Inflammatory Breast Cancer

Inflammatory breast cancer is a rare, very aggressive type of cancer that progresses rapidly. The cancer cells block the lymphatic vessels present in the skin of the breast making the affected breast appear red and swollen.

Inflammatory breast cancer is considered a locally advanced cancer, which means that it can spread from its point of origin to the nearby tissues and possibly to nearby lymph nodes. Most inflammatory breast cancers are invasive ductal carcinomas, which develop from cells lining the milk ducts of the breast, and then spread beyond the ducts.

Inflammatory breast cancer is usually diagnosed at either stage III or IV depending on whether cancer cells have spread to nearby lymph nodes or other tissues. It is usually confused with a breast infection.

Seek prompt medical attention if you notice skin changes on your breast, to help distinguish a breast infection from other breast disorders, such as inflammatory breast cancer.

Signs and symptoms of inflammatory breast cancer include:

• Rapid increase in the breast size or change in the appearance of one breast, over the course of several weeks.
• Thickness, heaviness or visible swelling of one breast.
• Discoloration of the skin of the breast, giving it a reddish purple, pink or bruised appearance.
• Unusual warmth or burning sensation in the affected breast.
• Pitted appearance or dimpling on the skin of the affected breast, similar to an orange peel.
• Tenderness, pain or aching
• Swelling of the lymph nodes under the arm, above or below collarbone or below the collarbone
• Flattening or turning inward of the nipple

Inflammatory breast cancer does not form a lump often, as with other forms of breast cancer.

Sometimes, the affected breast may have a solid tumor that can be felt during a physical examination, but most of the times, a tumor cannot be felt.

When to see a doctor

Make an appointment with your doctor if you have any of the above signs or symptoms that worry you. The signs and symptoms of inflammatory breast cancer may also be seen in other more common conditions.

A breast injury or breast infection (mastitis) may cause symptoms such as redness, swelling, and pain.

If you have been undergoing treatment for breast infection, but your signs and symptoms persist, contact your doctor. Your doctor will recommend a mammogram or other tests to evaluate your signs and symptoms.

Although it is not clear what exactly is the cause of inflammatory breast cancer, doctors know that it starts with an abnormal cell in one of the breast's ducts.

The gene mutations occurring within the abnormal cell's DNA cause its uncontrollable growth and division. These accumulated abnormal cells infiltrate and block the lymphatic vessels in the skin of your breast. The clogged lymphatic vessels gives rise to the characteristic red, swollen and piited skin appearance — a classic sign of inflammatory breast cancer.

You may see your family doctor or health care provider initially if you have any signs or symptoms of inflammatory breast cancer to receive a diagnosis.

If you have been diagnosed with inflammatory breast cancer, you may be referred to a doctor who specializes in treating cancer (oncologist).

As appointments may be brief, and there is often a lot of information to discuss, it is a good idea to be prepared. Here is some information that helps you get ready, and know what to expect from your doctor.

What you can do

• When you make an appointment, ask your doctor if there is anything you need to do in advance, such as pre-appointment restrictions in your diet.
• Write down all symptoms you are experiencing, including the ones that may seem unrelated to the reason of your appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all regular medications, vitamins or supplements that you take.
• Take a family member or a friend along. Sometimes, it can be difficult to remember all the information that is provided during an appointment. The person who accompanies you may help you remember that you missed or forgotten.
• Write down questions to ask your doctor. Preparing a list of questions helps you remember the details you want to know. For inflammatory breast cancer, some basic questions to ask your doctor include: 
  • Has my inflammatory breast cancer spread beyond my breast?
  • Will I need more tests?
  • What kind of treatment options are available?
  • Are there any potential risks associated with each treatment option?
  • Does any of these treatments cure my inflammatory breast cancer?
  • Which of these treatment options is best for me?
  • How much time may I take to choose a treatment approach?
  • How will the treatment affect my daily life?
  • Are there brochures or other printed material that I can take home? What websites do you recommend?

What to expect from your doctor

Your doctor may ask you a number of questions. Be ready to answer these questions to save more time later to discuss other points you want to address.

Your doctor may ask:

• When did you begin experiencing your symptoms first?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Is there anything that seems to improve or worsen your symptoms?

Diagnosing inflammatory breast cancer

The tests and procedures used to diagnose inflammatory breast cancer include:

• A physical examination: Your doctor will examine your breast to check for redness and other signs of inflammatory breast cancer.
• Imaging tests: Your doctor will advise a breast X-ray (mammogram) or a breast ultrasound to detect signs of cancer in your breast, such as thickened skin. Additional imaging tests, such as MRI scan may be recommended in certain conditions.
• Removing a tissue sample for testing (Biopsy): A biopsy is a procedure in which a small sample of suspected breast tissue is removed for testing. The tissue is then analyzed at a laboratory to check for presence of cancer cells. A skin biopsy may also be done at the same time as a breast biopsy.

