INFLAMMATORY BREAST CANCER
Written by : Dr.M.D.Mazumdar, MD
Inflammatory Breast Cancer (IBC) is a fast growing and aggressive cancer which is difficult to diagnose in its early stages. It can spread in a matter of weeks or months. At diagnosis, inflammatory breast cancer can be either stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.
The main method of diagnosing inflammatory breast cancer is by breast biopsy. Other methods like ultrasound or mammography cannot give an accurate picture since IBC does not form a definite lump. It grows in sheets or layers of cancerous cells which can be missed on physical examination.
IBC is also frequently misdiagnosed as a simple inflammation of the breast (mastitis).
About 30 percent of women with IBC have metastasis by the time they are diagnosed. Metastasis means spread of the cancer beyond the breast and nearby lymph nodes to other organs in the body such as the bones, lungs, liver or brain.
- Punch Biopsy: If clinical examination causes suspicion of an inflammatory breast cancer, a skin punch biopsy is usually ordered. This is a type of biopsy in which a a circular tool is used to remove a small section of the skin and its deeper layers. The wound is then closed with stitches.
- Core Needle Biopsy: If a specific mass or lesion can be identified, then an ultrasound guided core needle biopsy may be carried out. This procedure uses a somewhat larger needle with a sharp cutting edge. A core of tissue is cut from inside the mass. If the breast mass is quite large, as many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for microscopic analysis.
Inflammatory Breast cancer - Mammography
Additional tests: Once IBC has been diagnosed, additional tests are necessary to identify any spread (metastases) to other organs. Some of these tests are :
- Chest Xay
- CT scan of the chest, abdomen, and pelvis
- Bone scan
- PET Scan
- Liver function tests
Minimum criteria for a diagnosis of inflammatory breast cancer
- A rapid onset of erythema (redness), edema (swelling), and a peau d'orange appearance (ridged or pitted skin) and/or abnormal breast warmth, with or without a lump that can be felt.
- The above-mentioned symptoms have been present for less than 6 months.
- The erythema covers at least a third of the breast.
- Initial biopsy samples from the affected breast show invasive carcinoma.
Further examination of tissue from the affected breast should include testing to see if the cancer cells have hormone receptors (estrogen and progesterone receptors) or if they have greater than normal amounts of the HER2 gene and/or the HER2 protein (HER2-positive breast cancer).
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