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Inflammatory Breast Cancer
DESCRIPTION AND TYPES
Inflammatory breast cancer is a rare but aggressive form of breast cancer. While it accounts for 2-6% of all breast cancers, the 5-year overall survival rate is 40%, as compared to near 90% for all types of breast cancer combined. The key to survival is an early and accurate diagnosis and healthcare providers that specialize in inflammatory breast cancer.
Inflammatory Breast Cancer Symptoms
Inflammatory breast cancer can present in a number of ways, and each patient’s symptoms are unique. What makes inflammatory breast cancer different from other breast cancers is that the symptoms progress very rapidly, often within a matter of weeks. The majority of women with inflammatory breast cancer never detect a lump. Inflammatory breast cancer quickly covers the breast in sheets causing a thickening of the skin, but no detectable lump.
Inflammatory breast cancer symptoms may include:
- Breast swelling, which appears suddenly with one breast much larger than the other
- Itching
- Pink, red, or dark colored area, sometimes with a dimpling of the breast skin that looks like an orange peel (peau d’orange)
- Ridges and thickened areas of the skin
- Breast that feels warm to the touch
- Flattened or retracted nipple
- Breast pain
You do not need to have all of these symptoms to be concerned about inflammatory breast cancer. Each patient’s presentation is unique. Since inflammatory breast cancer symptoms are very similar to those of an infection (mastitis), your doctor may prescribe a round of antibiotics. If the symptoms have not improved or have grown worse, breast imaging (mammogram and ultrasound) and a biopsy are strongly recommended. These are simple screening procedures for cancer. Diagnosing inflammatory breast cancer at an early stage can possibly save your life.
...AND MD ANDERSON
PREVENTION
Risk Factors
The precise causes of inflammatory breast cancer have not yet been determined. However, research conducted at MD Anderson indicates that certain risk factors may be associated with an increased probability of developing inflammatory breast cancer:
Age: Inflammatory breast cancer can occur in women at any age. Women with inflammatory breast cancer tend to be somewhat younger than other breast cancer patients.
Race: Women of North African descent seem to be more likely to have inflammatory breast cancer than other ethnic groups.
Smoking: There has been no observable connection between inflammatory breast cancer and smoking.
Family history: Breast cancer, in general, seems to run in some families. At this time, there has been no detectable genetic risk of inflammatory breast cancer. The exact genes responsible have not been fully identified, but changes in DNA that increase a person's risk for other types of cancer may also increase the risk of inflammatory breast cancer.
Obesity: People with a body mass index (BMI) of over 30 are more likely to develop inflammatory breast cancer.
DIAGNOSIS
Diagnosis
If your breast is not responding to antibiotics, several diagnostic tests will be ordered to get a better look within the breast and lymph nodes. Rather than forming a lump, inflammatory breast tumors grow in flat sheets that cannot be felt in a breast exam.
Diagnostic test for inflammatory breast cancer include:
- Mammogram
- Ultrasound of the breast and lymph nodes
- Biopsy of any mass, enlarged lymph node, and/or breast skin
In most cases of inflammatory breast cancer, a mammogram will not reveal a distinct lump but may show skin thickening or enlarged lymph nodes. Again, in most cases, no distinct mass is seen. Ultrasound is used to further evaluate an abnormal area and to look at the lymph nodes. Ultrasound can also be used as a guide for a biopsy.
Once a biopsy confirms that cancer cells are present, more imaging scans and possibly more biopsies may be needed to get an accurate picture of the disease, a procedure known as staging.
The doctor may use several terms to refer to inflammatory breast cancer. These include invasive ductal carcinoma, breast carcinoma with dermal lymphatic invasion, or inflammatory carcinoma of the breast. All of these terms refer to IBC. Inflammatory breast cancer is a Stage IIIB upon diagnosis. If the cancer has spread to other areas (metastasized), it is a Stage IV cancer. Despite a late-stage diagnosis, women with inflammatory breast cancer may respond rapidly to treatment.
TREAT
A multi-disciplinary approach is necessary to successfully treat inflammatory breast cancer. A typical treatment plan will include chemotherapy initially, surgery, radiation therapy and possibly endocrine therapy to prevent recurrence.
Chemotherapy
The goal of chemotherapy is to eliminate or reduce inflammatory breast cancer before surgery. Using chemotherapy before surgery is call neoadjuvant chemotherapy. Anthracyclines (doxorubicin or epirubicin) and taxanes (paclitaxel or docetaxel) are the most effective chemotherapy drugs for IBC. Most women with IBC receive a combination of at least two different drugs.
Chemotherapy should be started as soon as possible to prevent the spread of the disease. If the disease has not metastasized (spread beyond the breast), chemotherapy treatment will last about six months, and involve several different chemotherapy drugs. These are very active drugs in the fight against breast cancer and generally you will see a marked improvement once chemotherapy starts.
Surgery
Because inflammatory breast cancer does not present as a distinctive lump, surgery to remove just the cancerous tissue (lumpectomy) is usually not possible. A complete mastectomy (removal of the entire breast) is recommended to get all of the affected areas. Many women with inflammatory breast cancer have axillary lymph nodes involved. The surgeon will be evaluating lymph nodes at the time of surgery. Breast reconstruction is not recommended until therapy has been completed and there is no evidence of disease.
Radiation Therapy
After chemotherapy and surgery is completed, radiation therapy is performed on the chest wall and lymph nodes. Radiation helps control disease and reduce the risk of recurrence, and may also be used to treat metastatic disease and manage pain, or for patients who cannot undergo surgery. Women with inflammatory breast cancer typically have twice-a-day radiation.
Endocrine Therapy
If the inflammatory breast cancer tumor is hormone receptor positive (Estrogen Receptor [ER] or Progesterone Receptor [PR]), then hormone therapy will be required. Oral medications designed to either block the production of estrogen and progesterone, or stop their activation. The type of hormone therapy depends on the patient's menopause status, but all patients can expect to remain on hormone therapy for five years.
Stem Cell Transplant
For a certain population, patients after completing their initial therapy or have responding metastatic disease, a stem cell transplant may be option with the goal to reduce the chance of recurrence.
SUPPORT
Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help and hope.
Support Groups
Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support Web sites or message boards for those who may not have access to a traditional meeting.
Complementary Therapies
Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, Tai Chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture.
Physical Activity
Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.
Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.
Journaling/Blogging
Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers.
Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own Web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.
Departments
News
March 19, 2012
III International MD Anderson Congress on Gynecologic Cancer ‘Designing the future’
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14-16 March 2012
