Inflammatory Breast Cancer

What is Inflammatory Breast Cancer?

Inflammatory breast cancer (IBC) is a type of breast cancer in which cancer cells enter and block the lymph vessels of the breast. This rare and aggressive type of breast cancer is called “inflammatory” because the skin of the breast often looks red and swollen as if it is inflamed.

Lymphatic vessels are like blood vessels that drain the fluid around tissues. The small vessels finally merge to form a large lymph vessel called the thoracic duct, which empties the lymph into a major vein. Along the lymph vessels are small filters called lymph nodes. These enlarge in the presence of an infection or a cancer. While lymph nodes affected by infection are usually tender, those affected by cancer are usually hard and rubbery.

What are the Causes of Inflammatory Breast Cancer?

Inflammatory breast cancer occurs when the cancer cells spread to the lymphatic vessels. The accumulating abnormal cells infiltrate and clog the lymphatic vessels in the skin of the breast causing it to become red and swollen and dimpled — a classic sign of inflammatory breast cancer.

What are the Symptoms and Signs of Inflammatory Breast Cancer?

The symptoms and signs of IBC include the following:

• Sudden visible enlargement of the breast, which appears heavy, harder and firmer than a normal breast
• Discoloration of the breast skin, giving the breast a red, purple, pink, or bruised appearance
• Dimples or ridges on the breast surface
• Tenderness and pain in the affected breast. Tenderness refers to pain on touch
• Itching over the breast
• Unusual warmth over the affected breast
• Enlarged lymph nodes around the breast
• Flattening or turning inward of the nipple (flattened look) or discharge from the nipple.

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Other rare symptoms may include the following:

• Swelling of the arm, which may occur due to obstruction of lymphatic drainage from the arm
• The breast size may decrease instead of increasing
• A lump may be noted, though it is usually not obvious in the swollen breast affected by inflammatory breast cancer.

How do you Diagnose Inflammatory Breast Cancer?

The symptoms of inflammatory breast cancer resemble those of breast infection, which has to be ruled out. Not all the symptoms mentioned above need to be present in order to make a diagnosis of inflammatory breast cancer.

One or more of the following imaging tests may be done to confirm the diagnosis of IBC:

• Mammography
• Breast ultrasound

• MRI (magnetic resonance imaging) scan
• CT (computed tomography) scan
• PET (positron emission tomography) scan, to understand the spread of the cancer to distant tissues
• Biopsy: Breast cancer is confirmed using a biopsy. In this procedure, a small piece of the breast tissue is obtained and examined under the microscope for the presence of breast cancer cells. The breast cancer cells also examined for the presence of estrogen or progesterone or HER2 protein. The presence of any of these receptors can determine which treatment will be effective.

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How do you Treat Inflammatory Breast Cancer?

To treat IBC, a combination of strategies is used, including chemotherapy, surgery, radiation therapy, and possibly targeted therapies.

• Chemotherapy: Neoadjuvant chemotherapy refers to the chemotherapy that is administered before surgery so that the cancer reduces in size and the operation is easier. It is recommended that at least 6 cycles of neoadjuvant chemotherapy be administered over the course of 4- to 6 months before the tumor is surgically removed.
• Surgery: The standard surgery for IBC is called a ‘modified radical mastectomy’. During this surgery, the entire breast and nearly all the lymph nodes in the adjoining arm are removed. The surgery may also involve the removal of the tissue over the chest muscles, and sometimes a small chest muscle called the pectoralis minor.

• Radiation: Radiation therapy is often recommended following surgical breast removal to kill any remaining cancer cells.
• Targeted therapy: IBCs often produce greater than normal amounts of the HER2 protein, hence drugs such as trastuzumab that target this protein can be given before as well as after surgery.
• Hormone therapy: IBCs are usually negative for estrogen and progesterone receptors. Therefore, hormone therapy is usually ineffective in this type of cancer.

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What is the Prognosis of Inflammatory Breast Cancer?

Inflammatory breast cancers account for around 1% to 5% of all breast cancers. It has been estimated that patients with stage III of the disease have a median survival rate of 57 months, while those with stage IV have a median survival rate of 21 months. These numbers however vary widely depending on the treatment options available to the patient.

Health Tips

• Every woman should regularly perform a simple manual breast self examination (BSE) herself in front of the mirror and bright light to notice any changes.
• Keep the diet simple and nutritious without additives, artificial colors, and preservatives as far as possible.
• Maintain ideal body weight and prevent obesity.
• Perform regular exercises to stay fit and keep diseases at bay.