What To Know About Inflammatory Breast Cancer (IBC)

Symptoms of inflammatory breast cancer (IBC) may include breast changes like a rash, swelling, and pitting of the skin that resembles an orange peel. These symptoms occur when cancer cells block the lymph vessels, causing a build-up of fluid in the breast.

IBC is a rare and aggressive (fast-growing) type of breast cancer. It makes up about 1% to 5% of all breast cancer cases in the United States. IBC progresses quickly in a matter of weeks or months, especially if you don't catch it early. The five-year survival rate depends on the stage but is about 39%. Treatments usually include chemotherapy, followed by surgery and other therapies.

Types

IBC is a rare type of invasive breast cancer. Invasive breast cancers are cancers that grow into the breast tissue. Most cases of breast cancer are considered invasive. The most common types of invasive breast cancer are invasive ductal and lobular carcinoma.

Invasive Ductal Carcinoma

Invasive ductal carcinoma starts in the cells that line the milk ducts. It's the most common type of invasive breast cancer, accounting for eight in 10 of all cases.

Invasive Lobular Carcinoma

Invasive lobular carcinoma starts in the breast glands that produce milk. This type is likelier to affect both breasts than ductal carcinoma. It occurs in about one in 10 cases of invasive breast cancer.

Inflammatory Breast Cancer Symptoms

Symptoms of IBC are different than typical breast cancer symptoms. Many people with this type of cancer do not feel a lump in the breast, and a lump is often not detected with a mammogram.

IBC develops quickly and usually occurs in one breast. Possible symptoms include:

• Breasts that are warm to the touch
• Easy bruising
• Heaviness in the breasts
• Inverted nipples
• Itching or burning sensation
• Pain
• Redness
• Swelling
• Swollen lymph nodes near the underarms or collarbone
• Thickening and pitting of skin that mimics the appearance of an orange peel
  

Causes

IBC occurs when cancer cells develop in the cells that line the milk ducts or lobules (glands) in the breast. Cancer cells quickly grow and multiply once they develop. Researchers aren't certain what causes cancer cells to develop in the milk ducts or lobules. Some evidence suggests that risk factors increase your chances of developing this aggressive condition. 

Risk Factors

IBC is rare, so experts need to conduct more research to understand the underlying cause of the condition. Risk factors that can increase likelihood may include:

• Being aged 40 or younger
• Being overweight or having obesity
• Breastfeeding
• Chronic inflammation
• Smoking
• Viral infections
• Young age at first birth

Diagnosis

IBC is aggressive and spreads quickly. Most people usually receive their diagnosis at an advanced stage. IBC is classified as stage III cancer once it starts to cause symptoms in the skin (such as redness and swelling). Up to 1 in 3 cases have already spread (metastasized) to other body parts at the time of diagnosis. 

People with IBC usually seek care only when symptoms develop. The symptoms of IBC are similar to those of mastitis and other infections, so a healthcare provider may first prescribe antibiotics. They'll likely recommend further testing if your symptoms don't improve within seven to 10 days. 

Diagnostic tests for IBC include:

• Breast biopsy: Is the only test that can officially diagnose IBC
• Breast magnetic resonance imaging (MRI): Determines if the cancer has spread
• Breast ultrasound: Can check for a tumor in the breast
• Mammogram: May detect a lump in the breast
• Skin biopsy: Takes a sample of the skin on your breast to check for cancer
  

Stages

IBC is diagnosed at stage III or stage IV, mostly since it doesn't cause symptoms until stage III. Here's what happens during both stages:

• Stage III: Cancer cells have spread to the skin of the breast and nearby lymph nodes. Symptoms include redness, swelling, and other skin changes.
• Stage IV: Cancer cells have spread to distant areas of the body, such as the lungs or bones.
  

Inflammatory Breast Cancer Treatments

The goal of treatment for IBC is to achieve remission, meaning there are no signs of the cancer being present in your body. The goal is to reduce symptoms and improve your quality of life if remission isn't possible.

Chemotherapy

This is the first step for most people with IBC. The goal is to shrink a breast tumor before surgery. Pre-surgery chemotherapy is called neoadjuvant chemotherapy.

A healthcare provider will likely recommend six cycles of chemotherapy over four to six months. Chemotherapy drugs include anthracyclines like Adriamycin (doxorubicin) and Ellence (epirubicin) or taxanes like Taxol (paclitaxel) and Taxotere (docetaxel).

Hormone Therapy

This may be an option if the cancer cells have hormone receptors. Drugs like Nolvadex (tamoxifen) prevent estrogen from binding to its receptor. Aromatase inhibitors block the body's ability to make estrogen. These drugs can shrink the tumor in the breast.

Surgery

A healthcare provider will discuss surgical options with you once the tumor has shrunk enough. A radical mastectomy (removes the entire breast) is a common option for IBC. A surgeon may also recommend removing the nearby lymph nodes.

Targeted or Radiation Therapy

A healthcare provider may recommend one of these options after surgery. Targeted therapy uses drugs that target certain proteins in the cancer cells. Herceptin (trastuzumab) works for cancer cells that have high levels of HER2 protein. Radiation therapy to the chest wall can kill any remaining cancer cells. It's usually given five days per week for six weeks. 

Some people also choose to have breast reconstruction surgery after their procedure is over. Discuss this surgical option with a healthcare provider once you've completed radiation therapy.

Prevention

Experts are unsure what exactly causes IBC, so it's not always possible to prevent it. Obesity is a known and modifiable (changeable) risk factor, so managing your weight can be helpful. 

Complications 

IBC may lead to complications as cancer cells grow and spread. Metastasis, or when cancer cells spread to other areas of the body, causes the most common complications.

Possible complications include:

• Kidney stones: Cancer cells that spread to the bone can lead to too much calcium in the blood (hypercalcemia). This raises the risk of kidney stones.
• Nausea and vomiting: Up to half of people with IBC have liver lesions, which may cause abdominal pain, nausea, and vomiting.
• Neurological problems: You may experience memory problems and confusion if cancer cells spread to the brain.
• Pain: Cancer cells that spread to the bones or organs may cause severe pain.
  

Living With Inflammatory Breast Cancer

IBC is an aggressive and rapidly growing type of cancer. This diagnosis has likely changed every area of your life. It's important to work with a healthcare team to develop a long-term treatment plan that helps manage symptoms and improves your quality of life. 

Most healthcare providers determine a person's prognosis using the five-year survival rate. This rate estimates the percentage of people living five years after a cancer diagnosis. 

The five-year survival rates for IBC are:

It may be helpful to work with several different specialists to live as well as possible with this type of cancer. You might work with a dietician or nutritionist to develop a meal plan that gives your body the nutrients you need. A pain specialist helps reduce discomfort if you have complications like chronic pain. You may also work with a mental health specialist to learn coping skills and discuss any psychological concerns.