Inflammatory breast cancer: Symptoms, diagnosis, and treatment

Inflammatory breast cancer is when cancer cells block the lymph vessels in the skin of the breast.

This rare and aggressive type of breast cancer is known as inflammatory breast cancer because the breast typically looks swollen, red, or inflamed.

Inflammatory breast cancer tends to be diagnosed at younger ages than other types of breast cancer. It accounts for just 1 to 5 of all breast cancers diagnosed in the United States.

Contents of this article:

1. Signs and symptoms
2. Diagnosis
3. Treatment
4. Support

Signs and symptoms

In most cases of inflammatory breast cancer, it is not possible to feel a solid tumor during a physical examination.

When someone has inflammatory breast cancer, the cancer cells block the lymph vessels in the skin of the affected breast. This means that lymph fluid, in which white blood cells are transported, is unable to flow normally through the breast tissue.

When cancer cells block the lymph vessels, white blood cells are unable to flow properly through the breast tissue.

This causes symptoms that are visible on the skin, such as:

• swelling and redness of a third or more of the breast
• bruised appearance of the breast
• skin that looks "pitted," resembling the appearance of orange skin

The affected breast may also:

• rapidly increase in size
• feel like it's burning
• feel tender
• feel heavy
• have an inward facing nipple (inverted nipple)

The lymph nodes under the arm or near the collarbone may also become swollen.

It is important to remember that these symptoms may also be signs of infections, injuries, or other diseases including other types of breast cancer.

Diagnosis

Diagnosis of inflammatory breast cancer can sometimes take a long time because the symptoms can be confused with other conditions.

There is often no identifiable lump that can be felt in a physical examination, or seen in a mammogram (an X-ray picture of the breast). This makes inflammatory breast cancer difficult to diagnose.

To help women who may have inflammatory breast cancer get diagnosed more quickly, an international panel of experts has agreed minimum criteria for diagnosis.

These are:

• redness
• swelling of the breast
• ridged or pitted skin

The symptoms must have appeared within 6 months and cover at least a third of the breast. A doctor will also take a biopsy from the affected breast, which will show whether there are cancer cells in the tissue.

To see how far the cancer has progressed, the doctor may order a mammogram or ultrasound imaging of the breast. These tests look at the breast tissue and the lymph nodes. A scan of other parts of the body can also show if the cancer has spread beyond the breast.

Treatment

There are a number of stages of treatment that can be used in combination to treat inflammatory breast cancer.

Chemotherapy

Chemotherapy may last for several months before the tumor is contained enough to operate on.

Chemotherapy can help to shrink inflammatory breast tumors, which are then removed by surgery. Radiation therapy is given afterward to try to kill any remaining cancer cells in the breast.

Chemotherapy may last for 4-6 months before the tumor is operated on. If the disease continues to progress, then chemotherapy may last for longer and surgery will be delayed.

Surgery

Ideally, by the end of chemotherapy, the tumor will have shrunk and the inflammation will have gone down. Even if the tumor has only shrunk by a small amount, surgery may be performed.

If there has been no change in the size of the tumor, then the doctor may recommend proceeding straight to radiation therapy. This is to try to shrink the tumor and maintain a "buffer" of healthy tissue around the cancer.

Surgery for inflammatory breast cancer usually involves removing the affected breast and most, or all of the lymph nodes under the arm adjacent to it.

With less aggressive cancers, it is sometimes possible to remove only part of the breast. However, because this type of cancer is aggressive and progresses quickly, doctors will not usually recommend this.

Breast reconstruction

Breast reconstruction is an option for most women who have had inflammatory breast cancer. However, doctors may recommend waiting months, or even years after treatment before considering this.

Radiation

After chemotherapy, the DNA of cancer cells is damaged. This means they are unable to heal in the way normal cells do.

To take advantage of the weakened state of the cancer cells, doctors will use radiation therapy to target any remaining cancer cells.

Radiation therapy can be used to target the remaining cancer cells in the body after chemotherapy.

Radiation therapy can be targeted at very precise areas. However, the treatment causes damage to every cell it touches, so treatments are spread out over a number of weeks.

The damage caused by radiation therapy is cumulative. This means areas of the body that have been targeted by radiation should not be retreated if possible.

If the cancer comes back in the same place radiation therapy may be used again, if there is no better alternative.

To try to prevent the cancer returning, an additional combination of chemotherapy, hormone therapy, or targeted therapy may be recommended.

New therapies

There are many new therapies currently being developed to treat inflammatory breast cancer. The most promising of these focuses on genes and the role played by the immune system.

Experts think that in the coming decades, there may be vaccines available that can help. These would mobilize the immune system to defend the body against cancer cells, or weaken cancer cells so that chemotherapy drugs can be more effective against them.

Support

Healthcare providers specializing in inflammatory breast cancer, such as the Dana-Farber Cancer Institute, offer family-centered care.

People with inflammatory breast cancer should ask their doctor about the local options for support and complementary therapies.

These programs include support and complementary therapies beyond clinical care, such as massage and acupuncture.

There are also patient organizations that support people with inflammatory breast cancer. One example is The IBC Network Foundation, which was founded by a survivor of the disease.

The IBC Network Foundation:

• runs support groups
• provides information about the disease
• raises awareness among the general public
• funds research into the disease

There is plenty of support available for people with inflammatory breast cancer. To find out more about what is available locally, people can discuss this with their doctor.

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