Inflammatory Breast Cancer

DEFINITION

Inflammatory breast cancer is a type of cancer that causes swelling, tenderness and redness of the breast which appears and spreads in a very short time frame. This type of breast cancer is rare, but can be very serious. Normally, lymph fluid draining from the breasts moves to the body through lymphatic ducts. In inflammatory breast cancer, these ducts become blocked off, fluid backs up and the breast becomes very swollen and painful. It is very easy to confuse inflammatory breast cancer with mastitis (a breast infection) so seeing a doctor to determine the difference is very important. Inflammatory breast cancer invades the tissues near it and moves rapidly to the lymph nodes, a condition doctors call “locally advanced cancer”. In inflammatory breast cancer, the DNA of some abnormal cells has a mutation that allows the cells to grow and reproduce at a very high rate. Instead of dying like a normal cell would, these cells live a long time and can spread through the body. In breast cancer, these abnormal cells form a mass in the breast that can metastasize to the lymph nodes and throughout the body. In inflammatory breast cancers, some of these abnormal cells block off the lymphatic drainage from the breast, causing the characteristic swelling, redness and pain. Risk factors for having inflammatory breast cancer include being a woman, being black, and being older (generally after age 50).

SYMPTOMS
Swelling of breast, pain of breast, red or purple color of the breast, rapid change in the character of the breast, thickness of the breast, heaviness of the breast, breast that is warm to the touch, dimpling of the skin of the breast causing an appearance like the peel of an orange, itching of the breast, swollen lymph nodes in the armpit or near the collarbone, inverted nipple

DIAGNOSIS
The diagnosis of breast cancer begins with a thorough history and physical exam by your doctor. Your doctor will focus specifically on the breast and surrounding to tissue to feel for lumps, look for nipple discharge, and check for lymph nodes. After this initial exam, your doctor will likely want to do some further imaging. A mammogram is the most common screening tool for breast cancer. Mammogram involves pressing the breast so they are slightly flatter and taking an X-ray which is then examined for abnormalities. Another imaging option is breast ultrasound, a sonogram of the tissue of the breast to looks for masses or abnormalities. A third imaging option is breast magnetic resonance imaging (MRI) which involves lying in a small tube while a machine that surrounds you takes pictures. If an abnormality is found on one of these imaging tests, your will likely see a surgeon for a biopsy. Fine needle aspiration is a type of biopsy that involves placing a long, thin needle into the mass and taking out some of the cells in that area. These cells are then sent to a pathologist who looks at the cells under a microscope with special stains to determine if they look abnormal. If needed, a surgery may be done to get a bigger biopsy sample. If you are found to have cancer, your oncologist (cancer doctor) and surgeon will want to do “staging” to determine how severe the cancer is and where it has spread. In order to do staging, your doctor may use blood tests, mammogram, chest x-ray, breast MRI, bone scan, CT scan, or PET scan. Generally, inflammatory breast cancer is at a more advanced stage when it is diagnosed than other types of breast cancer.

TREATMENT
Unlike other breast cancers, chemotherapy is usually the first step in treating inflammatory breast cancer. After chemotherapy, surgery or radiation may also be done. It is very important to talk to your doctor and other women who have undergone treatment to see what options are best for you. Chemotherapy is the kind of medications that are given to decrease the growth rate of rapidly growing cells, like the cells in cancer. Chemotherapy can be given through an intravenous (IV) line or can be taken by mouth, depending on the type. Chemotherapy can be given before surgery to shrink the size of the tumor, in conjunction with surgery, or after surgery to decrease the risk of recurrence. For people with disease that has spread, chemotherapy may help decrease some of the symptoms from that spread. Because chemotherapy decreases the rate of growth for rapidly dividing cells, other parts of the body including the blood may be affected. Common side effects are feeling fatigue, hair loss, low blood counts, and nausea. For inflammatory breast cancer, the type of surgery done is generally modified radical mastectomy. A modified radical mastectomy involves removing the entire breast as well as many of the lymph nodes from the armpit on the same side. Every surgery carries a risk of bleeding and infection, but some breast cancer surgeries can also increase the chances of having swelling in the arm (lymphedema). After mastectomy, it is possible to have breast reconstruction with a plastic surgeon sometimes even at the same time. Another treatment option, radiation therapy, involves the use of beams of energy focused on a certain area to prevent those cells from growing. Radiation can cause local reddening and pain of the skin as well as other, more rare problems. Certain types of breast cancer are also susceptible to hormone therapy. Hormone therapy blocks hormones that these cancers need to grow and thrive. These medications include those that decrease production of hormones in the body (aromatase inhibitors) and those that block hormones from getting to the cancer cells (selective estrogen receptor modulators). Surgery can also be done on the ovaries to stop the production of hormones. Blocking hormones can have side effects that are similar to the symptoms of menopause like vaginal dryness, hot flashes, mood swings and decreased sex drive as well as increased risk of osteoporosis. Some types of breast cancer are susceptible to targeted drugs like trastuzumab (Herceptin), bevacizumab (Avastin), and lapatinib (Tykerb). These medications can be quite expensive and may not be covered by your health insurance. You should discuss all of your treatment options with your doctor to help determine the best treatment plan for you. Inflammatory breast cancer moves more quickly than other types of cancer, so you may have to start treatment before you feel well-educated on your diagnosis. You should make sure to have an open discussion about your concerns with your doctor. No alternative treatments are known to help cure breast cancer, but many alternative treatments can help for the side effects of breast cancer treatment. To help combat fatigue, you might try light exercise, managing stress with relaxation techniques, and other types of relaxing activities like reading or taking a warm bath. It is very important to communicate with your family and friends and seek out a strong support network in order to cope with your diagnosis and treatment. You should consider educating yourself on your disease and share that information with others. You may find that joining a support group of other people with your disease is helpful including places like the Breast Cancer Network and Cancer Care. Make sure to keep your partner close as they may be the biggest support you have through your illness. Most importantly, you should take care of yourself and your body which means continuing to do things you enjoy, resting when you need to, and eating well. To prevent breast cancer, you should do regular self breast exams and have screening done regularly. You should avoid alcohol or limit yourself to one drink per day. Exercise and maintaining a healthy weight can also help decrease the chances of getting breast cancer. If you are at high risk for breast cancer, you should see a doctor about possible treatments such as medications and surgeries to prevent breast cancer in the future.