Inflammatory Breast Cancer is a very uncommon type of breast cancer. In this type of breast cancer, the cancer cells block the lymph vessels in the skin of the breast.This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” IBC accounts for 1 to 5 percent of all breast cancer cases in the United States . It tends to be diagnosed in younger women compared to non-IBC breast cancer. It occurs more frequently and at a younger age in African Americans than in Whites. Like other types of breast cancer, IBC can occur in men, but usually at an older age than in women. Some studies have shown an association between family history of breast cancer and IBC, but more studies are needed to draw firm conclusions.
symptoms of Inflammatory breast cancer:

Symptoms of Inflammatory breast cancer may include redness, swelling, and warmth in the breast, often without a distinct lump in the breast. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast may also appear pink, reddish purple, or bruised. The skin may also have ridges or appear pitted, like the skin of an orange (called peau d'orange), which is caused by a buildup of fluid and edema (swelling) in the breast. Other symptoms include heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward) . These symptoms usually develop quickly—over a period of weeks or months. Swollen lymph nodes may also be present under the arm, above the collarbone, or in both places. However, it is important to note that these symptoms may also be signs of other conditions such as infection, injury, or other types of cancer .
More Symptoms to look for can be one or many of these symptoms:

• Pain in the breast
• Skin changes in breast
• Reddened area with texture and thickness of an orange (peau d’orange)
• Bruise that does not go away
• Sudden swelling of the breast
• Itching of breast
• Nipple retraction (flattened look)or discharge
• Swelling of lymph nodes under the arm or in the neck
• Unusual warmth of the affected breast
• Breast is harder or firmer

Inflammatory breast cancer Diagnosis?

Diagnosis of IBC is based primarily on the results of a doctor's clinical examination . Biopsy, mammogram, and breast ultrasound are used to confirm the diagnosis. IBC is classified as either stage IIIB or stage IV breast cancer . Stage IIIB breast cancers are locally advanced; stage IV breast cancer is cancer that has spread to other organs. IBC tends to grow rapidly, and the physical appearance of the breast of patients with IBC is different from that of patients with other stage III breast cancers. IBC is an especially aggressive, locally advanced breast cancer.

Cancer staging describes the extent or severity of an individual's cancer. (More information on staging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers at http://www.cancer.gov/cancertopics/factsheet/Detection/staging on the Internet.) Knowing a cancer's stage helps the doctor develop a treatment plan and estimate prognosis (the likely outcome or course of the disease; the chance of recovery or recurrence).

• Surgical biopsy – larger samples of the breast skin and underlying tissue can be collected in a surgical or skin biopsy, with better chances for identifying the cancer cells.
• PET Scan – In the near future, this could be one of the most important diagnostic/staging tests for IBC, though it is still under study. PET scans enable oncologists to see more disease.

Stages and Staging Inflammatory breast cancer.

Staging is based on the size of the tumor and if it has spread beyond the breast. It is also based on if the cancer is invasive or non-invasive. Staging is designed to help organize the different treatment plans and to understand the prognosis better. IBC has three different staging groups:

• Stage IIIB means the cancer has spread to tissues near the breast, such as the skin or chest wall, including the ribs and muscles in the chest. The cancer may have spread to lymph nodes within the breast or under the arm.
• Stage IIIC means the cancer has spread to lymph nodes beneath the collarbone and near the neck. The cancer also may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
• Stage IV means that the cancer has spread to other organs. These can include the bones, lungs, liver, and/or brain, as well as the lymph nodes in the neck. ^[7]

Inflammatory breast cancer Treatment methods:

Treatment consisting of chemotherapy, targeted therapy, surgery, radiation therapy, and hormonal therapy is used to treat IBC. Patients may also receive supportive care to help manage the side effects of the cancer and its treatment. Chemotherapy (anticancer drugs) is generally the first treatment for patients with IBC, and is called neoadjuvant therapy. Chemotherapy is systemic treatment, which means that it affects cells throughout the body. The purpose of chemotherapy is to control or kill cancer cells, including those that may have spread to other parts of the body.

