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Inflammatory Breast Cancer

15 Dec 2016Health Essays

Inflammatory breast cancer is a less frequently occurring type of cancer that is very aggressive in nature, as the cancer cells block the local lymph vessels of the breast skin, making the breast appears inflamed, swollen and red. In the US, about 1 to 5 % of all breast malignancies are of this type. The term inflammatory in “IBC” is really not a correct term for this cancer, as the tissues are really not inflamed but superficially appear to be inflamed. One of the main problems associated with the IBC type of cancer is that many people may consider it to be a mild breast infection, and may not visit the doctor to provide relief. Frequently, the patient may consume antibiotics in order to seek relief from the so-thought-of infection.

However, antibiotics would not work for this condition. The prognosis and survival rate are much poorer for this condition than other form of breast cancers. The symptoms of IBC include swollen and reddened appearance of the breast, breast pain, breast mass, unusual warmth, itching, tenderness, enlargement of the regional lymph nodes, flattening of the nipples, etc. A close differential diagnosis needs to be conducted to differentiate it from inflammatory conditions such as mastitis and other types of breast cancers.

The condition usually occurs during the 5 to the 6th decade of life. Black American women are more likely to develop this condition than Caucasians. The diagnosis of IBC is made based on the history, signs, symptoms, physical examination, biopsy, X-rays, bone scans, ultrasound and CT scans. A hallmark of IBC is the presence of cancerous cells in the lymphatic vessels of the skin. This can be confirmed through the biopsy and ultrasound. According to the NCI, there are three stages of IBC cancer namely stage IIIB, stage IIIC and Stage IV (NCI. 2006, NCI, 2008, Mayo Clinic. 2008). In stage IIIB, the cancerous cells spread to the local tissues including the surrounding lymph vessels, whereas in Stage IV the tumor cells spreads to the other parts of the body including the distant tissues and the internal organs. The staging of cancer helps to determine the treatment plan, the chances of recurrence, the prognosis and the survival rate.

The treatment measures that may be required in the treatment of IBC include chemotherapy (first-line measure), mastectomy, radiation therapy, hormonal therapy and supportive care. Radiotherapy is administered to the chest wall to help destroy the cancerous cells in the region. Mastectomy helps to also remove the bulk of the tumor. Chemotherapy helps to reduce the number of cancerous cells systemically. Hormonal therapy is also required to help reduce the effect of the female estrogen hormone on the growth and multiplication of the cancerous cells. The prognosis of IBC is extremely poor (NCI. 2006, NCI, 2008, Mayo Clinic. 2008). The chances of survival are higher if a combination of radiotherapy, chemotherapy and surgery are administered. The five-year survival rate has been found to be around 42 % (IV Borisov, 2008).

One of the main questions which may be asked is whether IBC an advanced stage of cancer or is by itself a separate cancerous entity that is aggressive in nature right from the beginning. Let us now look at some of the sources and examine what they provide about IBC. According to the TNM (Tumor, Node and Metastasis) Classification of breast cancer, five stages are present, namely stage0, stage 1, stage 2, stage 3 and stage 4. Each of these stages is again pided into separate sub-pisions. In stage IIIB, the cancer cells spread to the surrounding tissues including the skin, chest wall, ribs or the chest wall muscles. The tumor cells also spread to involve the lymph node and vessels of the breast and/or the axillary region. In stage IIIC, the tumor need not be present, or even if present can be of any size. The tumor cells must cells would have spread to the chest wall and may involve the breast skin.

However, the lymph nodes that lie above the collar bone, below the collar bone, the armpits and those near the breast bone seem to be involved. Again depending on the exact area it has spread, the Stage IIIC cases can be pided into operable and inoperable cases. In operable cases, the tumor cells are present in the lymph nodes below the collar bone, the armpits, and near the breast bone. They should not cross into the lymph nodes that lie above the collar bone. Once the tumor cells spreads into the lymph nodes that lie above the collar bone, they are classified as inoperable cases (thus reducing their prognosis). In stage IV, the tumor cells are present in various other tissues and internal organs of the body including the bones, lungs, liver, brain, etc (NCI, 2008, NCI, 2004 and NCI, 2006).

However, IBC also has characteristics that are unique to this entity only. Some of the unique characteristics noticed include:

  • The condition more often occurs in younger woman
  • It tends to spread rapidly right from the beginning
  • There are several alterations between IBC and other local advancing breast cancers (which promotes local advancement of the cancer)
  • The tumor frequently tries to involve the blood vessels and the lymph vessels more often than the non-IBC forms.
  • IBC is frequently found to be estrogen-receptor negative than the non-IBC forms. IBC tumors are more likely not to release estrogen compared to the non-IBC forms
  • IBC tumor is more often found to be positive for various altered gene forms including ERBB2, EGFR and TP53 (TP53 positive found in 30 to 60 percent cases; and in general 40 to 45 % of any of the three genetic alterations)
  • Several substances such as cytokines, growth factors, etc, are found to often be involved in IBC cancer compared to non-IBC.
  • The intramural density of cancerous cells was found to be higher in IBC compared to non-IBC tumors (thus showing that IBC is highly angiogenic in nature)
  • Involvement of other genetic alterations in IBC

These have closely demonstrated that IBC is a separate entity of cancer, that is aggressive in nature (right from the beginning), having certain molecular, genetic and pathological characteristics. Certain genetic alterations would increase the risk of developing IBC. Due to it aggressive nature, it is considered either as stage IIIB or IIIC or stage IV.

References:

  • Florence Lerebours, Ivan Bieche, and Rosette Lidereau. “Update on inflammatory breast cancer.” Breast Cancer Res. 7.2 (2005): 52–58. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1064141
  • IV Borisov and TV Chkhikvadze. “Inflammatory breast cancer: clinical course, diagnosis and treatment.” Vopr Onkol 54.1 (2008):86-9. http://www.ncbi.nlm.nih.gov/pubmed/18416065?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
  • National Cancer Institute. “Dictionary of Cancer Terms.” 2008. NCI. 27 July 2008. http://www.cancer.gov/dictionary/db_alpha.aspx?expand=s#stage
  • National Cancer Institute. “Inflammatory Breast Cancer: Questions and Answers.” 2006. NCI. 27 July 2008 http://www.cancer.gov/cancertopics/factsheet/sites-types/ibc
  • National Cancer Institute. “Staging: Questions and Answers.” 2004. NCI. 27 July 2008. http://www.cancer.gov/cancertopics/factsheet/Detection/staging
  • Mayo Clinic Staff. “Inflammatory breast cancer.” 2008. Mayo Clinic. 27 July 2008 http://www.mayoclinic.com/health/inflammatory-breast-cancer/DS00632

 

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