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http://www.arizona-breast-cancer-specialists.com/about-cancer/inflammatory-breast-cancer.html

Inflammatory Breast Cancer

Highlights:
  • Inflammatory breast cancer is a type of advanced breast cancer.

    It is often mistaken for a breast infection because the breast is red and swollen. This redness and swelling is due to plugging of the skin lymph channels by breast cancer cells.
  • Inflammatory breast cancer is a rapidly growing breast cancer

    . It has usually spread to the surrounding lymph nodes by the time it is diagnosed, and it may have spread beyond to other organs.
  • Inflammatory breast cancer that has not spread beyond the breast-area lymph nodes is potentially curable

    . Treatment includes chemotherapy first, then surgical removal of the breast, and then radiation therapy to the chest wall area and surrounding lymph node areas.
  • Inflammatory breast cancer that has spread beyond the lymph nodes to other organs

    is often treated the same way but cure remains a challenge for such patients with metastatic breast cancer.
Inflamatory breast cancer
Illustration: Inflammatory Breast Cancer

What is Inflammatory Breast Cancer?

Inflammatory breast cancer is an uncommon form of advanced breast cancer

. It is so named because the breast looks inflammed: it is red, warm and swollen and looks like an infection. Many cases are mistakenly treated with antibiotics for weeks to months before the diagnosis of cancer is made.
The skin of the breast of patients with inflammatory breast cancer is swollen and red because cancer cells have grown into (and blocked) the lymph channels in the skin. This causes the skin to swell and appear red. Peau d'orange (po-dah-ranj) is a French term for 'orange skin' and refers to the dimpled appearance of the skin in this disease. It's worth mentioning that many non-cancer conditions can cause the orange-skin type appearance.
Swollen dimpled skin of inflammatory breast cancer
Orange peel resembles inflammatory breast cancer
The swollen dimpled skin of
inflammatory breast cancer resembles the skin of an orange.

Patients with inflammatory breast cancer may have an obvious cancer mass in the breast found on breast exam or on mammogram

. However, sometimes there is not an obvious mass in the breast. All that is seen is cancer in the skin lymph channels and a general 'fullness' of the breast. This is not uncommon; the cancer cells can spread throughout the breast without forming a large mass. If there are cancer cells in the skin lymph channels and the breast is red and swollen, the patient should still be considered to have inflammatory breast cancer and treated appropriately.

How Does Inflammatory Breast Cancer Behave?

Inflammatory breast cancers are faster growing than other breast cancers

. This makes them more dangerous; many inflammatory breast cancers have spread to the lymph nodes in the armpit by the time they are diagnosed, and some have already spread beyond to other organs (they have metastasized).
The fast growth of inflammatory breast cancers is a great concern, but it also makes these cancers more vulnerable to chemotherapy drugs. Chemotherapy drugs are more effective against cancer cells that are growing quickly. Because inflammatory breast cancers are growing quickly, they are usually vulnerable to chemotherapy.

How is Inflammatory Breast Cancer Treated?

Many cases of inflammatory breast cancer are curable. Cure requires the use of

chemotherapy, surgery and radiation therapy

. Inflammatory breast cancer is treated with chemotherapy first. Surgery to remove the breast is performed next. After surgery, additional chemotherapy may be given. Radiation is the last phase of treatment, and is given to the chest wall scar area and the lymph node areas of the armpit and behind the breastbone.
Experience has taught us that chemotherapy is the best first step. Years ago surgery was tried first, but patients experienced very unpleasant re-growth of the cancer in the chest wall scar line. Chemotherapy cannot penetrate this scar tissue very well; giving the chemotherapy first avoids this problem. Also, chemotherapy is the most important treatment for inflammatory breast cancer. If the cancer is vulnerable to chemotherapy, then cure is possible, and the doctors and patient know that surgery and radiation should follow chemotherapy. If the cancer does not shrink (respond) to chemotherapy, then cure is much less likely. Surgery may not be possible at all because the wounds do not heal well if a large amount of cancer is present in the skin and breast at the time of surgery.
The best result after chemotherapy is that all the cancer disappears. The scans become normal and the red, swollen breast returns to a normal appearance. If this happens, then surgery (mastectomy) is the next step; this surgery is usually combined with removal of lymph nodes from the armpit (axillary lymph node dissection).
If all the cancer disappears after chemotherapy, why remove the breast? We know from experience that invisibly small amounts of cancer almost always remain in the breast, even if it appears all the cancer has disappeared. Surgery helps remove much or all of this residual cancer and greatly improves the cure rate.
After chemotherapy and surgery, radiation therapy is almost always added as the final treatment. Again, even if all the cancer has disappeared after chemotherapy and surgery, experience shows that invisibly small amounts of cancer can be left behind after chemotherapy and surgery. This cancer can grow back (recur) in the chest wall scar area, or in the skin, or in the lymph node areas. Radiation therapy can sterilize these remaining cancer cells and prevent these recurrences. Radiation therapy improves the cure rate for inflammatory breast cancer.
Inflammatory breast cancer recurrence
Illustration: A photo of inflammatory breast cancer
that grew back in the scar area after mastectomy.

These are very difficult problems to treat and are best prevented with radiation therapy after chemotherapy and surgery.

Inflammatory breast cancer may have spread to other organs by the time it is diagnosed

. It is then called

metastatic inflammatory breast cancer

. Patients are often treated with the same approach: chemotherapy, surgery and radiation therapy. Metastatic inflammatory breast cancer may be controlled with this treatment for a long time, but cure for patients with metastatic inflammatory breast cancer remains a challenge.

Summary of Inflammatory Breast Cancer

Inflammatory breast cancer is a type of advanced breast cancer in which the breast appears red and swollen due to plugging of skin lymph channels by breast cancer cells. It may or may not have spread to nearby lymph nodes or beyond the breast to other organs.
Inflammatory breast cancer that is confined to the breast and lymph nodes (it has not spread to other organs) is potentially curable. Treatment for such cases typically includes chemotherapy first, then surgical removal of the breast, and then radiation therapy to the chest area. Inflammatory breast cancer that has spread beyond the lymph nodes to other organs may be treated the same way, but cure remains a challenge in these patients.