Clinical And Pathological Characteristics
Clinically, inflammatory breast cancer is characterized by the rapid onset of breast warmth, erythema, and edema often without a well-defined mass. Along with extensive breast involvement, women with inflammatory carcinoma often have early involvement of the axillary lymph nodes. Taylor and Meltzer provided a classic description of inflammatory breast cancer in their 1938 paper: “The redness, which may vary from a faint blush to a flaming red, spreads diffusely over the breast, which becomes hot, pitted, and edematous, presenting an ‘orange-skin’ appearance. Meanwhile the cancer spreads rapidly throughout the entire breast in the form of a diffuse ill-defined induration. The breast may swell to two or three times its original volume within a few weeks” . The rapidity of growth can be used to distinguish true ‘primary’ inflammatory carcinoma from neglected locally advanced breast tumors that have developed inflammatory features . The mammographic appearance of inflammatory breast cancer differs from other breast tumors because less than half will show a discrete mass . However, other abnormal findings such as skin thickening, trabecular thickening, and axillary adenopathy are present in the majority of patients . Figure shows the typical clinical and radiographic appearance of inflammatory breast carcinoma.
Introduction And Historical Backdrop
Inflammatory breast cancer was first described in 1814 by Sir Charles Bell as a purple color on the skin over the tumor accompanied by shooting pains.1 Thomas Bryant described the dermal lymphatic invasion as the cause for the inflammatory changes of the skin in 1887.2 IBC was referred to as mastitis carcinomatosa,3carcinoma mastoids, and acute carcinoma of the breast before arriving at its current identifier inflammatory breast cancer coined by Lee and Tannenbaum in 1924.4 Although the clinical presentation is what remains the cornerstone of diagnosis, what truly defines this disease as a distinct clinicopathologic entity is much more diverse and includes the explosive clinical course, a still not well-defined molecular profile, its response to current therapies, and ultimately its prognosis. In this chapter, we explore the characteristics unique to IBC and ways to capitalize on what we know about this disease to optimize treatment.
A. Sahin, H. Zhang, in, 2014
Why Is Inflammatory Breast Cancer So Deadly
Because of the tendency for misdiagnosis. IBC is often mistaken for mastitis, or sometimes even shingles. On other occasions, IBC may be mistaken for a different type of locally advanced breast cancer and not given the right treatment.
The difficulty of diagnosis in combination with the fast growth of cancer often means IBC is at an advanced stage at diagnosis.
Treatment Should Begin Without Delay
Inflammatory breast cancer needs treatment as soon as possible. However, because of the unique properties it is recommended that an oncologist with experience in inflammatory breast cancer heads the treatment and management team.
Management of inflammatory breast cancer requires a combined-modality approach to therapy.
What Causes Inflammatory Breast Cancer
Inflammatory breast cancer develops when cancer cells block lymph vessels. These tubes, which are hollow, allow lymph fluid to drain out of the breast.
In most cases of IBC, cancer cells spread outward from lymph vessels. When cancer metastasizes, it affects the skin and other organs and is more difficult to treat.
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Inflammatory Breast Cancer: The Diagnosis
So, frequently in the diagnosis of IBC a PET scan is utilized.
Furthermore, larger sample excisional biopsies are often necessary. A skin biopsy can find evidence of invasive breast cancer cells, but this is not always the case.
Inflammatory breast cancer has a tendency to grow in layers, so it may be quite a while before a palpable lump actually appears. Furthermore, if a lump develops it might appear quite suddenly.
Around 30% of inflammatory breast cancers never develop an actual breast lump.
Recent studies have pointed to the potential advantages of new diagnostic techniques, such as fluorodeoxyglucose positron emission tomography .
How Is Inflammatory Breast Cancer Different From Other Types Of Breast Cancer
Inflammatory breast cancer differs from other types of breast cancer in several ways:
- IBC doesn’t look like a typical breast cancer. It often does not cause a breast lump, and it might not show up on a mammogram. This makes it harder to diagnose.
- IBC tends to occur in younger women .
- African-American women appear to develop IBC more often than white women.
- IBC is more common among women who are overweight or obese.
- IBC also tends to be more aggressiveit grows and spreads much more quicklythan more common types of breast cancer.
- IBC is always at a locally advanced stage when its first diagnosed because the breast cancer cells have grown into the skin.
