Inflammatory Breast Cancer

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Overview

Inflammatory Breast Cancer (IBC) is an aggressive type of breast cancer, wherein the lymph arteries in the breast surface are obstructed by cancer cells. Because the breast is commonly swollen and red or inflamed, this type of breast cancer is called “inflammatory”. Inflammatory breast cancer accounts for only 5% of all breast cancer cases.

The majority of inflammatory breast cancers are invasive ductal carcinomas, meaning they began as cells lining the milk ducts of the breast and gradually spread beyond them.

The disease progression is rapid, and in many cases, it takes just a few weeks or months to become advanced. Depending on the extent of the spread, inflammatory breast cancers are often diagnosed in stage III or IV at the time of diagnosis.

Inflammatory breast cancer also exhibits the following characteristics:

In comparison to other breast cancers, inflammatory breast cancer is detected at a younger age.
This breast cancer type is more prevalent among obese women than in women of normal weight.
Inflammatory breast cancers are usually hormone-negative. It cannot be treated with hormone therapy that interferes with the proliferation of cancer cells driven by oestrogen.
Inflammatory breast cancer can affect men, much like other types of breast cancer, but normally at a later age than in women.

Symptoms

Inflammatory breast cancers progress quickly and are associated with a few symptoms. It is important to note that these symptoms could be associated with other breast cancer types as well. However, no symptom should be ignored. Following are the symptoms of inflammatory breast cancer:

Swelling and redness in the breast
The skin may have ridges or a pitted-like appearance
Heaviness, fullness, burning, or discomfort in the breast
A flattened or inverted nipple (facing inward).
Breast having red, purple, pink or bruised appearance
Presence of swollen lymph nodes in the regions of armpit, collarbone, or both
The affected breast may have unusual warmth
A sudden increase in breast size
Presence of a solid tumour that can be felt during the clinical examination

Courses

IBCs arise from abnormal cells in one of the breast’s ducts. These cells tend to divide quickly, infiltrate and obstruct the lymphatic veins in the breast surface. The red veins, puffy appearance and dimpled skin are caused by this obstruction. Inflammatory breast cancer seems to have no identifiable cause. However, a few key risk factors have been identified:

Gender: Inflammatory breast cancers are more prevalent among women than men.
Age: IBCs are reported in higher numbers among younger women.
Ethnicity: Inflammatory breast cancers are found to be more common among women of African-American ethnicity.
Obesity: Obese women are at a higher risk of developing inflammatory breast cancer.
Family History: Those with a positive family history of inflammatory breast cancer have a higher risk of developing the disease.

Diagnosis

In most cases, women diagnosed with inflammatory breast cancers have dense breast tissues, and this makes screening or testing through mammography challenging. Also, inflammatory breast cancer being aggressive can arise between scheduled screening mammograms and progress rapidly. The symptoms could also be pointing towards other breast cancer types or a different medical condition. Therefore, women must not ignore any symptoms and must immediately meet their physician if they feel something is abnormal.

a. Physical Exam: The doctor checks the breast for evidence of inflammatory breast cancer such as redness and other symptoms.

b. Mammogram: A screening test that creates an image of the inside of the breast using low-energy X-rays.

c. Imaging Tests: Imaging test methods such as PET/CT, MRI, ultrasound, etc., are employed in the diagnosis of breast cancer. Along with the diagnosis, PET/CT scans may also help in staging, treatment planning, therapy monitoring, etc.

d. Biopsy: During the biopsy, a tissue sample is collected from the suspected area and examined under a microscope for the presence of cancer cells. A biopsy is used to get a definitive diagnosis of the condition.

e. Bone Scan: If bone metastasis is suspected, a bone scan may be recommended.

Treatment

To minimise the size of the tumour, inflammatory breast cancer is usually treated with systemic chemotherapy initially. The tumour is then removed via surgery. Radiation is used after surgery to eradicate any remaining cancer cells. Just like other cancers, inflammatory breast cancer cases are found to have higher survival rates if treated with a multimodal approach. Following are the treatment options available for the management of inflammatory breast cancer:

a. Chemotherapy: Chemotherapy is usually administered right before the surgery (neoadjuvant therapy) and the course may go on up to 6 months, which will then be followed by the surgery. It may also be recommended after the surgery (adjuvant therapy) to bring down the risk of a relapse. Chemotherapy is also helpful in the management of IBC that has metastasised to nearby organs. It is also recommended as a part of palliative care.

b. Targeted therapy: Targeted therapy is devised based on the specific proteins on the surface of the cancer cells, specific genes and the tumour environment. Since inflammatory breast tumours create more HER2 protein than usual, targeted therapy against this protein may be recommended to treat the condition. Anti-HER2 therapy can be used as a neoadjuvant treatment or adjuvant treatment.

c. Hormone Therapy: Hormone therapy is another treatment option if the cells of a woman’s inflammatory breast cancer contain hormone receptors. Estrogen-dependent cancer cells can be made to stop growing and die by drugs that prevent estrogen from attaching to its receptor and aromatase inhibitors, which inhibit the body’s ability to manufacture estrogen.

d. Surgery: A modified radical mastectomy is the typical procedure for inflammatory breast cancer. The entire afflicted breast, as well as most or all of the lymph nodes under the neighbouring arm, are removed in this procedure. The lining over the underlying chest muscles is usually removed as well, but the chest muscles are left intact. However, the smaller chest muscle (pectoralis minor) may be excised in some cases.

e. Radiation therapy: Multimodal therapy includes post-mastectomy radiation therapy to the chest wall under the breast that was excised. Radiation therapy destroys any remaining cancer cells and reduces the risk of recurrence.

Frequently Asked Questions

1. Are inflammatory breast cancers treatable?

Yes, today, we can treat inflammatory breast cancers with positive clinical outcomes just like other breast cancer types. Treatment planning includes chemotherapy, surgery, radiation therapy, targeted therapy and hormone therapy.

Just like every other cancer, early detection increases the chances of successful health outcomes. Therefore, it is important for women to not ignore any symptom that lasts for more than two weeks.

2. Can inflammatory breast cancers be detected through mammography?

Not all inflammatory breast cancers can be detected through mammography. This is because IBCs usually don’t present themselves as lumps, like other breast cancers. IBCs present themselves as rashes usually and can be easily confused with an infection.

Another probable reason why mammography misses IBCs is that there is very little time between the disease initiation and the state where the cancer is fully blown. Dense breast tissue among a few women is one more reason why mammograms may miss inflammatory breast cancers.

3. How quickly can I have my breast reconstruction surgery after my IBC treatment?

Immediate reconstruction is usually not recommended after inflammatory breast cancer treatment. As this cancer type affects the skin and the radiation also damages the skin tissue, at least a gap of 6 months is recommended between the IBC surgery and breast reconstruction.