Types of Cancer : Inflammatory Breast Cancer

Definition

Inflammatory breast cancer is a rare but aggressive type of breast cancer that develops rapidly, making the affected breast red, swollen and tender. It's a locally advanced cancer, meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes.

The early signs of more-common forms of breast cancer — a breast lump or suspicious area on a routine, screening mammogram — are often absent in inflammatory breast cancer. Instead, the breast may appear normal until tumor cells invade and block lymphatic vessels in the overlying skin. Fluid backs up, and the breast swells and becomes discolored.

Inflammatory breast cancer can easily be confused with a breast infection, but if it's cancer, symptoms won't go away with antibiotics. Seek medical attention promptly if you notice skin changes on your breast, to help distinguish a breast infection from other breast disorders.

Inflammatory breast cancer accounts for between 1 percent and 6 percent of all breast cancer cases in the United States. Survival rates are lower than those observed in other locally advanced breast cancers. But new treatment approaches offer greater odds for survival than ever before.

Symptoms

Despite its name, inflammatory breast cancer does not cause inflammation the way an infection does. Signs and symptoms include:

• Rapid change in the appearance of one breast, over the course of days or weeks
• Thickness, heaviness or visible enlargement of one breast
• Discoloration, giving the breast a red, purple, pink or bruised appearance
• Unusual warmth of the affected breast
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel
• Itching
• Tenderness, pain or aching
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
• Flattening or turning inward of the nipple
• Swollen or crusted skin on the nipple
• Change in color of the skin around the nipple (areola)

Other conditions have symptoms resembling those of inflammatory breast cancer. A breast infection (mastitis) also causes redness, swelling and pain, but breast infections usually develop during breast-feeding. With an infection, you're likely to have a fever, which is unusual (but not unheard of) in inflammatory breast cancer.

Breast surgery or radiation therapy may block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. When caused by surgery or radiation treatments, however, these changes gradually subside.

Causes

As with other types of breast cancer, the exact cause of inflammatory breast cancer is unknown. All cancers are characterized by unregulated cell division, starting with one abnormal cell, in this case usually in one of the breast's ducts. In inflammatory breast cancer, the abnormal cells rapidly infiltrate and clog the lymphatic vessels in the skin over your breast. The blockage in the lymphatic vessels causes red, swollen and dimpled skin — a classic sign of inflammatory breast cancer.

Risk factors

Inflammatory breast cancer tends to affect women at an average age of 59 — about three to seven years younger than the average age at which other types of breast cancer are diagnosed. Men can develop the disease, but at an older age. Black women are slightly more likely than are white women to have inflammatory breast cancer.

When to seek medical advice

If you have an apparent breast infection that fails to improve despite a week of treatment with antibiotics, ask your doctor to do a further breast evaluation. This may include imaging studies such as ultrasound, mammogram or MRI scan and a biopsy. If 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 — especially one that includes a skin sample — or ask for a referral to a breast specialist.

Tests and diagnosis

A diagnosis of inflammatory breast cancer is based on your medical history, your physical examination and an excisional biopsy — taking a small sample of skin and some of the underlying tissue to examine under a microscope. An excisional biopsy that includes the skin is helpful because a hallmark of inflammatory breast cancer is finding tightly packed clumps of cancer cells (tumor emboli) in the lymphatic vessels of the skin. Imaging tests — mammogram and breast ultrasound — also may be used to confirm the diagnosis by showing areas of skin thickening.

If the biopsy results confirm that you have inflammatory breast cancer, the next step is to determine how advanced your cancer is — its stage, or extent and severity. Your doctor may perform additional tests, such as a CT scan of your chest and abdomen, chest X-ray, and bone scan, to check for the presence of cancer cells in other parts of your body (metastases).

Your cancer will also be tested for the presence or absence of receptors for the hormones estrogen and progesterone, and to see if the cancer produces too much of a protein called HER2. Inflammatory breast cancers are often hormone receptor negative and HER2-positive.

Inflammatory breast cancer is classified as stage IIIB or stage IV breast cancer. Stage IIIB is locally advanced cancer — meaning it has spread to nearby lymph nodes and to the fibrous connective tissue inside the breast. Stage IV cancer has spread to other parts of your body, such as bones or liver. About one-third of newly diagnosed inflammatory breast cancers are stage IV.

Treatments and drugs

Treatment for inflammatory breast cancer starts with chemotherapy, followed by surgery and radiation therapy. This combined-treatment approach has improved the outlook for women with inflammatory breast cancer. About half the women diagnosed with the condition survive five or more years, and nearly one-third are alive 20 years after diagnosis.

Chemotherapy (anti-cancer drugs)
Treatment of inflammatory breast cancer usually begins with several rounds of chemotherapy to kill or control cancer cells. This pre-surgical treatment, referred to as neoadjuvant therapy, is needed to shrink the cancer and resolve skin problems before the operation, since swelling can prevent the surgical incision from healing properly. The exact number of chemotherapy treatments will depend on how well the cancer responds to the treatments.

Surgery
After chemotherapy, women with inflammatory breast cancer usually have an operation to remove the affected breast (mastectomy). Surgery alone — without chemotherapy — offers a much smaller chance of a cure. Breast-conserving surgery (lumpectomy) isn't recommended for women with inflammatory breast cancer. Most women receive additional doses of chemotherapy after healing from the operation.

Radiation therapy
After surgery and any further chemotherapy, a course of radiation therapy is given to kill any remaining cancer cells in the breast and under your arm. This can help decrease the chance of cancer coming back in the area. Radiation typically involves about 30 treatments over six weeks.

Further treatments
Even after treatment with chemotherapy, surgery and radiation, recurrence rates remain high for inflammatory breast cancer. Because of this, your doctor may recommend further treatment (adjuvant therapy) to prevent the cancer from returning. This might include more chemotherapy or hormone therapy if your cancer tests positive for estrogen receptors. Hormone therapy, such as tamoxifen or anastrozole (Arimidex), interferes with the effects of the female hormone estrogen, which can promote cancer cell growth.

If your cancer is HER2-positive, your doctor will recommend a course of trastuzumab (Herceptin). You may also be offered the opportunity to participate in a clinical trial to test new treatments for inflammatory breast cancer.