Inflammatory Breast Cancer

Inflammatory breast cancer is a relatively rare but very serious, aggressive type of breast cancer. According to the National Cancer Institute (NCI), 1% to 5% of breast cancer cases in the United States are inflammatory breast cancer.

The symptoms of inflammatory breast cancer can include:

• Redness of the breast. The most distinguishing feature of inflammatory breast cancer is redness involving part of or the whole breast. Sometimes the redness comes and goes.
• Swelling of the breast. Part of or all of the breast may be swollen, enlarged, and hard.
• Warmth. The breast may feel warm.
• Orange-peel appearance. In some people, the breast can swell and start to look like the peel of a navel orange (this is called "peau d'orange").
• Other skin changes. The skin of the breast might look pink or bruised, or you may have what looks like ridges, welts, or hives on your breast.
• Swelling of lymph nodes. The lymph nodes under the arm or above the collarbone may be swollen.
• Flattening or inversion of the nipple. The nipple may go flat or turn inward.

About 50% of women with inflammatory breast cancer have a lump or a mass in their breast, but it may be difficult to feel since the breast is often bigger and harder than normal.

Inflammatory breast cancer is usually categorized as stage IIIB breast cancer because of the possible involvement of the skin, chest wall, or lymph nodes along the breast bone inside the chest wall. If the cancer has spread to other organs, such as the bones, lungs, liver, brain, or to the lymph nodes in the neck, it is categorized as stage IV.

Inflammatory breast cancer is hard to diagnose

Sometimes inflammatory breast cancer is misdiagnosed as an infection. Because the disease is rare, many doctors have never seen it. Also, it has not been studied as much as other types of breast cancer. An infection is a more common cause of swelling and redness of the breast—that's why doctors think of that diagnosis first. But infection is more likely to happen for a reason, such as breast feeding. Infections go away with proper antibiotic treatment, but inflammatory breast cancer does not respond to antibiotics.

A diagnosis of inflammatory breast cancer is made primarily by physical examination, although mammogram, breast MRI, or ultrasound is sometimes used. A diagnosis must be confirmed by a biopsy. However, sometimes a biopsy of inflammatory breast cancer may come back "clear," even as the redness and swelling worsen. So making a diagnosis is very tricky.

Treating inflammatory breast cancer involves chemotherapy up front, followed by surgery and radiation. Anti-estrogen and Herceptin (chemical name: trastuzumab) therapy may also have a role. Other forms of targeted therapy, such as Avastin (chemical name: bevacizumab), may be used. The kind and sequence of treatment depends on your individual situation.