What is Inflammatory Breast Cancer?

Inflammatory breast cancer is a particularly aggressive form of breast cancer that presents with symptoms of inflammation. In inflammatory breast cancer, rather than the cancer cells forming a lump, they grow along the lymph vessels in the breast causing them to become blocked.

The blocked vessels are then unable to drain fluid and filter out bacteria and waste materials and the breast becomes inflamed, giving rise to symptoms such as redness, heat, swelling and pain. As the cancer cells tend not to form a detectable tumor, the cancer is often missed on mammography or ultrasound screening.

Symptoms of inflammatory breast cancer

Symptoms of inflammatory breast cancer may develop rapidly, with sudden onset of the following:

• Redness across the breast
• Warm and swollen breast
• A raised or pitted appearance of the breast skin that resembles orange peel. This is called "peau d'orange."
• Pain in the breast
• Pain and discharge from the nipple

Diagnosis and treatment

Diagnosis is suspected based on the symptoms and is confirmed using other tests.

Biopsy is the only reliable method for confirming a diagnosis and is the most important test the doctor orders to diagnose inflammatory breast cancer. Small samples of the breast tissue are taken and sent to a laboratory for microscopic analysis. Samples may also be taken from the lymph nodes in the armpits.

A mammogram (breast X-ray) may be used to check for changes in the breast and also to examine the other breast. Additional imaging studies such as a magnetic resonance imaging (MRI) scan or an ultrasound scan may be recommended in certain situations.

Once diagnosis is confirmed, the cancer is staged, to determine the extent of the cancer. Staging is important in predicting the probable patient outcome and therefore the optimal treatment approach.

The breast cancer is staged using a staging system comprising four stages, numbered one to four. The number refers to the size and extent of the cancer, with stage 4 representing the most severe disease. As inflammatory breast cancer is quick to develop, it is never detected at stage 1 or 2, as cancers that initially present with a lump may do.

Instead, by time this cancer is diagnosed, it usually involves the whole breast, the breast skin and may or may not have spread into surrounding muscle tissue or lymph nodes in the armpit. Inflammatory breast cancer is therefore usually categorized as stage 3 by time it is diagnosed.

Inflammatory breast cancer spreads rapidly compared with other cancers. Treatment usually includes chemotherapy, followed by surgery and radiation therapy. This may then be followed up with other treatments such as hormonal therapy or biological therapy if tests suggest these may be beneficial.

During chemotherapy, an individual receives anti-cancer agents designed to destroy cancer cells, over 4 to 6 months. After chemotherapy, surgery is performed to remove the whole breast, nipple and the lymph nodes in the armpit. Radiotherapy is usually the next step, which uses high energy X-rays to destroy any remaining cancer cells.

Targeted therapy or biological therapies are drugs that recognize and attach to specific protein receptors present on cancer cells. For example, around 60% of women with inflammatory breast cancer have cancer cells that have a large amount of the HER2 receptor on their surfaces and this is called HER2-positive breast cancer.

A treatment called trastuzumab (Herceptin) is specifically designed to lock onto these HER2 receptors and prevent stimulation of their growth.

Another treatment option for some women is hormonal therapy. For example, tumors made up of cancer cells displaying estrogen receptors on their surfaces are called ER-positive breast cancers and their growth is stimulated by estrogen binding to the receptors.

These cancers can be treated with hormonal therapy to counteract the effects of estrogen, either by reducing the amount of estrogen made in the body or by preventing the estrogen from reaching the cancer cells.