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Rhihas

Joined 22 April 2009

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Rhihas

Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). It gets it name because of the breast looking red and swollen. It is unique because it often does not present with a lump and therefore often is not detected by mammography or ultrasound.[3] IBC only makes up 1-6% of all breast cancer cases in the USA.[4] IBC is usually diagnosed in younger women average age of 57 years old. African Americans are usually diagnosed at younger ages than Caucasian women and also have a higher risk of getting IBC. [5]

Symptoms

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Inflammatory Breast Cancer (IBC) causes changes in the nipple and the surrounding areas. Invasion of the local lymphatic ducts impairs drainage and causes edematous swelling of the breast. Because the skin of the breast is tethered by the suspensory ligament of Cooper, the accumulation of fluid causes the skin of the breast to assume a dimpled appearance reminiscent of the peel of an orange (peau d'orange). IBC often initially resembles mastitis, and is sometimes misdiagnosed as an insect bite or breast infection. In the case of IBC a lump is usually not present as in other forms of breast cancer. Symptoms to look for are:

  • Pain in the breast
  • Skin changes in breast
  • Reddened area with texture and thickness of an orange (peau d’orange)
  • Bruise that does not go away
  • Sudden swelling of the breast
  • Itching of breast
  • Nipple retraction or discharge
  • Swelling of lymph nodes under the arm or in the neck
  • Flattened or turned inward of the nipple
  • Unusual warmth of the affected breast
  • Breast is harder or firmer

Rare symptoms include:

  • Swelling of the arm
  • Breast decreases instead of increasing
  • Although a dominant mass is present in many cases, most inflammatory cancers present as diffuse infiltration of the breast without a well-defined tumor.
  • A lump may become present and grow rapidly


Most patients do not experience all the symptoms of IBC. All symptoms do not need to be present in order to be diagnosed. [6]

Diagnosis

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Inflammatory breast cancer is difficult to diagnose because it is rare and has not been studied as well as other forms of breast cancer. IBC usually is not detected by a mammogram or ultrasound like most breast cancer cases. (4) A doctor’s diagnosis involves a review of lab tests, family history, X-rays and any other form of medical history. A biopsy or and/or a PET scan are the most accurate ways for doctors to diagnose IBC. (3) A chest x-ray, bone scan and CT scan are used to determine the staging. (2)

Staging

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Staging is based on the size of the tumor and if it has spread beyond the breast. It is also based on if the cancer is invasive or non-invasive. Staging is designed to help organize the different treatment plans and to understand the prognosis better. IBC has three different staging groups:

  • Stage IIIB means the cancer has spread to tissues near the breast, such as the skin or chest wall, including the ribs and muscles in the chest. The cancer may have spread to lymph nodes within the breast or under the arm.
  • Stage IIIC means the cancer has spread to lymph nodes beneath the collarbone and near the neck. The cancer also may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
  • Stage IV means that the cancer has spread to other organs. These can include the bones, lungs, liver, and/or brain, as well as the lymph nodes in the neck. [7]

Treatment

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Chemotherapy: Most commonly used treatment. Chemotherapy is used to kill cancer cells and shrink the tumor size. It can be used before and after surgery.

Radiation therapy: often used after a mastectomy, it uses high-energy beams to kill cancer cells. Afterwards you may have some side effects like swelling and redness of the breast.

Hormone therapy: this is used in when patients test positive for estrogen and/or progesterone receptors on tumor cells. Hormone therapy is given after surgery and chemotherapy are completed. This is often given for 5 years.

Surgery: a mastectomy with lymph node surgery is highly recommended for women with IBC. a lumpectomy, when a portion of the breast is removed is not an option for IBC patients. Lymphodemia, swelling of an arm and hand on side of body where surgery was done, could be a side effect of a mastectomy. Reconstruction of the breast may be an option performed after a mastectomy. This is recommended for healthy women, if you smoke or have diabetes complications are more likely.[8]

Prevention

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Chemoprevention is a way you can help reduce chances of women getting breast cancer. Two common types of medicine used are: tamoxifen and raloxifene. [9]

Tamoxifen is a FDA approved. Tamoxifen reduces the effects estrogen which influences breast tumor growth in women 35 and over. It is used in patients who have had breast cancer to prevent recurrence. It was shown to improve the risk of recurrence. Trials have been done worldwide to see if tamoxifen would work with women who did not have cancer but had a high risk of getting it. Studies show that it lowered the women’s risk by one-third. It also showed that the women where still at low risk five years after they stopped taking the pill.

