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Inflammatory Breast Cancer

Inflammatory breast cancer is a rare but aggressive form of breast cancer. While it accounts for 2-6% of all breast cancers, the 5-year overall survival rate is 40%, as compared to near 90% for all types of breast cancer combined. The key to survival is an early and accurate diagnosis and healthcare providers that specialize in inflammatory breast cancer.

Inflammatory breast cancer can present in a number of ways, and each patient’s symptoms are unique. What makes inflammatory breast cancerdifferent from other breast cancers is that the symptoms progress very rapidly, often within a matter of weeks. The majority of women with inflammatory breast cancer never detect a lump. Inflammatory breast cancer quickly covers the breast in sheets causing a thickening of the skin, but no detectable lump.

 

Inflammatory breast cancer symptoms may include:

  • Breast swelling, which appears suddenly with one breast much larger than the other
  • Itching
  • Pink, red, or dark colored area, sometimes with a dimpling of the breast skin that looks like an orange peel (peau d’orange)
  • Ridges and thickened areas of the skin
  • Breast that feels warm to the touch
  • Flattened or retracted nipple
  • Breast pain

You do not need to have all of these symptoms to be concerned about inflammatory breast cancer. Each patient’s presentation is unique. Since inflammatory breast cancer symptoms are very similar to those of an infection (mastitis), your doctor may prescribe a round of antibiotics. If the symptoms have not improved or have grown worse, breast imaging (mammogram and ultrasound) and a biopsy are strongly recommended. These are simple screening procedures for cancer. Diagnosing inflammatory breast cancer at an early stage can possibly save your life.

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Mujerhoy Cancer Care
Salud, cuidados y prevención del cáncer en la mujer
8th MD Anderson Cancer Center International Meeting in Gnecologic Oncology Hybrid meeting - Madrid, Spain
An Era for Innovation and Progress
Teaching

At the moment there are no courses of Inflammatory Breast Cancer

Clinical trials
Sym015(Anti-MET) en Pacientes con tumor solido avanzado.
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
Regeneron para multipatología
PRIMER ESTUDIO EN EL SER HUMANO DE LA ADMINISTRACIÓN REPETIDA DE REGN2810, UN ANTICUERPO MONOCLONAL, TOTALMENTE HUMANO FRENTE A LA PROTEÍNA DE MUERTE CELULAR PROGRAMADA 1 (PD-1), EN MONOTERAPIA Y EN COMBINACIÓN CON OTROS TRATAMIENTOS ANTINEOPLÁSICOS, EN PACIENTES CON TUMORES MALIGNOS AVANZADOS
DU176b-D-U311
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Paclitaxel, Ipatasertib. Cáncer de mama triple negativo. (FAIRLANE)
Estudio clínico de fase II randomizado, doble ciego de Ipatasertib (GDC-0068), un inhibidor de AKT, en combinación con Paclitaxel como tratamiento neoadyuvante para pacientes con cáncer de mama triple negativo
Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética
Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.

The precise causes of inflammatory breast cancer have not yet been determined. However, research conducted at MD Anderson  indicates that certain risk factors may be associated with an increased probability of developing inflammatory breast cancer:

 

Age: Inflammatory breast cancer can occur in women at any age. Women with inflammatory breast cancer tend to be somewhat younger than other breast cancer patients. 

 

Race: Women of North African descent seem to be more likely to have inflammatory breast cancer than other ethnic groups.

 

Smoking: There has been no observable connection between inflammatory breast cancer and smoking.

 

Family history: Breast cancer, in general, seems to run in some families. At this time, there has been no detectable genetic risk of inflammatory breast cancer. The exact genes responsible have not been fully identified, but changes in DNA that increase a person's risk for other types of cancer may also increase the risk of inflammatory breast cancer.

 

Obesity: People with a body mass index (BMI) of over 30 are more likely to develop inflammatory breast cancer.

If your breast is not responding to antibiotics, several diagnostic tests will be ordered to get a better look within the breast and lymph nodes. Rather than forming a lump, inflammatory breast tumors grow in flat sheets that cannot be felt in a breast exam.

 

Diagnostic test for inflammatory breast cancer include: 

  • Mammogram
  • Ultrasound of the breast and lymph nodes
  • Biopsy of any mass, enlarged lymph node, and/or breast skin

In most cases of inflammatory breast cancer, a mammogram will not reveal a distinct lump but may show skin thickening or enlarged lymph nodes. Again, in most cases, no distinct mass is seen. Ultrasound is used to further evaluate an abnormal area and to look at the lymph nodes. Ultrasound can also be used as a guide for a biopsy.

 

Once a biopsy confirms that cancer cells are present, more imaging scans and possibly more biopsies may be needed to get an accurate picture of the disease, a procedure known as staging.

 

The doctor may use several terms to refer to inflammatory breast cancer. These include invasive ductal carcinoma, breast carcinoma with dermal lymphatic invasion, or inflammatory carcinoma of the breast. All of these terms refer to IBC. Inflammatory breast cancer is a Stage IIIB upon diagnosis. If the cancer has spread to other areas (metastasized), it is a Stage IV cancer. Despite a late-stage diagnosis, women with inflammatory breast cancer may respond rapidly to treatment.

A multi-disciplinary approach is necessary to successfully treat inflammatory breast cancer. A typical treatment plan will include chemotherapy initially, surgery, radiation therapy and possibly endocrine therapy to prevent recurrence.

 

Chemotherapy
 

The goal of chemotherapy is to eliminate or reduce inflammatory breast cancer before surgery. Using chemotherapy before surgery is call neoadjuvant chemotherapy. Anthracyclines (doxorubicin or epirubicin) and taxanes (paclitaxel or docetaxel) are the most effective chemotherapy drugs for IBC. Most women with IBC receive a combination of at least two different drugs.

 

Chemotherapy should be started as soon as possible to prevent the spread of the disease. If the disease has not metastasized (spread beyond the breast), chemotherapy treatment will last about six months, and involve several different chemotherapy drugs. These are very active drugs in the fight against breast cancer and generally you will see a marked improvement once chemotherapy starts.

 

Surgery
 

Because inflammatory breast cancer does not present as a distinctive lump, surgery to remove just the cancerous tissue (lumpectomy) is usually not possible. A complete mastectomy (removal of the entire breast) is recommended to get all of the affected areas. Many women with inflammatory breast cancer have axillary lymph nodes involved. The surgeon will be evaluating lymph nodes at the time of surgery. Breast reconstruction is not recommended until therapy has been completed and there is no evidence of disease.

 

Radiation Therapy
 

After chemotherapy and surgery is completed, radiation therapy is performed on the chest wall and lymph nodes. Radiation helps control disease and reduce the risk of recurrence, and may also be used to treat metastatic disease and manage pain, or for patients who cannot undergo surgery. Women with inflammatory breast cancer typically have twice-a-day radiation.

 

Endocrine Therapy
 

If the inflammatory breast cancer tumor is hormone receptor positive (Estrogen Receptor [ER] or Progesterone Receptor [PR]), then hormone therapy will be required. Oral medications designed to either block the production of estrogen and progesterone, or stop their activation. The type of hormone therapy depends on the patient's menopause status, but all patients can expect to remain on hormone therapy for five years. 

 

Stem Cell Transplant
 

For a certain population, patients after completing their initial therapy or have responding metastatic disease, a stem cell transplant may be option with the goal to reduce the chance of recurrence.