Tests For Inflammatory Breast Cancer
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 detect how much of the breast tissue and lymph nodes are 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.
How Is Inflammatory Breast Cancer Diagnosed And Treated
A diagnosis of inflammatory breast cancer is classified as Stage 3 breast cancer and is diagnosed through your physicians clinical judgment and a biopsy. A biopsy for inflammatory breast cancer is a biopsy of the skin of the breast.
If the pathology results show that the skin and dermal lymphatics of the breast skin contain breast cancer cells, this confirms it is inflammatory breast cancer.
Typically, IBC grows rapidly and requires aggressive treatment. This is the only type of breast cancer that requires urgent treatment, beginning with chemotherapy. Most oncologists recommend both local treatment of the affected breast and systemic treatment .
Surgery, radiation therapy, chemotherapy and hormone treatments may be included in the regimen. With aggressive treatment, the survival rate for inflammatory breast cancer patients has improved significantly in recent years.
Medically Reviewed on April 15, 2020
What Is Inflammatory Breast Cancer And How Does It Affect The Body
IBC causes symptoms of breast inflammation like swelling and redness, which is caused by cancer cells blocking lymph vessels in the skin causing the breast to look inflamed. Inflammatory breast cancer differs from other types of breast cancer in many ways: IBC doesnt look like a typical breast cancer.
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What Are The Symptoms
Inflammatory breast cancer can present in a number of ways. The symptoms are persistent and tend to develop relatively quickly . Heres what to watch for:
- Skin inflammation The skin of the breast can become warm and puffy and look like the peel of an orange .
- Nipple changes The nipple can become flat or inverted.
- Swelling One breast can significantly increase in size.
- Discoloration The skin of the breast can become very red or almost purple.
- Pain The breast can become tender.
What Questions Should I Ask My Doctor
Ask your healthcare provider about what your cancer diagnosis means for your treatment options and likely outcomes. Questions to ask include:
- What stage is my breast cancer?
- Which specialists will be involved in my care?
- What treatment options would you recommend?
- What outcomes should I expect from treatment?
- What are potential side effects or complications related to treatment?
- Can you connect me with resources ?
A note from Cleveland Clinic
Inflammatory breast cancer is a rare type of cancerthat spreads quickly. Schedule an appointment with your healthcare provider immediately if you notice changes in your breasts, especially a change in one breast but not the other. The changes may be a sign of a less serious condition, like an infection. Still, IBC spreads fast. If your symptoms are a sign of inflammatory breast cancer, youll want to begin treatment as early as possible. Dont delay seeking care that can potentially improve your prognosis.
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How Do You Know If You Have Inflammatory Breast Cancer
Instead, signs and symptoms of inflammatory breast cancer include: Rapid change in the appearance of one breast, over the course of several weeks. Discoloration, giving the breast a red, purple, pink or bruised appearance. Dimpling or ridges on the skin of the affected breast, similar to an orange peel.
When To See A Health Care Provider About Changes To The Skin Of The Breast
Even though breast skin changes usually dont mean anything serious, it’s important to know when you might actually need medical attention.
If wearing more breathable fabrics avoiding soaps and detergents that cause skin sensitivity and keeping your breasts clean and dry doesnt seem to help with the skin changes youre seeing, or if you notice your symptoms worsening, be sure to check in with a health care provider. And be sure to visit a health care provider if you notice any of these accompanying symptoms:
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How Can You Tell The Difference Between Inflammatory Breast Cancer And Mastitis
Inflammatory breast cancer typically occurs in older women, while acute mastitis usually affects younger, lactating women. If a trial of antibiotics does not decrease the signs and symptoms in the inflamed breast, inflammatory breast cancer must be considered, especially in older, nonlactating women.
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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Stage 4 Inflammatory Breast Cancer Treatment
Cancer thats spread to more distant areas of the body is typically treated using one or a combination of the systemic therapies mentioned above. These include:
Its unclear exactly what causes IBC. In general, cancer develops due to genetic changes. These can happen due to a variety of factors, such as:
- genetic changes inherited from your parents
- irregularities that naturally occur during cell division
- damage to DNA through environmental exposures
Sometimes gene mutations that are associated with cell growth and division can occur. When this happens, cells can grow and divide out of control.
In IBC, cells in the breast ducts or lobules begin to rapidly grow and divide. As cancer cells build up, they block the lymph vessels in the skin of the breast. This leads to the redness, swelling, and dimpling associated with IBC.
Susan G Komen Research Spotlight
Komen partnered with the Inflammatory Breast Cancer Research Foundation, the Milburn Foundation, patient advocates, doctors and researchers to review what is known about IBC and to propose new ways to improve diagnosis and treatment.
A new research tool using a scoring system was proposed as a way to better define IBC to increase diagnostic accuracy and help guide treatment. This research tool uses information from several sources, including a doctors exam of the breast, a pathologists exam of a sample of tumor tissue and imaging.
This research tool is not yet available and needs to be validated in future studies.
*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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Inflammatory Breast Cancer Treatments
Inflammatory breast cancer benefits from many types of treatment performed either alone or in combination. Its important to seek care from a major medical center like Duke, where a team of medical, surgical, and radiation oncologists combines their expertise to create a personalized treatment approach for your cancer. One or more of the following treatments may be part of your plan.
What Causes A Rash On The Breast
Breast Rash: Inflammatory Breast Cancer vs. Breast Infection. If you have red, swollen breasts, its a sign that something is wrong. Two things that can cause these symptoms are inflammatory breast cancer and a breast infection. Inflammatory breast cancer is a rare and aggressive form of breast cancer. IBC accounts for 1 to 5 percent of all
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How To Distinguish Ibc From Other More Common Conditions
It can be hard to distinguish breast changes caused by inflammatory breast cancer from other common conditions, such as an ordinary rash, allergic reaction, or infection. Thats why its important to see a health care provider as soon as you notice any of these changes to figure out the cause and get treatment, if necessary.