- In about 1 of every 3 cases, IBC has already spread to distant parts of the body when it is diagnosed. This makes it harder to treat successfully.
- Women with IBC tend to have a worse prognosis than women with other common types of breast cancer.
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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.
Treating Stage Iv Inflammatory Breast Cancer
Patients with metastatic IBC are treated with systemic therapy. This may include:
- Hormonal therapy
- Targeted therapy with a drug that targets HER2
One or more of these treatments might be used. Many times, a targeted drug is given along with chemotherapy or with hormone therapy. Surgery and radiation may also be options in certain situations. See Treatment of Stage IV Breast Cancer for more information.
Regardless of the stage of the cancer, participation in a clinical trial of new treatments for IBC is also a good option because IBC is rare, has a poor prognosis , and these studies often allow access to drugs not available for standard treatment.
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Re: Inflammatory Breast Cancer
Hi Maria, I have been away for a few days and have just seen your message on the new cancerchat site. Although my breast cancer is diferent to yours I too share the same feelings of fear and uncertainty for the future.If you read my site you will see my cancer went ‘walkabout’ so I was lucky enough be accepted on a full clinical trial to lengthen my odds for survival. I think I felt quite frightened after the active treatment finished as suddenly it was just me and my body left to get on with life, albeit with continued 6monthly checks. Any pains and tingling at the beginning scared me but as I still exprience them I just have to accept them as something I have to live with.I am now on anti-depressants and have been for a year as I had bad symptoms of anxiety linked to all the drugs. I am so grateful that one tiny pill has given me my life back and am at last living my life to the full but there are no guarentees in life and I too wonder what the future holds.You sound as though you have a good support network like I have but I sometimes feel I am putting on an act that everything is fine so as not to upset family and friends.But is that a bad thing? It certainly keeps a smile on faces when I go dancing or host parties and still telling bad jokes. Cancer is alonely experience and I just wanted you to know there are many kind, lovely people out there who share your feelings and I hope, like me, wish you well. Keep dancing. God Bless.
Deterrence And Patient Education
Breast cancer is the most common female cancer in the United States and the second most common cause of cancer death in women. Early detection and treatment of breast cancer will improve survival. Self-breast examination and screening mammograms play a crucial role in the early diagnosis of breast cancer. Patient-centered assessment and intervention with specific regard to cultural beliefs and practices should be considered. The participation of individuals, along with the involvement of the community, health care professionals, and organizations, is strongly recommended in increasing the awareness of breast cancer and its treatments.
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What Is The Prognosis Of Inflammatory Breast Cancer
Inflammatory breast cancers account for around 1% to 5% of all breast cancers. It has been estimated that patients with stage III of the disease have a median survival rate of 57 months, while those with stage IV have a median survival rate of 21 months. These numbers however vary widely depending on the treatment options available to the patient.
Things To Consider When Deciding What Will Be Of The Most Benefit
- If you are suffering from constipation, O3Right will help to ease the constipation. It also produces oxygen to help fight cancer.
- If a tumor is causing pain, add in 3 or more bottles a month of Red 65 or PapayaPro to digest the tumor and speed up a decrease in size of the tumor, and 3 bottles of Proteolytic Boost which helps enzymes work better while speeding up digestion of the tumor.
- If a tumor is just under the skin, use the SkinCanHeal 1 and SkinCanHeal 2 Combo. These are pulled into the tumor to kill it.
- If there is cancer in the lungs, then oxygenation support from OxyDHQ, Oxy Life Force Elixir and Ronuv is important. Also use Silver GlucoPlus in a nebulizer. They fight cancer and improve oxygenation of your cells. You will notice an increase in energy.
- Some people have a personality that could contribute to the development of cancer. Typically this includes being highly sensitive to the plight of others and the world, putting others first, being extra sensitive to criticism. If this is the case, use Release Elixir to reduce the cellular, cancer causing effects of this personality. For someone with this personality, Release Elixir is important to use. It would be in the top group of cancer fighters below, or in the cancer prevention protocol.
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 Signs Of Inflammatory Breast Cancer
Signs of inflammatory breast cancer can develop quickly and may include:
- the breast looks red or inflamed or develops a rash it often looks as if its infected or bruised
- the breast becomes swollen and enlarged and may feel heavy or uncomfortable
- the breast feels warm and tender
- skin on the breast can appear dimpled or pitted, like an orange peel.
