Most forms of breast cancer are not obvious from the outside, as the tumor or lesion is buried deep inside the breast and in some cases can’t be felt. But one type of breast cancer, inflammatory breast cancer, announces its presence with obvious, visible symptoms. In cases of this aggressive yet rare form of cancer, about a third of the breast is swollen, red and inflamed-looking. The skin may look pitted, like the skin of an orange, and some patients look like they have a large bruise.
The bad news: This form of cancer is as harsh as the inflammatory name sounds. “It’s a very aggressive type of breast cancer that can have a high chance of metastasis,” says Dr. Nikita Shah, medical oncology team leader for the Breast Cancer Specialty Section and medical director of the Cancer Risk Evaluation Program at UF Health Cancer Center — Orlando Health.
[See: 7 Innovations in Cancer Therapy.]
The National Cancer Institute reports that IBC is uncommon, accounting for about 1 to 5 percent of all breast cancers in the United States. And while the skin symptoms are obvious, it can be tricky to diagnose because there’s often no easily detectible lump in the breast. It may not show up on a mammogram, the American Cancer Society reports, and it can sometimes be mistaken for a skin infection or other less serious condition.
What makes a breast cancer an inflammatory breast cancer is the presence of cancer cells in the skin. “It’s cancer that’s gone into the skin of the breast,” says Dr. Nicole Williams, assistant professor of medical oncology at the Ohio State University Wexner Medical Center. IBC can occur with any type of breast cancer, but Shah says it’s more likely to occur with estrogen- or progesterone-negative and HER2-positive breast cancer. These are cancers that don’t feed on estrogen or progesterone to grow. Therefore, hormone therapy may not be a viable option for treating these cancers.
This happens because the cancer has invaded the derma, or skin, by way of the network of lymphatic vessels in the breast, Shah says. These cells “kind of clog up the skin,” creating the characteristic “puckering of the skin that gives it that orange peel appearance,” she says. IBC cancers can start virtually anywhere within the breast, but they become IBC when the cancer invades the skin. This movement of cancer cells into the skin is not considered a metastasis per se, but it’s a sign of later-stage disease. The earliest stage at which IBC can be diagnosed is stage 3. The ACS reports that one in three cases of IBC will be diagnosed at stage 4, meaning the cancer has metastasized to other organs beyond the breast and nearby lymph nodes.
Williams says this type of breast cancer can affect anyone. “It tends to be diagnosed slightly more often in younger women, but we see it in older women.” It’s also slightly more common among young African American women than Caucasian women, but it’s unclear why this disparity exists. Obese women may also be at higher risk, the ACS reports.
Because it’s a later-stage cancer that progresses quickly, time is of the essence in diagnosing and treating the disease. For some patients, IBC may look like cellulitis, a common bacterial infection of the skin, or mastitis, a blocking and inflammation of milk ducts in the breast that can cause the breast to become red, swollen and warm to the touch. At first, these patients may be put on a “course of antibiotics, but then it doesn’t get better, and so they start a second course of antibiotics,” Shah says. “It may be a month or six weeks from when they noticed [the symptoms], so the doctor sends the patient for a mammogram. The mammogram is usually normal, so now another few weeks go by, and eventually they get sent to a surgeon for a biopsy. And sure enough, it’s inflammatory breast cancer.” This process can take eight weeks or more, and “sometimes eight weeks can make all the difference.”
[See: A Tour of Mammographic Screenings During Your Life.]
For this reason, Shah stresses that IBC “is a clinical diagnosis. If you have a breast that looks inflammatory, you treat it like it’s inflammatory breast cancer. You don’t have to have the skin biopsy that shows the dermal lymphatic involvement. If you have the clinical picture of an inflammatory breast cancer, you treat it like an inflammatory breast cancer,” which is a more aggressive treatment approach than what’s used with earlier-stage breast cancers.
Williams says if you notice any skin changes or swelling of the breast that lasts longer than a few weeks, “go see your primary care doctor or OB-GYN to make sure that they take a look at it so that it can be worked up. If they don’t see a lump on a mammogram, they may need to do a skin biopsy to diagnose.” This is typically done as a punch biopsy or excisional biopsy in which a small chunk of skin and tissue is removed from the breast and then examined in the lab to determine whether cancer is present. If cancer is found “along with a red, swollen breast, that would make the diagnosis of inflammatory breast cancer,” Williams says.
Once IBC has been diagnosed, the next step is to determine whether the cancer has spread, or metastasized. “So oftentimes we get a whole-body scan to make sure it hasn’t spread,” Williams says.
Whether it has spread or not, treatment begins with chemotherapy. Shah says that “100 percent of the time, patients get upfront chemotherapy. You want to control it locally to prevent it from spreading farther first. By bringing chemo up front, you’re not only killing the cells you can see, but you’re also killing the microscopic cells that you cannot see that are floating around in the blood.”
Chemotherapy is followed by a mastectomy, a surgical procedure in which the entire breast is removed. “The surgery always has to be a mastectomy, never a lumpectomy,” Shah says. “You want to remove all that skin.” Patients will undergo radiation treatment after surgery. Williams says in cases where the cancer is hormone-receptor positive, the patient may be given a hormone treatment such as tamoxifen or an aromatase inhibitor.
[See: What Not to Say to a Breast Cancer Patient.]
Because IBC is a later-stage, aggressive cancer, IBC is harder to treat and the prognosis for patients with IBC is worse than for patients with other types of breast cancer. That said, individual prognosis varies quite a bit depending on overall health, age, genetic factors and treatment protocol. The American Cancer Society reports the median survival rate for stage 3 IBC is 57 months (four years and nine months). The median survival rate for people with stage 4 IBC is 21 months (one year and nine months).
The risk of recurrence of this cancer is also high. But if there is any good news to be had with IBC, it’s that the recurrence rate drops over time. Shah says that recurrence will typically occur within the first few years and “the further out the patient goes, the less the risk of recurrence.”
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What Is Inflammatory Breast Cancer? originally appeared on usnews.com
