Breast Cancer Treatment

Written by : Dr.M.D.Mazumdar, MD

Inflammatory Breast Cancer (IBC) is aggressive but a rare type of breast cancer.

The cancer starts as an invasive ductal carcinoma, which means the cancer develops from cells that line the milk ducts of the breast. The cancer cells spreads rapidly beyond the ducts in sheets to block the lymph vessels. It is called ' and cause the typical symptoms of a rash on the breast. It is called 'inflammatory' because the breast looks swollen, red and inflamed.

It constitutes only about 1-5% of all breast cancer cases. But it is a particularly aggressive form of cancer and can spread within hours or days of being diagnosed.

Age at Diagnosis

Inflammatory Breast Cancer occurs in somewhat younger women as compared to other types of breast cancer like ductal breast cancer or lobular breast cancer. The average age of diagnosis for inflammatory breast cancer is 52, compared to age 55-57 for the other types of breast cancers. In some women, IBC can occur in quite a young age - the first symptoms may even appear during pregnancy or lactation and may get ignored.

Most inflammatory breast cancers originate from invasive ductal carcinomas.

Like all other types of breast cancers, it can also occur in men, especially in overweight men.

Important Features of inflammatory breast cancer

• Inflammatory Breast Cancer usually grows in nests or sheets: Rather than as a confined, solid tumor, the cancer cells spreads as sheets or nests. So it can be present throughout the breast anatomy with no palpable mass and no other symptoms of breast cancer before it is diagnosed.

• Can be confused with Breast Infection: Delay in diagnosis of breast cancer can occur because it is often confused with simple inflammatory conditions like breast mastitis (infection of the breast). If symptoms of mastitis persist after a week of treatment with antibiotics, it is always advisable to get a biopsy.

• Genetic Cause: Scientists have now identified a key gene -- eIF4G1 -- that is overexpressed in the majority of cases of IBC, allowing cells to form highly mobile clusters that are responsible for the rapid metastasis that makes IBC such an aggressive and deadly cancer.

• Ethinicity: Black women are more at risk of this condition. It is also usually diagnosed at younger ages in African American women than in white women.

• Weight: Risks of getting inflammatory breast cancer increases in overweight women.

• Hormone Receptors: Inflammatory breast tumors are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.

INFLAMMATORY BREAST CANCER

Symptoms of Inflammatory Breast Cancer (IBC):

As already noted, the symptoms of Inflammatory breast cancer are very similar to Breast Mastitis. And very often it may be mistaken for this condition. And it has to be emphasized that any mastitis which does not respond to antibiotics and anti-inflammatory medicines after 1 week of treatment needs to be investigated for inflammatory breast cancer.

• No lump: There is no definite lump or mass felt in Inflammatory breast cancer.

• Redness of the Breast: In most cases, IBC can start with a diffuse redness of the breast without any identifiable cause for the apparent inflammation. The redness may start on one side and spread quickly, sometimes within hours. Sometimes it may look like a bruise on the breast that doesn't go away even after a week.

• Breast feels Warm: The breast feels warm to the touch as compared to the skin on other parts of the body due to the acute inflammatory reaction.

• Increase in Size of the Breast: The breast may increase suddenly in size over a relatively short period of time - sometimes a cup size in a few days. The breast may feel heavy, hard and uncomfortable. The enlargement may be caused by cancer cells blocking the lymph vessels in the skin and causing congestion.

• Severe Itching: There may be severe itching all over the breast, contributing to the redness and thickening of the skin. Very often, IBC is diagnosed only after the itching has not gone down with any anti-itch medicines, including anti-fungal medicine.

• Thickening of the Skin of the Breast: There may be ridges and thickened areas of the skin. The skin may appear pitted, like the skin of an orange (called peau d'orange) - this is caused by a buildup of fluid and edema (swelling) in the breast. Fluid buildup is caused by blockage of the lymph vessels, preventing the normal flow of lymph through the tissue.. The skin of the breast might look pink or bruised, and what looks like ridges, welts, or hives may be seen on the breast.
  
  Peau de Orange

• Nipple Discharge: Some women may have a nipple discharge which may be yellowish, greenish or reddish. Reddish implies the presence of blood while greenish or yellowish may indicate the presence of infection.

• Pain in the Breast: Breast pain which is constant or stabbing in nature may occur. The time of occurance of the pain is not related to the menstrual cycle. Breasts which have a constant deep aching or burning sensation should be investigated for inflammatory breast cancer.

• Nipple Changes: The nipple may go flat or turn inward (inversion). There may be change in the color and/or texture of the areola (pigmented area surrounding the nipple).
  
  Inverted Nipple

• Lymph Node Enlargement: Some women may present with enlarged lymph nodes of the armpit or the neck region, as a first symptom of inflammatory breast cancer. But in most women, it is a later sign.

• Swelling of the Arm: Rapid spread of cancer cells to the lymph nodes of the arm can cause blockage of the lymphatic channels of that arm. The arm may thus swell up and in rare cases, a swollen arm may be the first symptom of inflammatory breast cancer.

Stages of Inflammatory Breast Cancer.

This type of cancer is usually in one of three stages:

• Stage IIIB: By the time IBC is diagnosed, it is usually in Stage IIIB - it means that the cancer has spread to the tissues near the breast, such as the skin or chest wall, including the ribs and muscles in the chest. The cancer may have spread to lymph nodes within the breast or under the arm.
• Stage IIIC: A this stage, the cancer has spread to lymph nodes beneath the collarbone and near the neck. The cancer also may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
• Stage IV: The cancer has spread outside the breast and to lymph nodes in other parts of your body as well as to organs like the bones, lungs, liver and brain.

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