| What is Inflammatory
Breast Cancer? Inflammatory breast
cancer is an uncommon form of rapidly advancing breast cancer that usually
accounts for approximately 1% to 3% of all breast cancer diagnoses.
Inflammatory breast cancer is a form of invasive breast cancer that
progresses quickly and should be differentiated by physicians from other
forms of advanced breast cancer with similar characteristics. Inflammatory
breast cancer causes the breast to appear swollen and inflamed. This
appearance is often caused when cancer cells block the lymphatic vessels
in the skin of the breast, preventing the normal flow of lymph fluid and
leading to reddened, swollen and infect-looking breast skin—hence the
designation "inflammatory" breast cancer. Inflammatory breast cancer is
not caused by infection or inflammation as was once believed.
With inflammatory breast cancer, the breast skin
has a thick, pitted appearance that is classically described as peau
d’orange (resembling an orange peel). Sometimes the skin develops
ridges and small bumps that resemble hives.
The information below is from the
Inflammatory Breast Cancer Research
Foundation Website.
You will find links that will take you to the
information on their site.
There is more than one kind of breast cancer.
We have been taught and are reminded
frequently by public service announcements and by the medical community
that when a woman discovers a lump on her breast she should go to the
doctor immediately.
Inflammatory breast cancer usually
grows in nests or sheets, rather than as a confined, solid tumor and
therefore can be diffuse throughout the breast with no palpable mass. The
cancer cells clog the lymphatic system just below the skin. Lymph node
involvement is assumed. Increased breast density compared to prior
mammograms should be considered suspicious.
You Don't Have to Have a Lump to Have
Breast Cancer.
Some women who have inflammatory
breast cancer may remain undiagnosed for long periods, even while seeing
their doctor to learn the cause of her symptoms. The symptoms are similar
to mastitis, a breast infection and some doctors, not recognizing IBC,
will prescribe antibiotics. If a response to antibiotics is not apparent
after a week, a biopsy should be performed or a referral to a breast
specialist is warranted.
Age
52: Median age at time of diagnosis of IBC ... versus,
Age 62: Median age at time of diagnosis of Breast Cancer.
A surprising portion of young women
with IBC had their first symptoms during pregnancy or lactation. The
misconception that these young women are at lower risk for breast cancer
and the fact that IBC is the most aggressive form of breast cancer may
result in metastases when the diagnosis is made.
One or more of the following
are Typical Symptoms of IBC:
-
Swelling, usually sudden, sometimes a cup size in a few days
-
Itching
-
Pink,
red, or dark colored area (called erythema) sometimes with texture
similar to the skin of an orange (called peau d'orange)
-
Ridges and thickened areas of the skin
-
What
appears to be a bruise that does not go away
-
Nipple
retraction
-
Nipple
discharge, may or may not be bloody
-
Breast
is warm to the touch
-
Breast
pain (from a constant ache to stabbing pains)
-
Change in
color and texture of the aureole
These Symptoms May Be Present in
Benign Breast Disorders. See your doctor if you have any of these
symptoms.
Inflammatory Breast Cancer
is typically abbreviated as IBC. Non-inflammatory breast cancer may
include in its diagnosis the terms "in situ breast cancer," "infiltrating
breast cancer," or "invasive breast cancer" all of which may be
abbreviated with "ibc," but those terms alone do not specify inflammatory
breast cancer. To add to the possible confusion, the diagnosis may
include more that one kind of breast cancer; for example "inflammatory
breast cancer, invasive ductal carcinoma, and mucinous carcinoma" all in
the same breast. So if a person you know has been described as having IBC
or ibc, it may be well to ask what that is abbreviating, since it may not
be "inflammatory breast cancer" and therefore the symptoms and other
information presented here may not apply.
View pictures
showing common presentation of some of these symptoms.
Read
what patients write about their own symptoms prior to diagnosis.
View videos about IBC.
Is
inflammatory breast cancer the same disease in each person diagnosed?
Researchers and clinicians don't know
the answer to that question but hypothesize that there are "types,"
"sub-types," or "categories" of IBC. Typically, the sub-types
hypothesized are divided by presentation at time of diagnosis: 1) clinical
symptoms only, with no pathological confirmation finding tumor emboli
(tightly packed clumps of tumor cells, like a bunch of grapes but very
tightly packed together) in the dermal lymphatics of the affected breast;
2) pathological only, finding tumor emboli in the dermal lymphatics,
without presentation of clinical symptoms; and 3) clinical and
pathological.
Another way
to categorize IBC is by age and gender at time of diagnosis:
-
There is
documented evidence of two cases in girls as young as
12-years-old, one of whom had not begun menstruation.
-
There are several
documented cases of male IBC.