Some people may also have a lump in their breast or armpit, pain in the breast or nipple, discharge from the nipple or a nipple that turns inwards .
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British Columbia Specific Information
Breast cancer is the most common type of cancer in women in British Columbia. Breast cancer can occur in men as well, but it is not as common. Tests and treatments for breast cancer vary from person to person, and are based on individual circumstances. Certain factors such as your age, family history, or a previous breast cancer diagnosis may increase your risk of developing breast cancer. For information about your specific risk factors, speak with your health care provider.
A number of screening methods, including mammograms in women, can help find and diagnose breast cancer. The decision to have a mammogram or use any other screening method may be a difficult decision for some women. While screening for breast cancer is often recommended, it is not mandatory. Speak with your health care provider for information regarding how to get screened, the facts and myths about screening tests, how to maintain your breast health, and to get help making an informed decision.
For more information about breast cancer and breast cancer screening, visit:
If you have questions about breast cancer or medications, speak with your health care provider or call 8-1-1 to speak with a registered nurse or pharmacist. Our nurses are available anytime, every day of the year, and our pharmacists are available every night from 5:00 p.m. to 9:00 a.m.
What Tests And Exams Do Health Care Professionals Use To Diagnose Inflammatory Breast Cancer
Mammography and imaging tests
Screening mammography has made it possible to detect many breast cancers before they produce any signs or symptoms. However, inflammatory breast cancer produces symptoms, so in the case of this cancer, the mammogram may be used to evaluate the breast when symptoms are present or to determine the location for a breast biopsy. Due to the rapid spread of the cancer, this cancer is sometimes found between the routine mammogram exams. Other imaging tests, including MRI, ultrasound, PET scans, and CT scans may be used to evaluate the breast if inflammatory breast cancer is suspected. A bone scan to look for spread to the bones may also be performed if a diagnosis of inflammatory breast cancer is confirmed.
The diagnostic guidelines for inflammatory breast cancer require that the following factors are present:
- A rapid onset of erythema , edema , and a peau d’orange appearance and/or abnormal breast warmth, with or without a lump that can be felt
- These symptoms have been present for less than six months.
- The redness covers at least one-third of the breast.
- A biopsy from the affected breast reveals invasive cancer.
Specialized testing on breast cancer samples
Certain laboratory tests are typically performed on all breast cancer tumor samples to help determine the optimum treatment. These include:
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What Is The Treatment For Inflammatory Breast Cancer
Inflammatory breast cancer is a fast and aggressive cancer that needs to be treated as such. A diagnosis of inflammatory breast cancer is classified as stage III breast cancer. Treatment is as follows:
- Neoadjuvant chemotherapy This first line of treatment clears the breast and skin of the disease and to make the breast operable.
- Mastectomy and chest wall radiation
- Breast reconstruction We do not recommend immediate reconstruction because of the high risk of local recurrence of inflammatory breast cancer. However, reconstructive surgery is an option at a later date, once risk of recurrence is assessed.
- Hormonal therapy for estrogen receptor and/or progesterone receptor positive disease
- Biologic targeted therapy such as trastuzumab for HER2 positive disease
The Breast Center is consistently focused on using cutting-edge techniques for the effective treatment of breast cancer. Research is a critical part of our program and we lead clinical trials for the investigation of new treatment methods.
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What Are The Signs And Symptoms Of Inflammatory Breast Cancer
The symptoms of inflammatory breast cancer can develop quite quickly. A lump may or may not be present. Symptoms can include:
- Redness, warmth or swelling of the breast
- The skin of the breast changing colour or looking bruised
- Dimpling, ridges or thickening of the skin. Or the breast looking pitted like the skin of an orange
- An increase in breast size
- Pain or tenderness in the breast
- Persistent itching of the breast
- An inverted nipple
- Swelling or lumps in the armpit or around the collar bone
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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.
You may be familiar with the fact that there are different stages of breast cancer. These stages are used to reflect how far the cancer has progressed.
- Stage 3. In stage 3 IBC, the cancer has spread to some of the tissues surrounding the breast. This can include nearby lymph nodes, the skin of the breast, and the tissues of the chest wall.
- Stage 4. In stage 4 IBC, the cancer has spread to more distant areas of the body, such as the lungs, liver, or bones. This is called metastasis. According to the ACS, its estimated that IBC has metastasized in
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.