Staging of inflammatory breast cancer

The process of determining the extent (stage) of your cancer is called staging.

Additional tests that are used to stage your cancer include a computerized tomography (CT) scan, positron emission tomography (PET) scan, and bone scan. Your doctor will select the most appropriate tests based on your condition.

The stages of inflammatory breast cancer are:

• Stage III: At this stage, cancer is locally advanced, which means that it has spread to the nearby lymph nodes and fibrous connective tissue within the breast.
• Stage IV: At this stage, the cancer spreads to other parts of your body.

The treatment for inflammatory breast cancer generally begins with systemic chemotherapy to shrink the tumor. Then surgery is done to remove the tumor followed by radiation therapy.

This treatment is called multimodal approach, and includes the following therapies:

• Neoadjuvant Chemotherapy: Chemotherapy uses chemicals to destroy the cancer cells. The chemotherapy drugs are given through a vein (intravenously), in the form of a pill or both. Neoadjuvant chemotherapy is usually given before surgery, and includes both taxane and anthracycline drugs. The aim of this treatment is to shrink the tumor prior to the operation so that there is an increased chance of success during surgery. At least six cycles of neoadjuvant chemotherapy is recommended over the course of 4-6 months before the tumor is removed, unless the tumor progress rapidly during this time, and doctors advise immediate surgical removal of the tumor.
• Surgery: After chemotherapy, women with inflammatory breast cancer usually undergo an operation to remove the affected breast (mastectomy). The standard surgical procedure for inflammatory breast cancer is a modified radical mastectomy, which involves removal of the entire affected breast and most of the lymph nodes present under the adjacent arm. The lymph nodes are then checked for signs of cancer.
• Adjuvant therapy: Adjuvant systemic therapy is usually given after surgery to reduce the chances of tumor recurrence. This therapy includes additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or a combination of these treatments.
• Hormone therapy: Hormone therapy is recommended as a treatment option if the cells in the inflammatory breast cancer contain hormone receptors, and are sensitive to hormones. Hormone therapy treatments include:

1. A medication that blocks attachment of hormones to cancer cells: Tamoxifen is a type of drug called a selective estrogen receptor modulator (SERM). SERMs act by blocking estrogen present in the body from binding to the estrogen receptor on the cancer cells, thus killing the cancer cells and slowing down the tumor growth. Tamoxifen is given to both pre- and postmenopausal women.
2. Medications that prevent the production of estrogen after menopause: Also called aromatase inhibitors, these drugs can block the action of an enzyme that converts androgens in the body into estrogen. These drugs can result in the arrested growth of estrogen-dependent cancer cells and their death. These are effective only in postmenopausal women. Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).

• Targeted therapy: Targeted therapies destroy cancer cells by focusing on their vulnerabilities. Inflammatory breast cancers often produce more than normal amounts of the HER2 protein that helps in growth and survival of cancer cells. The medications such as trastuzumab (Herceptin) and pertuzumab (Perjeta) that block this protein, and cause death of cancer cells may be used to treat them. Trastuzumab and pertuzumab can be combined with chemotherapy.
• Radiation therapy: Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a large machine moves around you, directing the energy beams to your chest wall. Radiation therapy can be used after chemotherapy and surgery to kill any cancer cells that might remain around your breast and under your arm.

Breast reconstruction can be undertaken in women with inflammatory breast cancer, but, because of the importance of radiation therapy in treating this disease, doctors generally recommend delayed reconstruction.

Lifestyle modifications are necessary in order to cope with inflammatory breast cancer.

Inflammatory breast cancer is a rapidly progressing disease. Sometimes, this means that you may need to start treatment even before you have had time to think about it.

This can feel overwhelming, but you can try these measures to cope with the disease:

• Learn enough about inflammatory breast cancer to make treatment decisions: Try to learn facts about your cancer and treatment from your doctor. Know what stage your cancer is at and the treatment options available.

  Also, ask your doctor about the trustworthy sources of information that can be referred to learn more. Some examples of reputed organizations for cancer information include the National Cancer Institute and the American Cancer Society.

• Seek support: You might feel comfortable if you to talk to someone about your feelings as you begin cancer treatment. You might have a close friend or family member who is a good listener or ask your doctor to refer you to a counselor who works with cancer survivors. 

• Try connecting with other cancer survivors: Other people with cancer are a unique source of support. Cancer survivors can often provide you practical advice on what to expect and how to cope during your treatment. 
• Ask your doctor about support groups near your place or register yourself in the online message boards run by organizations such as the American Cancer Society.

The factors that increase your risk of inflammatory breast cancer include: 

• Gender: Women are more likely to develop inflammatory breast cancer than men, but men can also develop inflammatory breast cancer.
• Race: Black women are at a greater risk of developing inflammatory breast cancer than white women.
• Advancing age: The risk of inflammatory breast cancer also increases as one gets older.
• Being obese: Obese women are more likely to have inflammatory breast cancer than women of normal weight.