You probably know that a lump in the breast may be a symptom of breast cancer. But what about breast cancer that develops without that warning sign? Inflammatory breast cancer is a fast-moving cancer that doesn’t usually form a lump; instead, the skin on one breast changes rapidly, explains Tina Hieken, MD, a surgical oncologist at Mayo Clinic Comprehensive Cancer Center.
Inflammatory breast cancer often comes with symptoms that mimic inflammation of the breast, such as a change in skin colour to a pink, red, purple or bruised appearance; unusual warmth in the affected breast; and orange peel-like skin, a symptom known as peau d’orange.
As a result, inflammatory breast cancers may be misdiagnosed as cellulitis, mastitis, Paget’s disease of the breast, or other more benign conditions.
Inflammatory breast cancer accounts for roughly one to five per cent of breast cancer diagnoses but 10 per cent of breast cancer deaths, statistics show.
“When there are changes in the skin of the breast, particularly in women who aren’t nursing and do not have breastfeeding-associated redness, that can be a warning sign of cancer and should be evaluated by a medical professional,” Dr Hieken says.
“In inflammatory breast cancer, symptoms can develop within a few months,” she notes. “That’s different from someone noting a lump in the breast over a period of time, and then secondarily, skin changes in the breast over a year or longer.”
In inflammatory breast cancer, abnormal cells go through the lymphatic channels in skin and soft tissue, accounting for the skin changes in the breast, Dr Hieken explains.
Inflammatory breast cancer is treated first with systemic therapy: a treatment that goes through the whole body, she says. That therapy is based on the cancer’s biological features, or subtype, such as whether it expresses the estrogen receptor or overexpresses the HER2 protein.
The systemic therapy is usually delivered intravenously and could be:
. Chemotherapy directed at rapidly dividing cells.
. Targeted therapy aimed at cells that overexpress the HER2 protein.
. Immunotherapy to help the body fight cancer that doesn’t express the estrogen receptor or the HER2 protein; this is the least common type, Dr Hieken says.
Then, surgery may include removal of the breast and nearby lymph nodes, typically followed by radiation that includes the chest, armpit and shoulder. This three-mode approach of whole-body therapy, surgery and radiation is critical to disease control for cancer that has a high risk of spreading to other parts of the body or recurring in the breast and surrounding area, Dr Hieken says. More common forms of breast cancer may not require all types of available treatments.
Treatment advances
There have been several innovations in the treatment of inflammatory breast cancer.
“Very similar to non-inflammatory breast cancer, giving treatment at the beginning that is designed for one of those three or four subtypes of breast cancer is probably the biggest innovation,” Dr Hieken says. “I think, in parallel, the other big innovation is better cross-sectional imaging so that, at the outset, we know whether patients have disease that has spread beyond the breast and the regional lymph nodes.”
Among the breast cancer subtypes, progress has notably been made in HER2-positive inflammatory breast cancer, with the addition of two different drugs that work in a complementary way to block the effects of the HER2 protein overexpression, she adds.
“It’s been a huge advantage and has really improved outcomes for women,” Dr Hieken says. “Then, for those women who have less than a complete response to that systemic treatment, there are new targeted therapies that can be given after surgery.”
Another improvement is intensity modulated radiotherapy, or IMRT, that is delivered using CT integrated planning, she says. This allows the care team to look at a patient in three dimensions and determine how to personalise radiation therapy to minimise the effects through such techniques as having the patient practise breath-holding or lie on her stomach during radiation therapy.
“We’re learning a lot,” Dr Hieken adds.
A team approach
At Mayo Clinic, physicians from across treatment disciplines work alongside researchers seeking new care options for patients with this aggressive form of cancer.
Specialists from medical oncology, radiation oncology, surgical oncology and radiology work together. They collaborate with additional healthcare professionals such as genetic counsellors, pathologists, social workers, occupational and physical therapists, psychotherapists, and integrative medicine experts to offer comprehensive support to patients.
Source – Mayo Clinic:
