Diagnosing inflammatory breast cancer

Tests and procedures used to diagnose inflammatory breast cancer include:

• A physical exam. Your doctor examines your breast to look for redness and other signs of inflammatory breast cancer.
• Imaging tests. Your doctor may recommend a breast X-ray (mammogram) or a breast ultrasound to look for signs of cancer in your breast, such as thickened skin. Additional imaging tests, such as MRI, may be recommended in certain situations.
• Removing a sample of tissue for testing. A biopsy is a procedure to remove a small sample of suspicious breast tissue for testing. The tissue is analyzed in a laboratory to look for signs of cancer. A skin biopsy may also be helpful, and this can be done at the same time as a breast biopsy.

Determining the extent of the cancer

Additional tests may be necessary to determine whether your cancer has spread to your lymph nodes or to other areas of your body.

Tests may include a CT scan, positron emission tomography (PET) scan and bone scan. Not everyone needs every test, so your doctor will select the most appropriate tests based on your particular situation.

Your doctor uses information from these tests to assign your cancer a stage. Your cancer's stage is indicated in Roman numerals. Stages of inflammatory breast cancer range from III to IV, with the higher stage indicating that cancer has spread to other areas of the body.

The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you.

Overview

Inflammatory breast cancer is a rare type of breast cancer that develops rapidly, making the affected breast red, swollen and tender.

Inflammatory breast cancer occurs when cancer cells block the lymphatic vessels in skin covering the breast, causing the characteristic red, swollen appearance of the breast.

Inflammatory breast cancer is considered a locally advanced cancer — meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes.

Inflammatory breast cancer can easily be confused with a breast infection, which is a much more common cause of breast redness and swelling. Seek medical attention promptly if you notice skin changes on your breast.

Symptoms

Inflammatory breast cancer doesn't commonly form a lump, as occurs with other forms of breast cancer. Instead, signs and symptoms of inflammatory breast cancer include:

• Rapid change in the appearance of one breast, over the course of several weeks
• Thickness, heaviness or visible enlargement of one breast
• Discoloration, giving the breast a red, purple, pink or bruised appearance
• Unusual warmth of the affected breast
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel
• Tenderness, pain or aching
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
• Flattening or turning inward of the nipple

For inflammatory breast cancer to be diagnosed, these symptoms must have been present for less than six months.

When to see a doctor

Make an appointment with your doctor if you notice any signs or symptoms that worry you.

Other more common conditions have signs and symptoms resembling those of inflammatory breast cancer. A breast injury or breast infection (mastitis) may cause redness, swelling and pain.

Inflammatory breast cancer can be easily confused with a breast infection, which is much more common. It's reasonable and common to be initially treated with antibiotics for a week or more. If your symptoms respond to antibiotics, additional testing isn't necessary. But if the redness does not improve, your doctor may consider more serious causes of your symptoms, such as inflammatory breast cancer.

If you've been treated for a breast infection but your signs and symptoms persist, contact your doctor. Your doctor may recommend a mammogram or other test to evaluate your signs and symptoms. The only way to determine whether your symptoms are caused by inflammatory breast cancer is to do a biopsy to remove a sample of tissue for testing.

Causes

It's not clear what causes inflammatory breast cancer.

Doctors know that inflammatory breast cancer begins when a breast cell develops changes in its DNA. Most often the cell is located in one of the tubes (ducts) that carry breast milk to the nipple. But the cancer can also begin with a cell in the glandular tissue (lobules) where breast milk is produced.

A cell's DNA contains the instructions that tell a cell what to do. The changes to the DNA tell the breast cell to grow and divide rapidly. The accumulating abnormal cells infiltrate and clog the lymphatic vessels in the skin of the breast. The blockage in the lymphatic vessels causes red, swollen and dimpled skin — a classic sign of inflammatory breast cancer.

Risk factors

Factors that increase the risk of inflammatory breast cancer include:

• Being a woman. Women are more likely to be diagnosed with inflammatory breast cancer than are men — but men can develop inflammatory breast cancer, too.
• Being younger. Inflammatory breast cancer is more frequently diagnosed in people in their 40s and 50s.
• Being black. Black women have a higher risk of inflammatory breast cancer than do white women.
• Being obese. People who are obese have a greater risk of inflammatory breast cancer compared with those of normal weight.

Diagnosis

Diagnosing inflammatory breast cancer

Tests and procedures used to diagnose inflammatory breast cancer include:

• A physical exam. Your doctor examines your breast to look for redness and other signs of inflammatory breast cancer.
• Imaging tests. Your doctor may recommend a breast X-ray (mammogram) or a breast ultrasound to look for signs of cancer in your breast, such as thickened skin. Additional imaging tests, such as an MRI, may be recommended in certain situations.
• Removing a sample of tissue for testing. A biopsy is a procedure to remove a small sample of suspicious breast tissue for testing. The tissue is analyzed in a laboratory to look for signs of cancer. A skin biopsy may also be helpful, and this can be done at the same time as a breast biopsy.

