Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer.  It makes up only 1-5% of all breast cancers diagnosed in the United States and presents in younger women, on average, than the more common type of breast cancer.  This locally advanced, rapidly growing cancer typically blocks/clogs the lymphatic vessels in the skin of the breast.  These lymph vessels usually drain to the armpit lymph nodes.

Symptoms include redness, warmth, heaviness, enlargement, and/or swelling of the breast.  The breast may even have a pink or bruised appearance. The nipple may visibly change in color, position, or shape.  Only 50% of patients can feel a lump in the same breast.  Enlargement of the lymph nodes in the armpit are not uncommon.  These various changes can occur within a short period of time, often from weeks to a few months.  This reinforces the need for prompt evaluation and avoidance of patient denial. The diagnosis can be difficult as infections may have a similar presentation.  If any of these symptoms develop, the patient should be evaluated by their Primary Care Physician or General Surgeon. 

On examination, the physician is looking for signs of redness, warmth, tenderness, enlargement, or peau d’orange (the skin changes which give an orange peel appearance).  This latter skin change results from the blocking of the skin lymphatic ducts by the cancer cells.  However, peau d’orange can also be seen in cases of breast infections.  That is why making the diagnosis can be problematic.  It is not uncommon for an antibiotic to be prescribed initially for seven to ten days.  If there is no significant improvement with the use of the antibiotic(s), a biopsy of the breast skin is mandatory.  Even if the biopsy is unrevealing of cancer and the symptoms do not improve rather quickly, a second skin biopsy should be done.

When IBC is diagnosed, a plan of care should be coordinated by your surgeon.  IBC is typically treated with intravenous chemotherapy first (under the direction of a Medical Oncologist); followed by complete surgical removal of the breast and the lymph nodes in the same armpit.  Sometimes, radiation therapy (under the direction of a Radiation Oncologist) is included to the treatment regimen. Treatment is prompt and judicious.
Prognosis is generally not good.  The average patient lives only 3 years.  Between 25- 50% live 5 years and only 33% live 10 years after diagnosis.  Urgent detection and treatment provide the only chance for a cure.