Inflammatory breast cancer is a type of breast cancer in which cancer cells block lymph vessels in the skin of the breast, causing it to become red and swollen.
How is inflammatory breast cancer diagnosed?
Inflammatory breast cancer progresses very quickly, and at diagnosis, is considered either stage III or IV. Because there is often no lump present in the breast, this type of cancer can be difficult to diagnose through a physical examination or mammogram. Often, it is initially misdiagnosed as an infection of the breast or the overlying skin, like mastititis or cellulitis. The following symptoms are the minimum criteria for diagnosing inflammatory breast cancer: erythema (redness), edema (swelling), peau d'orange (ridged or pitted skin) in the affected breast, and/or abnormal breast warmth; the symptoms have been present for less than 6 months; the erythema covers at least a third of the breast; and initial biopsy samples from the affected breast show invasive carcinoma.
A doctor will perform a diagnostic mammogram of the affected breast and nearby lymph nodes, as well as a PET or CT scan and a bone scan, to determine if the cancer has spread to other parts of the body. Determining the stage of inflammatory breast cancer helps doctors determine the best possible treatment plan. Biopsied cells will be tested to determine whether the cancer is hormone receptor positive or HER2 positive.
How is inflammatory breast cancer treated?
Inflammatory breast cancer is typically treated with systemic chemotherapy to help shrink the tumor, then surgery to remove the tumor, then radiation therapy.
Neoadjuvant (pre-surgery) chemotherapy is given generally for six cycles over the course of 4–6 months. If the cancer is HER2 positive, a targeted therapy can be used to specifically target its cells with drugs like trastuzumab and pertuzumab. This type of treatment can be given as part of neoadjuvant (pre-surgery) therapy and after surgery. If cancer cells are hormone receptor positive, hormone therapy will be used; hormone therapies either block hormones from binding to their receptors, or block the production of that hormone, which causes the cancer cells to stop growing and die.
The type of surgery used to treat inflammatory breast cancer is typically a modified radical mastectomy. This surgery involves the removal of the entire breast, most or all of the lymph nodes under the adjacent arm, and sometimes the lining over the underlying chest muscles or the smaller chest muscle.
After surgery, doctors may radiate the chest wall under the removed breast. While breast reconstruction is an option post-surgery, many doctors recommend delaying reconstruction because of the importance of radiation therapy in treating inflammatory breast cancer.
Adjuvant (post-surgery) therapy, including chemotherapy, hormone therapy, targeted therapy, or some combination of those treatments, may be administered after surgery to reduce the chance of cancer recurrence.