• Inflammatory Breast Cancer

    (IBC; Inflammatory Carcinoma of the Breast; Inflammatory Breast Carcinoma)

    Definition

    Inflammatory breast cancer (IBC) is a rare form of breast cancer . Cancer is the uncontrolled division and growth of cells. As the cancer cells grow, they crowd out healthy cells and interfere with normal body processes. In most cases, the cell growth forms a mass (ie, tumor). However, IBC cells grow in more of a sheet-like shape.
    IBC is an aggressive form of cancer that can be hard to detect. It may look like mastitis , which is simply inflammation of the breast. Early diagnosis and treatment are important. The sooner treatment is started for IBC, the more favorable the outcome.
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    Causes

    The exact cause of IBC and all breast cancers is not known.

    Risk Factors

    The average age for women with IBC (59 years old) is lower than that of women with other breast cancers. African American women also have a slightly higher risk of IBC.
    Some factors that increase your risk for any type of breast cancer include:
    • Being a woman (Men can also get breast cancer.)
    • Personal history of breast cancer
    • Family members with breast cancer
    • Changes in breast tissue
    • Changes in certain genes
    • Increased exposure to estrogen over a lifetime through:
      • Starting menstruation at an early age
      • Starting menopause at a later age
      • Not having children or having children later in life
      • Not breastfeeding
      • Taking hormone replacement therapy for long periods of time (eg, Prempro for more than four years)
    • Tobacco use
    • Increased breast density
    • Radiation therapy before the age of 30 years
    • Overuse of alcohol
    Note: Studies show that most women with known risk factors do not get breast cancer. Many women who get breast cancer have none of the risk factors listed above.

    Symptoms

    If you have any of these symptoms, do not assume it is due to IBC. These symptoms may be caused by other conditions. As the IBC cells get into the skin and lymph ducts they may cause signs and symptoms such as:
    • Rapid change in the size, shape, or feel of one breast (can occur over days or weeks)
    • Discoloration of the breast; breast may appear red, purple, pink, or bruised
    • An area of the breast that looks like the skin of an orange
    • Thickened areas of skin
    • Breast feels warm to the touch
    • Changes in the nipple, such as flattening, turning in, retracting, or areola color change
    • Enlarged lymph nodes under the arm or above or below the collarbone
    • Itching
    • Breast pain
    Some of these symptoms are similar to a condition known as mastitis . However, mastitis should respond to treatment . If it does not, talk to your doctor again right away.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will also be done. Since IBC develops in a sheet-like pattern instead of lumps, it is hard to find by a breast exam or mammogram .
    If your doctor suspects IBC, she may order:
    • Biopsy (excisional or skin)—a sample of tissue is removed and examined for cancer cells
    • PET scan —to look for any sign of the cancer outside of the breast
    If cancer is detected, the cancerous tissue will also be tested to look for:
    • Hormone receptors
    • HER2 gene—suggests an aggressive form of cancer

    Treatment

    Cancer treatments vary from person to person. Talk with your doctor about the best plan for you. The goal is to treat the IBC locally and to prevent it from spreading and recurring. Common treatment options include the following:

    Chemotherapy

    Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs travel through the body in the blood, killing mostly cancer cells. Some healthy cells are killed as well. Chemotherapy drugs for IBC may include:
    • Anthracyclines (eg, doxorubicin or epirubicin )
    • Taxanes (eg, paclitaxel or docetaxel )
    • Antimetabolites (eg, capecitabine )

    Surgery

    The timing of surgery can be an important factor in the outcome. Surgical options may include:
    • Lumpectomy (may also be called tylectomy or quadrantectomy)—removal of the breast cancer and some normal tissue around it (Often, some of the lymph nodes under the arm are also removed.)
    • Segmentectomy—removal of the cancer and a larger area of normal breast tissue around it
    • Simple mastectomy —removal of the breast, or as much of the breast as possible (The surgeon will try not to remove lymph nodes.)
    • Radical mastectomy—removal of the breast, chest muscles, the lymph nodes under the arm, and some additional fat and skin (This procedure is only considered in rare cases. It is done if the cancer is found in the chest muscles.)
    • Modified radical mastectomy—removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles
    Some surgical procedures may also be done to determine if the cancer has spread:
    • Axillary lymph node dissection—removal of the lymph nodes under the arm (This will help find any cancer cells that have entered the lymphatic system.)

    Radiation

    Radiation therapy is the use of radiation to kill cancer cells. Two main types of radiation may be used:
    • External radiation therapy—radiation directed at the breast from a source outside the body
    • Internal radiation therapy—radioactive materials placed into the breast in or near the cancer cells

    Other

    There are other factors about your specific type of cancer that can affect treatment such as:
      Hormone receptors—some cancers have hormone receptors attached to them. Certain drugs can target these receptors to help control or eliminate the cancer. This hormone therapy may include drugs such as:
      • Tamoxifen
      • Aromatase inhibitor
      HER2—Cancers with the HER2 gene tend to be more aggressive. Drugs that may be effective against HER2-positive cancer include:
      • Trastuzumab (Herceptin)
      • Lapatinib (Tykerb)

    Prevention

    It is important to catch IBC as early as possible. If you have any of the symptoms listed above, see your doctor right away. If you are being treated for mastitis that is not responding to treatment, see your doctor again.
    Breast exams may help identify changes in your breast such as the “orange-peel skin” effect. For breast exams, the American Cancer Society recommends:
    • Women aged 20 or older may perform a breast self-exam (BSE) every month. Report any changes to your doctor right away.
    • Women aged 20-39 should have a clinical breast exam by a health professional every three years. Starting at age 40, women should have a clinical breast exam every year.
      • A breast exam should be done more regularly if there is a family history or there have been previous breast biopsies.

    RESOURCES

    Breast Cancer.org http://www.breastcancer.org/

    Inflammatory Breast Cancer Research Foundation http://www.ibcresearch.org/

    National Cancer Institute http://www.cancer.gov/cancertopics/types/breast

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Women’s Health Matters http://www.womenshealthmatters.ca/

    References

    Breast cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 2009. Accessed August 7, 2009.

    Inflammatory breast cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F6X%5FInflammatory%5FBreast%5FCancer.asp . Accessed August 6, 2009.

    Inflammatory breast cancer. National Breast Cancer Foundation website. http://www.nationalbreastcancer.org/about-breast-cancer/inflammatory-breast-cancer.aspx . Accessed August 7, 2009.

    Inflammatory breast cancer: questions and answers. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/sites-types/ibc. reviewed 8/29/2006 . Accessed August 6, 2009.

    LaRusso L. Breast cancer. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated February 2009. Accessed August 7, 2009.

    Symptoms. Inflammatory Breast Cancer Research Foundation website. Available at: http://www.ibcresearch.org/symptoms/ . Accessed August 6, 2009.

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