Inflammatory breast cancer (IBC) results from cancer cells blocking the lymph vessels in the breast skin. IBC is rare and a very destructive disease. It is called inflammatory because the breasts swell and turn red. IBC is responsible for approximately 1-5% of all diagnoses of breast cancer in the USA. Most of the IBCs are invasive ductal carcinomas, indicating that cells make them within the lining of the breast’s milk ducts and spread beyond them. Cancer progresses swiftly within weeks or months. Diagnosis of inflammatory breast cancer is difficult. When diagnosed, it is already stage III or IV. It depends on whether the cells have spread to the nearby lymph nodes or other tissues. Diagnosed at stage III or IV makes it life-threatening. However, it is not impossible to diagnose and treat it. The treatment has to be aggressive.
Other features of inflammatory breast cancer are;
- The diagnosis stage is at a younger age than other breast cancer types.
- IBC is relatively more prevalent in African American women and less in white women.
- One cannot treat Inflammatory breast tumors with hormone therapies as they are frequently hormone receptor-negative. Examples of hormone therapies include tamoxifen, which interferes with the growth of cancer cells fueled by estrogen.
- IBC is more common in women who are far above the recommended healthy weight for their height and age.
Symptoms
Symptoms of IBC include redness (erythema) and swelling (edema) affecting the breast. The skin may even appear purple or bruised. Additionally, the skin may also become pitted like an orange. The symptoms result from fluid (lymph) accumulation in the breast skin. It occurs due to cancer cells blocking the lymph vessels in the skin. It prevents the regular flow of lymph into the area it should be going to. The breast might sometimes contain a solid tumor that a doctor might feel in a physical examination; however, most of the time, they cannot even feel it.
Another symptom of IBC includes an immediate increase in the size of the breast, along with heaviness, tenderness, or burning. A nipple might invert (face inwards). Moreover, there may be swollen lymph nodes under the arm near the collarbone. However, it is also important to note that these conditions can also be symptoms of other diseases, like any injury, infection, or other types of breast cancer. It is why the diagnosis of IBC is late.
Diagnosis
A very common question patients ask is; how I knew I had inflammatory breast cancer. An inflammatory breast cancer diagnosis is not easy. During the physical check-up, the doctor may not feel any lump. It might not be seen in a screening mammogram. Additionally, the majority of women diagnosed with IBC have dense breast tissue. It makes the diagnosis even more difficult during a screening mammogram. Mammography specialists can even miss the diagnosis of inflammatory breast cancer or confuse it with any other disease like mastitis, which is also a breast infection. Since how to diagnose IBC has been a very important question, a panel of international experts recommended doctors diagnose and stage IBC correctly.
The points below encompass the base criteria for IBC diagnosis;
- A fast spread of redness and swelling and the pitted skin or abnormal breast warmth either with or without a lump.
- The symptoms above have been for 6 months or less.
- The redness covers at least three-fourths of the breast.
- There is an invasive carcinoma in the initial biopsy samples.
One can further investigate it from the tissue in the affected breast, which should include testing if cancer cells have hormone receptors or if the amount of the HER2 gene and HER2 protein is higher than normal. If yes, it means HER2-positive breast cancer.
Diagnosis includes imaging and stage testing through;
- An ultrasound and a diagnostic mammogram of the breast and lymph nodes in the surrounding area.
- A CT scan, a PET scan, and a bone scan determine whether the cancer has reached other body parts.
Diagnostic Center for Women does all these tests. Once diagnosed, doctors can create the most viable management strategy and estimate the consequences of the illness. Patients with IBC must consult a specialist in this disease.
Breast Imaging Tests
Diagnostic Mammography
It is an x-ray to create an image of the body’s internal structure to see what is behind the skin. It uses a small amount of radiation and is similar to screening mammography, also used to see for a breast tumor, if any, in people having no symptoms. Specialists use diagnostic mammography when an individual is experiencing signs like a lump or nipple discharge. It is also used in case any anomalous thing is found during a mammogram.
Ultrasound
The image of the breast tissue is created through high-frequency sonic waves. It can segregate between a solid mass and a fluid-filled cyst. A solid mass may be cancer, while a cyst is not cancer.
Magnetic Resonance Imaging
MRI uses magnetic fields to create detailed body images. It can be utilized to evaluate the size of the tumor. A special dye is given, called a contrast medium, into the patient’s vein before the scan to assist in developing a clear picture of possible cancer. Breast MRI is used once breast cancer is diagnosed to check the spread of the disease. It can also be used for screening along with mammography for the ones with a high risk of breast cancer development.
Surgical Tests
Biopsy refers to removing a small tissue for investigation through a microscope. Other tests can indicate that the patient has cancer. However, only a biopsy can make sure. A pathologist then assesses the sample. A pathologist refers to a doctor who specializes in understanding the laboratory tests and assessing cells, organs, and tissues to diagnose the disease. Various kinds of biopsies are categorized by method or needle size to gather the sample of the tissue. The types of biopsies are fine needle aspiration biopsy, a core needle biopsy, skin biopsy, surgical biopsy, image-guided biopsy, and Sentinel lymph node biopsy.
Analyzing The Biopsy Sample
Assessing the sample removed during the biopsy assists the doctor in learning about specific characteristics of cancer and identifying treatment options.
Tumor features. Investigation of the tumor through a microscope is used to determine if it is invasive and has gone to the lymph nodes, which means cancer has spread. IBC is always invasive.
ER and PR. ER and PR Testing assists in determining both types of treatment and the probability of reoccurrence. The type of treatment determined would be the one that minimizes the risk of reoccurrence. IBC is usually ER/PR negative. On the other hand, other inflammatory breast cancers are ER/PR positive.
HER2. The status assists in determining whether drugs targeting the HER2 receptor play a role in treating cancer. IBC is often HER2 negative; however, it can have these receptors sometimes.
Blood Test
To learn more about the patient’s health, doctors might also need blood tests;
- The complete blood count is a test to measure the number of various types of cells like white blood cells and red blood cells in the blood sample. The purpose is to evaluate the functioning of the bone marrow.
- Serum chemistry tests are conducted to see minerals in the blood, like sodium and potassium. They also assess the kidney and liver health and functioning.
- Blood tumor marker tests check the levels of serum tumor markers. A higher level may have various underlying causes, not necessarily cancer. The purpose is to look at the growth of metastatic breast cancer and symptoms and imaging tests. This test is unnecessary for individuals not showing symptoms of metastatic breast cancer.
Other Tests
Your consultant may suggest additional tests to ascertain the spread of cancer. It depends on various aspects, such as your medical history, disease growth, symptoms, and physical examination results. The tests include X-ray, bone scan, CT or CAT scan, and PET-CT scan.
After looking at the methods of IBC diagnosis, it can be established that it is not easy to diagnose it. After the tests are completed, the doctor reviews the results with the patient. The results are helpful in determining the spread of cancer in the body. It is called staging. Moreover, if there are suspicious areas other than breasts, at least one area should be biopsied if possible to determine cancer diagnosis.