THERE IS MORE THAN ONE KIND OF BREAST CANCER
We have been taught and are reminded frequently by public service announcements and by the medical community that when a woman discovers a lump on her breast she should go to the doctor immediately. Inflammatory breast cancer usually grows in nests or sheets, rather than as a confined, solid tumor and therefore can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin. Lymph node involvement is assumed. Increased breast density compared to prior mammograms should be considered suspicious.
YOU DON’T HAVE TO HAVE LUMP TO HAVE BREAST CANCER
Some women who have inflammatory breast cancer may remain undiagnosed for long periods, even while seeing their doctor to learn the cause of her symptoms. The symptoms are similar to mastitis, a breast infection and some doctors, not recognizing IBC, will prescribe antibiotics. If a response to antibiotics is not apparent after a week, a biopsy should be performed or a referral to a breast specialist is warranted.
SIGNS & SYMPTOMS OF IBC
Inflammatory breast cancer grows rapidly — changes can become apparent in a matter of days to weeks. Unlike other types of breast cancer, you probably won't develop a distinct lump. Instead, you might notice an area of thickness or a feeling of heaviness in one of your breasts. Inflammatory breast cancer tends to develop as a sheet rather than a lump or tumor.
A breast that appears red, purple, pink or bruised
A tender, firm and enlarged breast
A warm feeling in the breast
Itching of the breast
Ridged or dimpled skin texture, similar to an orange peel
Thickened areas of skin
Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
Flattening or retraction of the nipple
Swollen or crusted skin on the nipple
Change in color of the skin around the nipple (areola)
CAUSE Despite its name, inflammatory breast cancer isn't caused by an inflammation or infection. Inflammatory breast cancer occurs when cancer cells clog the lymphatic vessels in the skin overlying the breast. The blockage in the lymphatic vessels causes the red, swollen and dimpled skin that's a classic sign of inflammatory breast cancer.
WHEN TO SEEK MEDICAL ADVICE
Because inflammatory breast cancer progresses rapidly, by the time most women seek medical advice, the cancer is already quite advanced. If you notice any of the signs and symptoms of inflammatory breast cancer, see your doctor right away.
If you're being treated for a breast infection (mastitis), but your signs and symptoms last longer than a week after starting antibiotics, ask your doctor to do some imaging studies of the breast or to perform a breast biopsy. If these test results show no signs of cancer, but your signs and symptoms appear to be getting worse, talk with your doctor about performing another biopsy or ask for a referral to a breast specialist.
SCREENING & DIAGNOSIS
Diagnosing inflammatory breast cancer can prove difficult. Often no lump can be felt, and the area of concern may not show up on a mammogram. Additionally, the signs and symptoms can be easily mistaken for a breast infection (mastitis).
If your doctor suspects that you have inflammatory breast cancer, he or she will recommend a biopsy — taking a small sample of skin and tissue for microscopic analysis.
If the biopsy results confirm that you have inflammatory breast cancer, the next step is to determine how advanced your cancer is. Inflammatory breast cancer, given its aggressive nature, tends to be advanced by the time a woman seeks medical treatment. Your doctor will perform additional tests, such as a chest X-ray, computerized tomography (CT) scan of your chest and abdomen, and bone scan, to check for the presence of cancer cells in other parts of your body (metastasis).
Historically, inflammatory breast cancer was treated by surgery and was associated with a 100 percent mortality rate. However, significant progress has been made in recent years using a combination of treatments, including chemotherapy, surgery and radiation therapy. The combined-treatment approach has vastly improved the prognosis for a woman with inflammatory breast cancer. What was once universally fatal is now a disease that results in half of women diagnosed being alive in five years and one-third of women diagnosed surviving 10 or more years.
Several rounds of systemic therapy — usually chemotherapy — are required initially in the treatment of inflammatory breast cancer. With inflammatory breast cancer, the skin is swollen and fluid-filled, which makes operating on it difficult. It also may not heal well after an operation. Chemotherapy kills the cancer cells and allows the skin to become more normal, giving it the best chance for healing. Systemic therapy — which could include chemotherapy or hormone therapy — before surgery (neoadjuvant therapy) works to shrink the size of the cancerous area to make the operation most effective. Further chemotherapy treatments are often given after the operation in an effort to kill any cancer cells that remain.
After neoadjuvant therapy, an operation to remove the affected breast (mastectomy) is recommended for women with inflammatory breast cancer. Surgery alone — without neoadjuvant therapy — offers a much smaller chance of a cure. Breast-conserving surgery (lumpectomy) isn't recommended for women with inflammatory breast cancer. Many women experience involvement of their underarm (axillary) lymph nodes with inflammatory breast cancer. During surgery, your surgeon will examine your axillary lymph nodes for evidence of the disease.
After surgery, a course of radiation therapy further reduces the chances of local recurrence of the cancer. Radiation therapy might also be considered as a primary treatment in cases in which the cancerous area can't be operated on.
However, even after treatment with chemotherapy, surgery and radiation, recurrence rates remain high for this type of breast cancer. Because of this, your doctor may recommend further treatment (adjuvant therapy) to prevent the cancer from returning. This might include more chemotherapy, if you responded well to it before surgery, or hormone therapy, such as tamoxifen (Nolvadex) or anastrozole (Arimidex), if your cancer tests positive for estrogen receptors. Your doctor may also consider adjuvant therapy with trastuzumab (Herceptin), if your cancer cells are sensitive to this medication. You may be offered the opportunity to participate in a clinical trial to test new treatments for inflammatory breast cancer.
Reconstruction after surgery is a possibility, although not for all women treated for inflammatory breast cancer. Your options may be limited if you've had extensive radiation therapy.
Visual Clinical Symptoms