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
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.
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
If you have any of these symptoms, it does not mean that you have IBC, but you should see a doctor right away. 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.
Treatment with antibiotics 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. Let your doctor know if it doesn’t help, especially if the symptoms get worse or the affected area gets larger. 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. Ask to see a specialist if youre concerned.
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Staging Inflammatory Breast Cancer
By the time a doctor diagnoses inflammatory breast cancer, the breast cancer cells have usually grown into the skin. This local advancement means the cancer is at least stage III. In some cases, the breast cancer cells have already spread to parts of the body away from the breast which means the cancer is metastatic or stage IV.
After diagnosing inflammatory breast cancer, doctors order more tests to collect information about the cancers characteristics. These tests, as well as the results of your biopsy and any imaging tests, make up the various parts of your pathology report.
Doctors also collect the following information on inflammatory breast cancer:
targeted therapy at the same time as chemotherapy if the cancer is HER2-positive
a different chemotherapy regimen or radiation therapy if the cancer has not responded well to treatment, meaning the breast skin is still showing signs of inflammatory breast cancer symptoms
After mastectomy, doctors recommend radiation therapy to destroy any remaining cancer cells. Still, in some cases, doctors may recommend more chemotherapy after mastectomy but before radiation therapy. Doctors do not offer radiation therapy after surgery to anyone who has radiation therapy before surgery because the cancer did not respond to chemotherapy.
Playing An Active Role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.
Learn more about factors that affect treatment options.
For a summary of research studies on neoadjuvant chemotherapy and breast cancer treatment, visit the Breast Cancer Research Studies section.
For a summary of research studies on neoadjuvant hormone therapy and breast cancer treatment, visit the Breast Cancer Research Studies section.
For a summary of research studies on radiation therapy following mastectomy in women with invasive breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on chemotherapy and overall survival in breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on survival in women with IBC, visit the Breast Cancer Research Studies section.
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Stages Of Inflammatory Breast Cancer
This type of cancer is usually in one of three stages:
- Stage IIIB: All Inflammatory breast cancers start in this stage since they involve the skin of your breast.
- Stage IIIC: This cancer has spread to lymph nodes around your collarbone or inside your chest.
- Stage IV: The cancer has spread outside your breast and nearby lymph nodes to other parts of your body.
Family Physicians Role In Management
Family physicians are gatekeepers: they play a crucial role in identifying IBC and referring patients appropriately. The oncology team treats the cancer and related problems however, the family doctor manages nononcologic diagnoses that were present before diagnosis of IBC. Some conditions might be affected by treatment for instance, blood-glucose control in patients with diabetes often worsens during chemotherapy, owing to steroids given adjunctively. The family doctor often needs to provide psychological support to the patient and her family. Once treatment is finished, close clinical surveillance and annual mammography are shared responsibilities of the oncologist and family doctor. The family doctor also monitors for long-term side effects of treatment .
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Targeted Therapies And Hormone Therapy
Many inflammatory breast cancers are HER2 positive , so treatment with HER2-targeted therapies can be effective in controlling the tumor. These drugs are usually given along with the other treatments after a diagnosis of IBC. If the cancer is sensitive to estrogen, hormone therapy may also be an option.
Most inflammatory breast cancers are estrogen receptor and progesterone receptor negative, so hormonal therapy with tamoxifen or aromatase inhibitors isn’t commonly used.
What To Do After A Physical Exam For Ibc
After taking a careful medical history and doing a physical exam, your doctor will likely order imaging studies or perform a breast biopsy to further understand your symptoms. These studies not only help diagnose IBC, but also but help rule out conditions, such as mastitis, that can cause similar symptoms.
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What Is The Best Treatment For Inflammatory Breast Cancer
Hormone therapy: If the cells of a womans inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. Drugs such as tamoxifen, which prevent estrogen from binding to its receptor, and aromatase inhibitors such as letrozole, which block the bodys ability to make estrogen, can cause estrogen-dependent cancer cells to stop growing and die.
Symptoms Of Inflammatory Breast Cancer
Because the lymph channels are blocked, the breast might become:
- hot to the touch
The breast can also be painful in inflammatory breast cancer, but this is not always the case.
Other possible symptoms include:
- ridges or thickening of the skin of the breast
- pitted skin, like orange peel
- a lump in the breast
- a discharge from the nipple
- an inverted nipple the nipple is pulled into the breast
Inflammatory breast cancer symptoms can appear quite suddenly.
Inflammatory breast cancer is often confused with an infection of the breast . This is because the symptoms are very similar. Mastitis is uncommon in women who aren’t pregnant or breast feeding and it is particularly rare in women who have had their menopause.
Your doctor might give you a course of antibiotics if they think that you could have mastitis. But they will refer you to a specialist if they think you are unlikely to have an infection or if your symptoms dont clear up after antibiotics.
While inflammatory breast cancer can cause these particular symptoms, its worth being aware of the general symptoms of breast cancer.
Make an appointment to see your doctor if you notice any change in the look or feel of your breasts.
Your GP usually refers you to a breast clinic for tests.
You might have a:
- mammogram, which is an x-ray of the breast
- breast ultrasound
- biopsy of the skin in the breast
- biopsy of a breast lump
- MRI scan of the breast
Other tests may include a CT scan or PET-CT scan, and bone scan
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