Inflammatory breast cancer symptoms, diagnosis and treatments

Inflammatory breast cancer is an accelerated form of breast cancer that is usually not detected by mammogram or ultrasound.

It is a rare cancer, accounting for approximately 1% to 3% of all breast cancers. Inflammatory breast cancer causes the breast to appear swollen and inflamed. The inflammation occurs because the cancer cells block the lymphatic vessels in the skin of the breast. This causes a blockage in lymph flow leading to the reddened, inflamed appearance to the breast.

What are the symptoms of inflammatory breast cancer?

Unlike the more common form of breast cancer, inflammatory breast cancer does not generally present itself as a lump. The disease grows as nests or sheets that clog the lymph system under the skin. Often the symptoms are attributed to other diseases and   diagnosis may take a long time to occur.

Symptoms include:

• Pain in the breast. Often inflammatory breast cancer is mistaken as a breast infection and treated with antibiotics. If response to antibiotics doesn't occur after a week, request a breast biopsy or referral to a breast specialist.
• Skin changes in the breast area. You may find pink or reddened areas often with the texture and thickness of an orange (peau d'orange).
• A bruise on the breast that doesn't go away.
• Sudden swelling of the breast.
• Itching of the breast.
• Nipple retraction or discharge.
• Swelling of the lymph nodes under the arm or in the neck.

These changes often occur quickly, over a period of weeks.

How is inflammatory breast cancer diagnosed?

Inflammatory breast cancer is often misdiagnosed as another medical condition. It's important to pursue a breast or skin biopsy if treatments for another breast condition like an infection don't work.

How is inflammatory breast cancer treated?

Inflammatory breast cancer is an aggressive cancer that can spread quickly. Treatment options include:

• Surgery. If the inflammatory breast cancer has not spread beyond the breast, a mastectomy can be performed to remove the tumour. However, mastectomy has been known to increase the chance of recurrence because inflammatory breast cancer involves the lymph nodes of the skin - and the skin is stitched together after mastectomy.
• Chemotherapy (anti-cancer therapy). This is often given before surgery (neoadjuvant therapy) to reduce the amount of tumour present and decrease the recurrence risk.
• Radiation. Often radiation is given after chemotherapy and/or surgery
• Hormone therapy. If the cancer cells have oestrogen receptors on their surface, you may be offered a hormonal treatment. Hormone therapy is designed to slow or stop the growth of cancer cells which are sensitive to circulating hormones.
• High dose chemotherapy/bone marrow transplant. Researchers are studying whether giving high doses of chemotherapy, followed by bone marrow or stem cell transplantation is effective for treating inflammatory breast cancer.
• Trastuzumab. This is one of a new group of drugs called monoclonal antibodies. Trastuzumab works by blocking a protein called HER2 which allows cancer cells to grow and divide. Trastuzumab only works in tumours which have high levels of the protein HER2 (these tumours are known as HER2 positive). You can be tested for this protein: about 60% of people with inflammatory breast cancer are HER2 positive.