|What Is Inflammatory Breast Cancer?
Inflammatory breast cancer is a rare form of breast cancer that causes the breast to appear inflamed, swollen and warm to touch. It spreads very quickly and is usually treated more aggressively than other types of breast cancers. Inflammatory breast cancer accounts for about 1 to 5 percent of all breast cancers reported in the United States. The 5 year survival rate is 34 percent compared to 84 percent with other types of breast cancer.
How Does It Spread?
Inflammatory breast cancer starts in the skin and lymph vessels of the breast. Lymph vessels are like tiny highways that run throughout the body and drain excess fluid from the body's cells, returning it to the bloodstream for eventual filtering and excretion. When cancer infiltrates this highway system, it can spread rapidly and is difficult to cure. In comparison, the more common types of breast cancer start in the relatively self-contained breast milk ducts. It is only when cancer cells eventually escape the ducts and invade the lymph system or bloodstream that they can infect other parts of the body. This is a much slower process. Inflammatory breast cancer on the other hand can spread rapidly within a matter of weeks.
What Are The Symptoms?
Inflammatory breast cancer is different to other types of cancer because it rarely causes a lump and it does not show up on a mammogram. It is called 'inflammatory' because the breast appears inflamed.
Symptoms appeared in this 45 year old
woman over a 2 week period.
Signs and symptoms include:-
• One breast rapidly changes in appearance over the course of a few weeks.
• The breast turns pink, red or purple in color and looks bruised.
• The breast is warm to touch.
• Rapid increase in breast size (edema). This is because cancer cells have blocked the lymph vessels so fluids cannot drain away.
• The skin of the breast appears dimpled, similar to orange peel.
• Nipple flattens or turns inwards.
• Breast skin thickens.
• Enlarged lymph nodes under the arm or above or below the collarbone.
• Pain, tenderness or aching in the affected breast.
It is important to note that many of these symptoms can be signs of other conditions such as infection (mastitis) or injury.
Early Symptoms And Warning Signs
Small rash which looks like an
• Persistent itching on one breast.
• Appearance of a rash or small irritation similar to an insect bite.
What Causes It?
Doctors still don't know what causes cancer. With our present knowledge there is no way that we can say for definite that this or that action caused cancer. Each individual will have different mixtures of reactors including age, strength of immune system and exposure to carcinogen’s (cancer causing substances, many of which we do not even know yet).
How Is It Diagnosed?
Because inflammatory breast cancer does not look like typical breast cancer it is never diagnosed in the early stages. By the time symptoms appear, it is already advanced. It does not show up on a mammogram and a breast lump is rarely present. For this reason, inflammatory breast cancer is always stage 3 or 4 at the time of diagnosis.
Inflammatory Breast Cancer Stages
Stage 3: Locally advanced cancer, this means it has spread to nearby lymph nodes.
Stage 4: It has spread to other parts of the body.
Your doctor will perform a physical exam of the breast and perform a breast biopsy. The tissue sample will be sent to a lab and fast-tracked to check for signs of cancer. Additional imaging tests such as a CT scan or MRI scan should be ordered to stage the cancer if the biopsy comes back positive. Proper diagnosis and staging will help doctors determine the best treatment plan and estimate your chance of survival and risk of recurrence.
How Is It Treated?
The fact that inflammatory breast cancer is always advanced at time of diagnosis, and that it tends to spread very fast, makes it more difficult to treat than other types of breast cancers. Most oncologists (doctors who specialize in the treatment of cancer) recommend a combination of local treatment (such as radiation direct to the breast) and systemic treatment (whole body treatment like chemotherapy). Surgery (such as mastectomy, to remove the affected breast) will also be necessary. Hormonal therapy (pills) may also be added to the treatment mix to aid recovery and reduce the risk of recurrence.
Typical Treatment Regime
Treatment typically begins with chemotherapy, followed by surgery and radiation therapy. After this, hormonal therapy or targeted therapy may be recommended if follow-up tests reveal the patient could benefit from these additional therapies. Occasionally these therapies may also be given before surgery.
Neoadjuvant chemotherapy is given before surgery. The patient receives the chemo drugs in pill form or intravenously through the vein (sometimes both ways). The patient undergoes at least 6 cycles of chemotherapy which takes 4 to 6 months. The aim is to reduce the size of tumor or area of cancer before surgery to improve the outcome. If the cancer continues to spread during this period, the oncologist may perform surgery sooner.
If the biopsy results show that the patient's cancer cells have a specific tumor marker that can be targeted with targeted therapy drugs - she may be given these drugs in addition to chemotherapy before surgery (neoadjuvant therapy). Or she may be given the drugs after surgery (adjuvant therapy). For example, many inflammatory breast cancers produce a protein called HER2 protein. The drug trastuzumab (Herceptin) is effective in targeting this protein. Studies show that women treated with chemo and trastuzumab have better survival rates.
If the biopsy shows that the patient's cancer cells contain certain types of hormone receptors, hormonal therapy is another treatment option that may be used. For example, the drug tamoxifen can help block the effects of estrogen in estrogen-positive breast cancer cases. It forces estrogen dependent cancer cells to die.
Standard surgery for inflammatory breast cancer is called modified radical mastectomy. This removes the entire affected breast and all or most of the lymph nodes in the nearby arm. The removed lymph nodes will be tested for signs of cancer.
Radiation therapy involves the use of high powered energy beams, applied directly to the affected area, to kill cancer cells. It is usually applied after surgery as an additional precaution. If you plan on having breast reconstruction surgery and an implant is to be inserted, radiation is delayed until after the implant is in place. If you choose a tissue flap procedure (where the woman's own tissue is used to reconstruct the breast rather than an implant), radiation is applied before the reconstruction surgery.
What Are My Survival Chances?
According to results from a large-scale study carried out by the National Cancer Institute (SEER program), the 5 year survival rate associated with inflammatory breast cancer is 34 percent. This compares to 87 percent for women diagnosed with other types of invasive breast cancer.
Factors That Affect Your Survival Rate
Stage: Women with stage 3 inflammatory breast cancer have a 40 percent survival rate compared to 11 percent for those with stage 4.
Tumor size: Tumors are graded from 1 to 3. The higher the grade, the larger the tumor. 77 percent of women with grade 1 or 2 tumors are alive 2 years after diagnosis. This reduces to 65 percent for grade 3 tumors.
Ethnicity: African American women with inflammatory breast cancer generally have a worse outcome than other race or ethnic groups. 53 percent of African American women diagnosed with the disease are alive 2 years after diagnosis. This compares to 69 percent for all other women.
Estrogen receptor status: Women whose cancer cells are described as estrogen receptor-positive tend to live longer than those who are estrogen receptor-negative.
Treatment program: Studies show that women with inflammatory breast cancer who are treated aggressively have a better chance of survival. In the past, women were only treated with surgery and radiation therapy - less than 5 percent of them survived longer than 5 years. One long term studied showed that those who were treated with multimodal therapy - that is, in addition to surgery and radiation, chemotherapy before and/or after surgery is applied - 28 percent survived 15 years or longer after treatment.