Inflammatory breast cancer
Breast Cancer
Breast Cancer
risk factor | genetic | malignant | stats | staging | metastic | unusual cancer
inflammatory | paget's disease | pregnancy

Inflammatory Breast Cancer - Rare, Lump-free and Deadly

Every woman knows the importance of checking her breasts and to seek immediate medical help when she discovers a lumpSo it’s pretty scary to now hear that you don’t have to have a lump to have Breast Cancer. Inflammatory Breast Cancer (IBC) usually grows in nests or sheets rather than as a confined, solid tumour, which is why so many cases remain undiagnosed. It’s a rare, advanced and accelerated form of Breast Cancer usually not detected by mammograms or ultrasounds, and because the symptoms are similar to mastitis - a breast infection – it’s frequently misdiagnosed, often with deadly results.

LUCINDA GREYLING (30), married, mother of Saunté(6) and Jaydyn(3)
In May last year I noticed a puckering and thickening like orange peel on my right breast. It didn’t worry me- there was no lump and I had no pain- so I ignored it for a month. I discussed it with the nursing sister at the pharmacy I worked at and she suggested I see a specialist surgeon ