Inflammatory Breast Cancer
- Inflammatory breast cancer is a rare, aggressive form of breast cancer accounting for 1-5 percent of all breast cancer diagnoses in the United States.
- Inflammatory breast cancer can develop rapidly, in a few weeks to months, and can mimic a breast infection.
- A hallmark sign of inflammatory breast cancer is thickened skin overlying the breast tissue. This is from tumor cells invading and blocking the dermal lymphatics.
- Treatment requires a multimodality approach, with expertise in medical oncology, surgical oncology and radiation oncology.
Signs and Symptoms
- Skin redness, warmth and thickening of the skin, similar to the feel of an orange peel (peau de orange), are common symptoms of inflammatory breast cancer.
- These are similar to symptoms associated with breast infections; it is often difficult to distinguish the two.
- Occasionally a mass may be felt in the breast or under the arm.
The workup of a possible inflammatory breast cancer needs to be careful and thorough. At Breastlink, we use a number of diagnostic tools to help rule-out, or rule-in, this diagnosis:
- In addition to a careful history and physical exam, imaging is often required. This includes mammogram and ultrasound.
- In some cases, an MRI of the breasts can help in identifying breast disease.
- If an infection is suspected, ultrasound can identify if a discrete abscess, or collection of pus, is present. If an abscess is indeed present, a Breastlink physician will drain the collection in the office on the same day. This fluid or pus will be sent for culture examination (for bacteria, fungus, etc).
- Since inflammatory breast cancer can mimic a breast infection, a short course of antibiotics is often given initially to differentiate these disease processes. Infections improve with antibiotics, while inflammatory breast cancer can briefly appear better, but often returns. Careful follow-up is mandatory.
- Misinterpreting inflammatory breast cancer for a breast infection is a common mistake. It is essential to have dedicated breast specialists review each patient’s case.
Tissue sampling is often needed to aid in the diagnostic workup. At Breastlink, we strive to do this in a timely manner so as to avoid any delays in diagnosis and treatment.
- A skin biopsy can be performed in the office using the punch biopsy device. Local anesthesia is given and a biopsy is taken of the skin and tissue just beneath the skin. With inflammatory breast cancer, tumor cells can often be seen in the lymphatics of the tissue beneath the skin.
- If a mass is seen on ultrasound, a core-needle biopsy of the mass can be performed in the office to identify if cancer is deep within the breast tissue.
The standard treatment of inflammatory breast cancer requires a combination of chemotherapy, surgery and radiation. At Breastlink, we utilize specialists in each of these areas to provide comprehensive treatment. Our medical oncologists will administer chemotherapy to shrink the tumor and help treat disease in both the breast and the skin. Our surgeons will surgically remove the tumor, typically with a mastectomy and removal of lymph nodes under the arm. We also utilize radiation oncologists after these medical and surgical treatments are complete.