Inflammatory Breast Cancer: Symptoms, Diagnosis & Treatment

Inflammatory breast cancer is one of the many types of breast cancers that affect women today. It accounts for about 1% to 5% of all breast cancers and are a rare form of breast cancer.

What is Inflammatory Breast Cancer?

Inflammatory Breast Cancer is a type of invasive ductal carcinoma ( i.e affect cells that line the milk ducts of the breast) that differs from other types of breast cancer in its signs and symptoms, appearance and and treatment. In this type of breast cancer, the growing cancer cells block the lymphatic vessels on skin around the breast. It is inflammatory in the sense that breast often looks swollen and reddish, or inflamed.

Inflammatory Breast Cancer Sypmptoms

Symptoms associated with Inflammatory breast cancer mostly develop within 3-6 months. The following signs and symptoms are mostly common. They include the following;

  • Edema (swelling) of the skin of the breast
  • Redness involving more than one-third of the breast
  • One side of the breast looks bigger than the other because of swelling
  • One side of the breast feels warmer and heavier than the other side
  • Feeling of tenderness, pains or itchness of the breast
  • The skin around the breast becomes thickened so that it may look and feel like an orange peel
  • A retracted or inverted nipple
  • Swelling of the lymph nodes under the arms or near the collarbone

Unique Features of Inflammatory Breast Cancer include;

  • This type of cancer tends to be diagnosed at younger ages compared to other types of breast cancer
  • It’s very common and diagnosed at younger ages in African American women than in white women.
  • Inflammatory breast tumors cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen because they are mostly hormone receptor negative.
  • Inflammatory breast cancer is very common in women who are obesed than in women who have normal weight. 
  • Similar to other types of breast cancer, inflammatory breast cancer can occur in men of older age than in women.

Diagnosis of Inflammatory Breast Cancer

Diagnosing Inflammatory breast cancer can be very difficult because most times, there is no lump that can be felt during a physical exam or seen in a screening mammogram. Also, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult.

Also, the symptoms of inflammatory breast cancer may be mistaken for those of mastitis – an infection of the breast, or another form of locally advanced breast cancer.

Inorder to avoid delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.

To be diagnosed with inflammatory breast cancer, the following minimum criteria is required;

  1. Rapid onset of swelling, and redness (erythema) and a peau d’orange appearance (ridged or pitted skin) and/or abnormal breast warmth, with or without a lump that can be felt.
  2. Above-named symptoms present for less than 6 months.
  3. Redness covering at least a third of the breast.
  4. Initial biopsy samples from the affected breast show invasive carcinoma.

Further examination of tissue from the affected breast should include testing to see if the cancer cells have hormone receptors (estrogen and progesterone receptors) or if they have greater than normal amounts of the HER2 gene and/or the HER2 protein (HER2-positive breast cancer).

Imaging and staging tests include the following:

  • A diagnostic mammogram and an ultrasound of the breast and regional (nearby) lymph nodes
  • A PET scan or a CT scan and a bone scan to see if the cancer has spread to other parts of the body

Proper diagnosis and staging of inflammatory breast cancer helps doctors develop the best treatment plan and estimate the likely outcome of the disease. Patients diagnosed with inflammatory breast cancer may want to consult a doctor who specializes in this disease.   

How is inflammatory breast cancer treated?

Inflammatory breast cancer can be treated by using multimodoal approach whereby the tumour is subjected to systemic chemotherapy to help shrink the tumor, followed by a surgery to remove the tumor, and lastly radiation therapy.

Researches have shown that women with inflammatory breast cancer who are subjected to the multimodal approach of treatment have better responses to therapy and longer survival.

The treatments used in a multimodal approach may include those described below.

  • Neoadjuvant chemotherapy:
  • Targeted therapy:
  • Hormone therapy:
  • Surgery:
  • Radiation therapy:
  • Adjuvant therapy:

In Neoadjuvant chemotherapy, anthracycline and taxane drugs are given before surgery is carried out. Physicians normally recommend that at least six cycles of neoadjuvant chemotherapy be given over the course of 4 to 6 months before the tumor is removed, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.

Hormone therapy is effective treatment option if the cells of a woman’s inflammatory breast cancer contain hormone receptors. In this form of treatment, drugs such as tamoxifen and aromatase inhibitors such as letrozole can cause estrogen-dependent cancer cells to stop growing and die. Tamoxifen prevents estrogen from binding to its receptor whereas letrozole blocks the body’s ability to make estrogen,

For Surgery, modified radical mastectomy is mostly adopted. Here, surgery involves removing the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Although the smaller chest muscle (pectoralis minor) may be removed, too.

Adjuvant systemic therapy might be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.

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