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Inflammatory breast cancer

Inflammatory breast cancer (IBC) is an uncommon type of breast cancer, accounting for only 1%–4% of all cases of breast cancer. IBC is not caused by a breast infection or inflammation. Instead, the term inflammatory describes the appearance of the breast with this type of cancer.

 

Inflammatory breast cancer begins in the breast ducts. The cancer cells move from the ducts into the lymph vessels (tubes that carry lymph fluid) in the skin of the breast.

 

Inflammatory breast cancer is more likely to be diagnosed in women of African ancestry and in younger women.

Signs and symptoms

The symptoms of inflammatory breast cancer are different than those of more common breast cancers. The symptoms are caused by the cancer cells in the skin’s lymph vessels, can appear suddenly and vary from woman to woman.

 

The signs and symptoms of inflammatory breast cancer may include:

  • a breast that feels warm to the touch
  • skin changes:
    • pink, red or purple in colour
      • The colour can change from a light colour to a darker colour as the cancer advances.
    • dimpled or pitted like an orange peel (peau d’orange)
    • bumps or ridges
  • breast tenderness or pain
  • breast swelling or a sudden increase in breast size over a short period of time
  • itching of the breast or nipple
  • thickening of the breast tissue
  • nipple discharge
  • nipple changes
  • breast lump – rare
  • swollen lymph nodes under the arm (axillary lymph nodes) or above the collarbone

 

The symptoms of IBC can be similar to a breast infection (mastitis), which can be effectively treated with antibiotics. Symptoms that do not go away after antibiotic treatment should be discussed with a doctor. Further testing to rule out inflammatory breast cancer may be needed.

Diagnosis

If the signs and symptoms of inflammatory breast cancer are present, or if the doctor suspects IBC, tests will be done to make a diagnosis.

 

Tests done to diagnose inflammatory breast cancer may include:

Pathology and staging

Inflammatory breast cancer can grow and spread quickly. Cancer cells have often spread to the lymph nodes under the arm (axillary lymph nodes) by the time it is diagnosed.

 

IBC is classified using the staging system for breast cancer:

  • stage III (IIIB or IIIC) – The cancer is found only in the breast, the lymph nodes under the arm or both.
  • stage IV – The cancer has spread distant sites (lungs, liver, bone or distant lymph nodes).

Prognosis for inflammatory breast cancer

Women with inflammatory breast cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a woman’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

 

Inflammatory breast cancer is an aggressive form of breast cancer. It is often diagnosed at a later stage, when the cancer has spread to other parts of the body. Compared to other forms of breast cancer, the prognosis for inflammatory breast cancer is less favourable.

Treatment

Inflammatory breast cancer is treated like other locally advanced breast cancers that cannot be removed by surgery (stage IIIB and stage IIIC). Treatment begins as soon as possible and usually involves a combination of treatments, including the following.

Chemotherapy

Treatment for inflammatory breast cancer often starts with neoadjuvant chemotherapy to reduce the size of the tumour and kill cancer cells that may have spread to other parts of the body.

 

Chemotherapy for inflammatory breast cancer usually involves a combination of drugs because this has been shown to be more effective than single drugs on their own.

 

The most common chemotherapy combinations used to treat inflammatory breast cancer are:

  • AC
    • doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan, Procytox)
  • AC > Taxol
    • doxorubicin and cyclophosphamide, followed by paclitaxel (Taxol)
  • AC > Taxol (Dose Dense)
    • doxorubicin and cyclophosphamide, followed by paclitaxel, with less time between treatments (dose dense)
      • This combination is usually given with filgrastim (Neupogen) or pegfilgrastim (Neulasta).
  • TC
    • docetaxel (Taxotere) and cyclophosphamide
  • TAC (or DAC)
    • docetaxel, doxorubicin and cyclophosphamide
  • FAC (or CAF)
    • cyclophosphamide (by mouth), doxorubicin and 5-fluorouracil (Adrucil, 5-FU)
  • CEF
    • cyclophosphamide (by mouth), epirubicin (Pharmorubicin) and 5-fluorouracil
  • FEC
    • cyclophosphamide (into a vein, or intravenous), epirubicin and 5-fluorouracil
  • FEC > T
    • cyclophosphamide, epirubicin and 5-fluorouracil, followed by docetaxel
  • CMF – IV
    • cyclophosphamide (intravenous), methotrexate and 5-fluorouracil
  • CMF – PO
    • cyclophosphamide (by mouth), methotrexate and 5-fluorouracil
  • Taxol > FAC
    • paclitaxel, followed by cyclophosphamide, doxorubicin and 5-fluorouracil

 

Mammography may be done after several rounds of chemotherapy to find out if the cancer has responded to treatment. This mammogram is compared to the mammogram that was done at the time of diagnosis.

 

If the inflammatory breast cancer does not respond to the chemotherapy, other chemotherapy combinations may be offered but surgery will not be done.

 

For more detailed information on specific drugs, go to sources of drug information.

Biological therapy

If the inflammatory breast cancer is HER2 positive, trastuzumab (Herceptin) is given along with chemotherapy.

Surgery

If the inflammatory breast cancer responds to neoadjuvant chemotherapy, surgery may be offered:

  • modified radical mastectomy
    • used to treat IBC without distant metastasis
  • axillary lymph node dissection
    • This surgery is done in most cases of inflammatory breast cancer
  • breast-conserving surgery is not recommended for IBC because of a higher risk of recurrence

Radiation therapy

After mastectomy or breast-conserving surgery, external beam radiation therapy is given to the chest wall and lymph nodes in the chest, shoulder and underarm.

Adjuvant therapies

Further treatment may be given after surgery and radiation therapy (adjuvant therapy). The types of adjuvant therapy that may be offered for inflammatory breast cancer are:

Hormonal therapy

Hormonal therapy may be offered to women whose inflammatory breast cancer tumours are hormone receptor positive. The types of hormonal therapy offered are:

  • tamoxifen (Novaldex, Tamofen)
  • aromatase inhibitors – may be offered to women after menopause (post-menopausal)
    • anastrozole (Arimidex)
    • letrozole (Femera)

Chemotherapy

Chemotherapy may be continued after surgery for inflammatory breast cancer.

Biological therapy

If the inflammatory breast cancer is HER2 positive, trastuzumab (Herceptin) is given along with chemotherapy.

References

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