. Doctors have to examine any changes to the breast and order a biopsy if they suspect inflammatory breast cancer.

Doctors also may recommend additional imaging tests, such as an ultrasound or breast MRI.

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Clinical Trials For Ibc

Research is ongoing to improve treatment for IBC.

New therapies are being studied in clinical trials. The results of these trials will decide whether these therapies will become part of the standard of care.

After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.

What Are The Symptoms Of Inflammatory Breast Cancer

Symptoms of inflammatory breast cancer include swelling and redness that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange . These symptoms are caused by the buildup of fluid in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.

Other symptoms of inflammatory breast cancer include a rapid increase in breast size sensations of heaviness, burning, or tenderness in the breast or a nipple that is inverted . Swollen lymph nodes may also be present under the arm, near the collarbone, or both.

It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.

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Treatment Of Inflammatory Breast Cancer

At diagnosis, IBC is either Stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well. Standard IBC treatments include preoperative chemotherapy or systemic therapy to help shrink the tumor then surgery to remove the tumor, most often a modified radical mastectomy followed by radiation therapy.

Regardless of the stage of the cancer, treatment of IBC requires an experienced multidisciplinary team with demonstrated expertise in the management of this condition and access to more advanced diagnostic tests and new drugs.

Sudden Change In Breast Size

IBC can change the appearance of the breasts. This change can occur suddenly. Because this cancer can cause inflammation and swelling, breast enlargement or thickness can occur.

The affected breast may appear noticeably larger than the other breast or feel heavy and hard.

If youve always had symmetrical breasts and you notice a sudden increase or decrease in the size of one breast, speak with your doctor to rule out IBC.

diagnostic criteria for IBC include:

• breast redness, swelling, dimpling, or warmth that comes on quickly, with or without a detectable lump or mass
• redness that includes at least a third of the breast
• symptoms that have lasted for no longer than 6 months
• confirmation of the presence of cancer cells through a biopsy

Now lets explore the diagnostic methods that can be used for IBC in a little more detail.

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Survivorship Care After Inflammatory Breast Cancer Treatment

Treatments for inflammatory breast cancer can increase many peoples risk of developing certain diseases and conditions as they get older, including high blood pressure, heart disease, or osteoporosis.

As a result, medical experts recommend survivorship care plans to help make sure people get regular screenings for these and other diseases and conditions.

Survivorship care plans are written documents made up of two parts. The first part is a treatment summary of all the breast cancer treatments youve received. The second part is a roadmap of what you can expect in the years after treatment, including any late or long-term side effects that you may have, and a schedule of how your healthcare team plans to make sure you get the screenings you need. This part of the survivorship care plan usually includes:

How Is Inflammatory Breast Cancer Distinct From Other Kinds Of Breast Cancer

When we compare inflammatory breast cancer to other types of cancer diseases, we can notice variations like:

• It seems different- usually, IBC comprises no lumps, but your breast might look swollen, red, or inflamed. In general, it is called bug bite inflammatory breast cancer.
• It is challenging to diagnose- it cant get diagnosed easily with the help of a mammogram.
• IBC is more truculent and grows more rapidly than other cancer types
• This form of breast cancer is to be diagnosed early, particularly among African-American women.
• Inflammatory breast cancer is more likely to affect plus-size women.
• It is usually further along when its diagnosed.
• At times, it has grown past the breast skin when its diagnosed, which makes it more challenging to diagnose and treat

The inflammatory breast cancer survival rate is 39%. However, survival rates of inflammatory breast cancer may vary based on the tumor grade, stage, specific features of cancer, and the treatment provided.

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Our Approach To Inflammatory Breast Cancer Treatment

The Don & Erika Wallace Comprehensive Breast Program at Moffitt Cancer Center features a multispecialty team trained specifically in the evaluation and treatment of all types of breast cancer. At Moffitt, inflammatory breast cancer patients have access to medical oncologists, radiologists, fellowship-trained surgeons, radiation oncologists, plastic surgeons, experienced nurses, social workers and many other healthcare professionals in a single location.

Our comprehensive, patient-centered approach to cancer treatment sets Moffitt apart in many ways:

• Our multispecialty team provides patients with a complete range of health care services for all types of breast cancer in one place, including everything from screening and diagnostic tests to the latest options in progressive treatments.
• Our patients and their families have access to an extensive range of supportive care, including family advising, massage therapy, yoga and nutrition counseling and social services.
• Because our team of specialists works closely together to discuss and evaluate complex cases at regular tumor board reviews, treatments and treatment schedules are individualized and more precise, improving survival rates and cosmetic outcomes and reducing the need for secondary surgeries or treatments.
• Moffitt provides long-term care and support to our patients for life through our various wellness and support programs.

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.

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.

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Challenges Of Diagnosing Ibc

Routine mammography may miss IBC because of its rapid onset, which may happen between scheduled mammograms.

IBC can also be hard to see on a mammogram. IBC often spreads throughout the breast or it may only show up as a sign of inflammation, such as skin thickening .

In some cases, skin changes or a lump may be noted during a clinical breast exam.

IBC may first be mistaken for an infection or mastitis because of symptoms such as redness and swelling, and the frequent lack of a breast lump.

If you have any of the warning signs listed above and they last longer than a week, tell your health care provider. Its always OK to get a second opinion if youre not comfortable with your health care providers recommendation.

How Is Inflammatory Breast Cancer Treated

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.

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How Do You Treat Inflammatory Breast Cancer

To treat IBC, a combination of strategies is used, including chemotherapy, surgery, radiation therapy, and possibly targeted therapies.

• Chemotherapy: Neoadjuvant chemotherapy refers to the chemotherapy that is administered before surgery so that the cancer reduces in size and the operation is easier. It is recommended that at least 6 cycles of neoadjuvant chemotherapy be administered over the course of 4- to 6 months before the tumor is surgically removed.
• Surgery: The standard surgery for IBC is called a modified radical mastectomy. During this surgery, the entire breast and nearly all the lymph nodes in the adjoining arm are removed. The surgery may also involve the removal of the tissue over the chest muscles, and sometimes a small chest muscle called the pectoralis minor.

• Radiation: Radiation therapy is often recommended following surgical breast removal to kill any remaining cancer cells.
• Targeted therapy: IBCs often produce greater than normal amounts of the HER2 protein, hence drugs such as trastuzumab that target this protein can be given before as well as after surgery.
• Hormone therapy: IBCs are usually negative for estrogen and progesterone receptors. Therefore, hormone therapy is usually ineffective in this type of cancer.