-
There are
cases diagnosed during pregnancy or lactation.
-
And there
are cases that don't fall into any of the first three categories, but
are diagnosed in each of three menopausal periods of life: premenopausal,
perimenopausal, and postmenopausal.
Beyond
those categories, there are IBC cases that have special circumstances:
-
3 cases
diagnosed in 10 months amongst 24 co-workers
-
more than one case in
the same family: mother-daughter, sisters, and 1st degree cousins
-
IBC
diagnosed in a breast with an implant
-
IBC
diagnosed post-hysterectomy, in some cases including oophorectomy
Strange things doctors have told IBC patients about their symptoms prior
to their diagnosis with IBC:
-
The doctor said that if it was
breast cancer he would be able to find a lump and not just inflammation
and swollen nodes, with a discharge and calcifications in the breast
tissue due to caffeine (which she doesn't drink.)
-
The doctor said she had spider
bites when she developed skin metastasis following treatment for regular
breast cancer.
- After her mammogram the radiologist told her to
stop wearing under wire bras.
- She was told to change bras and detergent to
get rid of the rash.
- My sister was told that her blue colored bruise
was a fatty necrosis and no way was it cancer.
-
At age 20 she was told the lump she
felt was "rib cartilage" and not to worry as she was too young to have
breast cancer. She wasn't properly diagnosed until 2 years and 3 exams
later. She died of IBC at age 25.
-
She was told she had regular breast
cancer instead of IBC. The doctor said he had seen plenty of IBC cases
and she didn't have it. (She did have IBC. The clinical presentation
of inflammatory breast cancer may vary from patient to patient.)
-
She had inflammation with intense
itching on one breast which appeared and disappeared 4 times. The first
time it was diagnosed as spider bites.; the second time as an allergic
reaction to food or detergent, and irritation from cyst fluid from
fibrocystic breast the 3rd time. The 4th time, she was diagnosed with
inflammatory breast cancer.
- Her IBC was first diagnosed as shingles.
-
Finally, although this woman had
not been diagnosed with IBC when she wrote this, it does not change the
fact that her doctor's explanation of how IBC starts is erroneous.
She was told she didn't need a biopsy because IBC "starts with a lump
which then disperses and she couldn't have IBC because the lump would
have shown up on one of her previous mammograms."
If you have been diagnosed
with inflammatory breast cancer, and would like to share something strange
you were told about your symptoms by a doctor prior to your diagnosis,
please write to us. Your
message will be treated confidentially.
Be your own best advocate to
have symptoms diagnosed to know the cause. Here is one example, written
by a newly diagnosed IBC patient, who wishes to remain anonymous.
"I would like to thank you
for this web site. This web site has helped me. I was having problems and
the doctors was treating me for mastitis with medicine and it wasn't
working. My ultra sound and mammogram said that it was mastitis. I told
the surgeon he had to do a biopsy, because I thought that I had IBC. He
said he thought I needed another week of medicine and I said no, get me
scheduled for surgery next week. Two weeks later they told me that I have
IBC. I found your information helpful. Thank you for giving the
information to fight this. I am hoping and praying that I get to raise my
2 year old son. I have started the road to fight this and beat it."
"When I first
experienced pain in my breast, I made an appointment with my internist
and my OB/GYN. I found comfort when after both examinations, both
doctors separately told me: "The good news is that cancer doesn't
hurt". I held on to those words for five months before the pain
and breast became worse and I was diagnosed with IBC."
Another example:
"I am 53 yrs. old. I was diagnosed with IBC in Jan. 2003. I first
noticed something wrong with my left arm. It hurt and I couldn't raise it
as high as usual. I went to the Dr. at a clinic and they started by
treating me for Mastitis. They did this for almost a year. I kept
telling them something was very wrong. Then my breast started to hurt on
the left side. I went to urgent care and the Dr. there said I had cancer
and needed to see a surgeon. By then my nipple was inverted. I finally
got to see a breast surgeon. He had given me some needle biopsies. They
came back negative. I told them something was still wrong. They told me
to put warm wash cloths on my nipple for 10 minutes twice a day. That was
the strange part. Well that didn't help and finally on the 24th of Jan. I
was given a biopsy during surgery and was told on Jan. 31st of 2004 I had
cancer. I had to be very persistent and almost aggressive to find out the
truth. Then I told them I wanted a second Dr. to tell me the same thing
since it took them so long."
The words "signs"
and "symptoms" have different medical meanings. Symptoms are those
problems that a patient notices or feels. Signs are those things that a
physician can objectively detect or measure. For instance, a patient will
feel hot, this is a symptom. The physician will touch the patient's skin
and note that it is warm and moist; this is a sign.
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