Determining the extent of the cancer

Additional tests may be necessary to determine whether your cancer has spread to your lymph nodes or to other areas of your body.

Tests may include a CT scan, positron emission tomography (PET) scan and bone scan. Not everyone needs every test, so your doctor will select the most appropriate tests based on your particular situation.

Your doctor uses information from these tests to assign your cancer a stage. Your cancer's stage is indicated in Roman numerals. Because inflammatory breast cancer is aggressive and grows quickly, stages usually range from III to IV, with the higher stage indicating that cancer has spread to other areas of the body.

The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you.

Treatment

Inflammatory breast cancer treatment begins with chemotherapy. If the cancer hasn't spread to other areas of the body, treatment continues with surgery and radiation therapy. If the cancer has spread to other areas of the body, your doctor may recommend other drug treatments in addition to chemotherapy to slow the growth of the cancer.

Chemotherapy

Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. You may receive chemotherapy drugs through a vein (intravenously), in pill form or both.

Chemotherapy is used prior to surgery for inflammatory breast cancer. This pre-surgical treatment, referred to as neoadjuvant therapy, aims to shrink the cancer before the operation and increase the chance that surgery will be successful.

If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend additional chemotherapy after you've completed other treatments in order to decrease the chance that the cancer will recur.

Surgery

After chemotherapy, you may have an operation to remove the affected breast and some of the nearby lymph nodes. The operation usually includes:

• Surgery to remove the breast (mastectomy). A total mastectomy includes removing all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola.
• Surgery to remove the nearby lymph nodes. The surgeon will remove the lymph nodes under the arm and near the affected breast (axillary dissection).

Talk with your doctor about your options for breast reconstruction. Surgery to reconstruct the breast is often delayed until after you complete all of your breast cancer treatments.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays or protons, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation).

For inflammatory breast cancer, radiation therapy is used after surgery to kill any cancer cells that might remain. The radiation is aimed at your chest, armpit and shoulder.

Targeted therapy

Targeted drug treatments attack specific abnormalities within cancer cells. As an example, several targeted therapy drugs focus on a protein that some breast cancer cells overproduce called human epidermal growth factor receptor 2 (HER2). The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can damage cancer cells while sparing healthy cells.

If your inflammatory breast cancer cells test positive for HER2, your doctor might recommend combining targeted therapy with your initial chemotherapy treatment. After surgery, targeted therapy can be combined with hormone therapy.

For cancer that spreads to other parts of the body, targeted therapy drugs that focus on other abnormalities within cancer cells are available. Your cancer cells may be tested to see which targeted therapies might be helpful for you.

Hormone therapy

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is used to treat breast cancers that use your hormones to grow. Doctors refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

Treatments that can be used in hormone therapy include:

• Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
• Medications that stop the body from making estrogen after menopause (aromatase inhibitors)
• Surgery or medications to stop hormone production in the ovaries

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option if your cancer has spread to other areas of the body and is triple negative, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. Your doctor may test your cancer cells to see if they're likely to respond to immunotherapy.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Coping and support

Inflammatory breast cancer progresses rapidly. Sometimes this means you may need to start treatment before you've had time to think everything through. This can feel overwhelming. To cope, try to:

• Learn enough about inflammatory breast cancer to make treatment decisions. Ask your doctor for the facts about your cancer and treatment. Ask what stage your cancer is and what treatment options you have. Also ask your doctor about good sources of information where you can learn more. Examples of organizations for reliable cancer information include the National Cancer Institute and the American Cancer Society.
• Seek support. It might comfort you to talk about your feelings as you begin cancer treatment. You might have a close friend or family member who is a good listener. Or ask your doctor to refer you to a counselor who works with cancer survivors.
• Connect with other cancer survivors. Other people with cancer can provide a unique source of support. Cancer survivors can offer practical advice on what to expect and how to cope during your treatment. Ask your doctor about support groups in your community. Or try the online message boards run by organizations such as the American Cancer Society or BreastCancer.org.

Preparing for an appointment

Start by first seeing your family doctor or health care provider if you have any signs or symptoms that worry you. If you're diagnosed with inflammatory breast cancer, you'll be referred to a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For inflammatory breast cancer, some basic questions to ask your doctor include:

• Do I have inflammatory breast cancer?
• Has my inflammatory breast cancer spread beyond my breast?
• Do I need more tests?
• Can I have a copy of my pathology report?
• What are my treatment options?
• What are the potential risks of each treatment option?
• Can any treatments cure my inflammatory breast cancer?
• Is there one treatment you feel is best for me?
• If you had a friend or family member in my situation, what would you recommend?
• How much time can I take to choose a treatment?
• How will cancer treatment affect my daily life?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?