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Inflammatory breast cancer
Classification and external resources
ICD-O: 8530/3

Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). It gets its name from the red, swollen, inflamed appearance of the breast. It is unique because it often does not present with a lump and therefore often is not detected by mammography or ultrasound.[3] IBC only makes up 1-6% of all breast cancer cases in the USA.[4] IBC is usually diagnosed in younger women (average age of 57 years old). African-Americans are usually diagnosed at younger ages than Caucasian women, and also have a higher risk of getting IBC. [5]

Contents

Symptoms

Inflammatory breast cancer (IBC) is a very aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed”, sometimes overnight, and can be misdiagnosed as mastitis. Invasion of the local lymphatic ducts impairs drainage and causes edematous swelling of the breast. Because the skin of the breast is tethered by the suspensory ligament of Cooper, the accumulation of fluid may cause the skin of the breast to assume a dimpled appearance similar to an orange peel (peau d'orange). IBC is sometimes misdiagnosed as an insect bite or breast infection. In the case of IBC, a lump is usually not present as in other forms of breast cancer. Symptoms to look for can be one or many of the following:

  • Pain in the breast
  • Skin changes in breast
  • Reddened area with texture and thickness of an orange (peau d’orange)
  • Bruise that does not go away
  • Sudden swelling of the breast
  • Itching of breast
  • Nipple retraction (flattened look)or discharge
  • Swelling of lymph nodes under the arm or in the neck
  • Unusual warmth of the affected breast
  • Breast is harder or firmer

Other symptoms may rarely include:

  • Swelling of the arm
  • Breast decreases instead of increasing
  • Although a dominant mass is present in many cases, most inflammatory cancers present as diffuse infiltration of the breast without a well-defined tumor.
  • A lump may become present and grow rapidly

Most patients do not experience all the symptoms of IBC. Not all symptoms need to be present in order to be diagnosed. [6]

Diagnosis

Standard diagnostic tests for breast cancer, such as mammograms, MRI and biopsies, generally cannot accurately diagnose IBC. The following tests are used to make a diagnosis:

  • Surgical biopsy: larger samples of the breast skin and underlying tissue can be collected in a surgical or skin biopsy, with better chances for identifying the cancer cells.
  • PET scan: In the near future, this could be one of the most important diagnostic/staging tests for IBC, though it is still under study. PET scans enable oncologists to see more disease.

Staging

Staging is based on the size of the tumor and if it has spread beyond the breast. It is also based on whether the cancer is invasive or non-invasive. Staging is designed to help organize the different treatment plans and to understand the prognosis better. IBC has three different staging groups:

  • Stage IIIB means the cancer has spread to 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 means 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 means that the cancer has spread to other organs. These can include the bones, lungs, liver, and/or brain, as well as the lymph nodes in the neck. [7]

Treatment

Chemotherapy: Inflammatory breast cancer is typically treated with chemotherapy before surgery.

Radiation therapy: often used after a mastectomy, it uses high-energy beams to kill cancer cells. After treatment, patients may have some side effects such as swelling and redness of the breast.

Hormone therapy: this is used when patients test positive for estrogen and/or progesterone receptors on tumor cells. Hormone therapy is given after surgery and chemotherapy are completed. This is often given for 5 years.

Surgery: a mastectomy with lymph node surgery is highly recommended for women with IBC. A lumpectomy, when only a portion of the breast is removed, is not an option for IBC patients. A lymph node dissection is also recommended over a sentinel lymph node biopsy. Lymphedema, swelling of the arm and the hand on the side of the body where surgery was performed, may be a complication after a lymph node dissection. Reconstruction of the breast may be an option for healthy women after a mastectomy. However, for patients who smoke or have diabetes, complications are more common.[8]

Prevention

Chemoprevention is a way to help reduce the chances of women getting breast cancer. Two common types of medicine used are tamoxifen and raloxifene. [9]

Tamoxifen is FDA approved. It reduces the effects of estrogen, which influences breast tumor growth in women 35 and over. It is used in patients who have had breast cancer to prevent recurrence, as it is shown to improve the risk of recurrence. Trials have been done worldwide to see if tamoxifen would work with women who did not have cancer but had a high risk of getting it. Studies show that it lowered the women’s risk by one-third. It also showed that the women were still at low risk five years after they stopped taking the pill.