• Chemotherapy: Inflammatory breast cancer is typically treated with chemotherapy before surgery.
• Radiation therapy: often used after a mastectomy, it uses high-energy beams to kill cancer cells. After treatment, patients may have some side effects like swelling and redness of the breast.
• Hormone therapy: this is used in when patients test positive for estrogen and/or progesterone receptors on tumor cells. Hormone therapy is given after surgery and chemotherapy are completed. This is often given for 5 years.
• Surgery: a mastectomy with lymph node surgery is highly recommended for women with IBC. A lumpectomy, when only a portion of the breast is removed, is not an option for IBC patients. A lymph node dissection is also recommended over a sentinel lymph node biopsy. Lymphedema, swelling of the arm and the hand on the side of the body where surgery was performed, may be a complication after a lymph node dissection. Reconstruction of the breast may be an option for healthy women after a mastectomy. However, for patients who smoke or have diabetes, complications are more common.

After chemotherapy, patients with IBC may undergo surgery and radiation therapy to the chest wall. Both radiation and surgery are local treatments that affect only cells in the tumor and the immediately surrounding area. The purpose of surgery is to remove the tumor from the body, while the purpose of radiation therapy is to destroy remaining cancer cells. Surgery to remove the breast (or as much of the breast tissue as possible) is called a mastectomy. Lymph node dissection (removal of the lymph nodes in the underarm area for examination under a microscope) is also done during this surgery.

After initial systemic and local treatment, patients with IBC may receive additional systemic treatments to reduce the risk of recurrence (cancer coming back). Such treatments may include additional chemotherapy, hormonal therapy (treatment that interferes with the effects of the female hormone estrogen, which can promote the growth of breast cancer cells), targeted therapy (such as trastuzumab, also known as Herceptin®), or all three. Trastuzumab is administered to patients whose tumors overexpress the HER–2 tumor protein. More information about Herceptin and the HER–2 protein is available in the NCI fact sheet Herceptin® (Trastuzumab): Questions and Answers, which can be found at http://www.cancer.gov/cancertopics/factsheet/therapy/herceptin on the Internet.

Supportive care is treatment given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. It prevents or treats as early as possible the symptoms of the disease, side effects caused by treatment of the disease, and psychological, social, and spiritual problems related to the disease or its treatment. For example, compression garments may be used to treat lymphedema (swelling caused by excess fluid buildup) resulting from radiation therapy or the removal of lymph nodes. Additionally, meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. A social worker can often suggest resources for help with recovery, emotional support, financial aid, transportation, or home care.

Prevention of Inflammatory breast cancer?

Chemoprevention is a way to help reduce and prevent the chances of women getting breast cancer. Two common types of medicine used are tamoxifen and raloxifene.

Tamoxifen is FDA approved. It reduces the effects of estrogen which influences breast tumor growth in women 35 and over. It is used in patients who have had breast cancer to prevent recurrence, as it is shown to improve the risk of recurrence. Trials have been done worldwide to see if tamoxifen would work with women who did not have cancer but had a high risk of getting it. Studies show that it lowered the women’s risk by one-third. It also showed that the women were still at low risk five years after they stopped taking the pill.

Side effects include menopausal symptoms, weight gain, life threatening blood clots, cancer of the womb lining for post-menopausal women , bladder and urinary problems, vaginal discharge, vaginal dryness, nausea and menstrual irregularities, strokes, cataracts, and Endometrial cancer or uterine cancer.

Some benefits of tamoxifen include lowering cholesterol for post menopausal women and keeping bones healthy and strong. In pre-menopausal women estrogen reduces risks of weak bones and heart disease.

Raloxifene is FDA approved. This pill is used to reduce breast cancer risk in post-menopausal women. It is also approved for helping to prevent bone weakening and osteoporosis. There was a study done that shows that raloxifene did not prevent the risk of non-invasive breast cancers as well as tamoxifen did.

Side effects include blood clots, uterine cancers, hot flashes, vaginal dryness, vaginal irritation, flu like symptoms, leg cramps, swelling of hands or feet, and strokes.

Benefits include improved bone strength and reduced risk of osteoporosis.

Aromatase inhibitors are not FDA approved for prevention of breast cancer. These inhibitors reduce the amount of estrogen that your body produces depriving cancer cells of getting their food to grow. These are commonly used after surgery to prevent recurrence. Aromatase inhibitors are only used for postmenopausal women.

Side effects include hot flashes, headache, joint and muscle pain, and vaginal dryness.

Risks include broken bones and osteoporosis.

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