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Inflammatory breast cancer (IBC), also known as inflammatory breast carcinoma or inflammatory carcinoma of the Breast, is a subtype of breast cancer which can be difficult to detect and often does not feature breast lumps. It requires aggressive treatment and carries a high mortality.
Definition and staging
Due to its nature, IBC is automatically staged as Stage IIIb or IV (with the staging system being I-IV).
Signs and symptoms
Many of the signs and symptoms are similar to those of mastitis. Not all or even most of the signs and symptoms are necessary for inflammatory breast cancer to be diagnosed.
- Increase in breast size over a relatively short period of time (sometimes a cup size in a few days)
- Itching (or pruritus) that is unrelenting and unrelieved by medicated creams and ointments
- Erythema (pink, red, or dark-colored area) sometimes with peau d'orange (texture similar to the skin of an orange)
- Ridges and thickened areas of the skin
- What appears to be a bruise that does not go away
- Nipple flattening or retraction
- Nipple discharge - usually clear or bloody
- Breast has increased warmth to the touch compared to the other breast
- Breast is harder or firmer than usual
- Breast pain which is not cyclic in nature (may be constant or stabbing)
- Change in color and/or texture of the areola or aureole (the dark pigmented area surrounding the nipple)
- Swollen lymph nodes in the axillary (underarm) area or the supraclavicular (above the collarbone) area
Although a dominant mass is present in many cases, most inflammatory breast cancers present as diffuse infiltration of the breast without a well-defined tumor.
Diagnosis
IBC is often not detected by mammography or ultrasounds. Rather, it features diffuse denseness of the breast gland and pain, which leads to easy confusion with mastitis. According to many authorities, biopsy should be performed if supposed mastitis does not resolve with the use of antibiotics.
Treatment
Neoadjuvant chemotherapy
IBC requires quick, aggressive treatment with chemotherapy prior to surgery in order to reduce the size of the breast and eliminate other symptoms before surgery occurs in order to increase the chances of clear margins and a better prognosis. As a result, it is treated differently than more common types of breast cancer where surgery is often performed first.
Surgery
A Modified Radical Mastectomy (MRM) which includes the removal of the lymph nodes in the axilla as well as removal of the breast is usually performed for Inflammatory Breast Cancer.
Prognosis
IBC has a higher risk of recurrence than other types of breast cancer. It is the most aggressive of the various types of breast cancer, but an early diagnosis and quick initiation of treatment improves the chances of long-term survival. Chemotherapy is usually begun within days of diagnosis. With new and upcoming treatment protocols, there is continued increased incidence of long-term survival.
Screening and prevention
We have all been positively conditioned to the fact that when a woman discovers a lump in her breast she should go to the doctor immediately, BUT how many people know that YOU DON'T HAVE TO HAVE A LUMP TO HAVE BREAST CANCER. Mammograms and Ultrasounds are not enough. A biopsy is necessary for proper diagnosis.
Pathological anatomy
Inflammatory Breast Cancer usually grows in nests or sheets, rather than as a confined, solid tumor; and therefore, it can be diffuse throughout the breast with no palpable mass. The cancer cells can clog the lymphatic system just below the skin. Lymph node involvement is often assumed. Increased breast density compared to prior mammograms should be considered suspicious.
Support groups
IBC has been diagnosed in very young women, and many patient members of an international web-based support group for Inflammatory Breast Cancer are young women in their twenties and thirties. A surprising number of these young women were eventually diagnosed during pregnancy or during lactation (breast feeding). While young women normally are at lower risk for breast cancer, the fact that IBC is more aggressive than most forms of breast cancer and IBC has unique signs and symptoms, some of these young women have metastases (spread of the cancer) to distant sites (Stage IV) by the time a diagnosis is made.
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