Side effects include menopausal symptoms, weight gain, life-threatening blood clots, cancer of the womb lining for post-menopausal women [10], bladder and urinary problems, vaginal discharge, vaginal dryness, nausea and menstrual irregularities, strokes, cataracts, and endometrial cancer or uterine cancer. [11]

Some benefits of tamoxifen include lowering cholesterol for post-menopausal women and keeping bones healthy and strong. In pre-menopausal women, estrogen reduces risks of weak bones and heart disease. [12]

Raloxifene is FDA approved. This pill is used to reduce breast cancer risk in post-menopausal women. It is also approved for helping to prevent bone weakening and osteoporosis. There was a study done that shows that raloxifene did not prevent the risk of non-invasive breast cancers as well as tamoxifen did. [13]

Side effects include blood clots, uterine cancers, hot flashes, vaginal dryness, vaginal irritation, flu-like symptoms, leg cramps, swelling of hands or feet, and strokes. [14]

Benefits include improved bone strength and reduced risk of osteoporosis.

Aromatase inhibitors are not FDA approved for prevention of breast cancer. These inhibitors reduce the amount of estrogen that the body produces, depriving cancer cells of getting their food to grow. These are commonly used after surgery to prevent recurrence. Aromatase inhibitors are only used for postmenopausal women.

Side effects include hot flashes, headache, joint and muscle pain, and vaginal dryness.

Risks include broken bones and osteoporosis.[15]

See also

References

  1. ^ "Inflammatory Breast Cancer: Questions and Answers". National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/IBC. Retrieved 2006-12-02.  
  2. ^ "Inflammatory breast cancer". Mayo Foundation for Medical Education and Research. http://www.mayoclinic.com/health/inflammatory-breast-cancer/DS00632. Retrieved 2006-12-02.  
  3. ^ "Facts for Life - Inflammatory Breast Cancer" (PDF). Susan G. Komen for the Cure. http://www.komen.org/stellent/groups/public/@dallas/documents/-komen_site_documents/dsbcinflammatory.pdf. Retrieved 2006-12-02.  
  4. ^ Wingo, Phillis. "Population-based statistics for women with inflammatory breast cancer (United States)." Cancer Causes and Control 15 (2004): 321-28
  5. ^ 11) Gordon, Lisa. "Picture This." CLINICAL JOURNAL OF ONCOLOGY NURSING 5 (2001). EBSCO. Academic Search Complete. 02 Apr. 2009
  6. ^ "Inflammatory Breast Cancer Help—Signs and Symptoms." Inflammatory Breast Cancer Association. 02 Apr. 2009 <http://www.ibchelp.org/symptoms/>
  7. ^ "Diagnosis and Staging of Inflammatory Breast Cancer." BreastCancer.org—Breast Cancer Treatment Information and Pictures. 15 Apr. 2009 <http://www.breastcancer.org/symptoms/types/inflammatory/diagnosis_staging.jsp>
  8. ^ "Inflammatory breast cancer;breast cancer treatment;IBC;breast cancer - nccn.com." National Comprehensive Cancer Network - nccn.com. 13 Apr. 2009 <http://www.nccn.com/inflammatory_breast_cancer.aspx>
  9. ^ "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>
  10. ^ "Can you take a tablet to stop you getting breast cancer?: Cancer Research UK: CancerHelp UK." Homepage: Cancer Research UK: CancerHelp UK. 02 Apr. 2009 <http://www.cancerhelp.org.uk/help/default.asp?page=411>
  11. ^ "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living—MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>
  12. ^ "Can you take a tablet to stop you getting breast cancer?: Cancer Research UK: CancerHelp UK." Homepage: Cancer Research UK: CancerHelp UK. 02 Apr. 2009 <http://www.cancerhelp.org.uk/help/default.asp?page=411>
  13. ^ "ACS :: Medicines to Reduce Breast Cancer Risk." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. 02 Apr. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Tamoxifen_and_Raloxifene_Questions_and_Answers_5.asp>
  14. ^ "ACS :: Medicines to Reduce Breast Cancer Risk." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. 02 Apr. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Tamoxifen_and_Raloxifene_Questions_and_Answers_5.asp>
  15. ^ 6) "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>

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