Side effects include: menopausal symptoms, weight gain, life threatening blood clots, cancer of the womb lining for post-menopausal women [10] bladder and urinary problems, vaginal discharge, vaginal dryness, nausea and menstrual irregularities, strokes, cataracts, Endometrial cancer or uterine cancer. [11]

Some benefits of tamoxifen include: lower cholesterol for post menopausal women, keeps bones healthy and strong. In pre-menopausal women oestrogen reduces risks of weak bones and heart disease. [12]

Raloxifen is FDA approved. This pill is used to reduce breast cancer risk in post-menopausal women. It is also approved for helping to prevent bone weakening and osteoporosis. There was a study done that shows that raloxifen did not prevent the risk of non-invasive breast cancers as well as Tamoxifen did. [13]

Side effects include: blood clots, uterine cancers, hot flashes, vaginal dryness, vaginal irritation, flu like symptoms, leg cramps, swelling of hands or feet, stokes. [14]

Benefits include: improve bone strength and reduce risk of osteoporosis.

Aromatase inhibitors are not FDA approved for prevention of breast cancer. These inhibitors reduce the amount of estrogen that your body produces depriving cancer cells of getting their food to grow. These are commonly used after surgery to prevent recurrence. Aromatase is only used for postmenopausal women.

Side effects include: hot flashes, headache, joint and muscle pain and vaginal dryness.

Risks include: broken bones and osteoporosis.[15]


Inflammatory breast cancer is defined histologically by the presence of cancer cells in the subdermal lymphatics on skin biopsy. Diagnosis is done with an MRI or biopsy.


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References

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  1. ^ "Inflammatory Breast Cancer: Questions and Answers". National Cancer Institute. Retrieved 2006-12-02.
  2. ^ "Inflammatory breast cancer". Mayo Foundation for Medical Education and Research. Retrieved 2006-12-02.
  3. ^ "Facts for Life - Inflammatory Breast Cancer" (PDF). Susan G. Komen for the Cure. Retrieved 2006-12-02.
  4. ^ Wingo, Phillis. "Population-based statistics for women with inflammatory breast cancer (United States)." Cancer Causes and Control 15 (2004): 321-28
  5. ^ 11) Gordon, Lisa. "Picture This." CLINICAL JOURNAL OF ONCOLOGY NURSING 5 (2001). EBSCO. Academic Search Complete. 02 Apr. 2009
  6. ^ "Inflammatory Breast Cancer Help - Signs and Symptoms." Inflammatory Breast Cancer Association. 02 Apr. 2009 <http://www.ibchelp.org/symptoms/>
  7. ^ "Diagnosis and Staging of Inflammatory Breast Cancer." BreastCancer.org - Breast Cancer Treatment Information and Pictures. 15 Apr. 2009 <http://www.breastcancer.org/symptoms/types/inflammatory/diagnosis_staging.jsp>
  8. ^ "Inflammatory breast cancer;breast cancer treatment;IBC;breast cancer - nccn.com." National Comprehensive Cancer Network - nccn.com. 13 Apr. 2009 <http://www.nccn.com/inflammatory_breast_cancer.aspx>
  9. ^ "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>
  10. ^ "Can you take a tablet to stop you getting breast cancer?: Cancer Research UK: CancerHelp UK." Homepage: Cancer Research UK: CancerHelp UK. 02 Apr. 2009 <http://www.cancerhelp.org.uk/help/default.asp?page=411>
  11. ^ "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>
  12. ^ "Can you take a tablet to stop you getting breast cancer?: Cancer Research UK: CancerHelp UK." Homepage: Cancer Research UK: CancerHelp UK. 02 Apr. 2009 <http://www.cancerhelp.org.uk/help/default.asp?page=411>
  13. ^ "ACS :: Medicines to Reduce Breast Cancer Risk." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. 02 Apr. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Tamoxifen_and_Raloxifene_Questions_and_Answers_5.asp>
  14. ^ "ACS :: Medicines to Reduce Breast Cancer Risk." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. 02 Apr. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Tamoxifen_and_Raloxifene_Questions_and_Answers_5.asp>
  15. ^ 6) "Chemoprevention: Drugs that can reduce breast cancer risk - MayoClinic.com." Mayo Clinic medical information and tools for healthy living - MayoClinic.com. 10 Apr. 2009 <http://www.mayoclinic.com/health/breast-cancer/WO00092>

See also

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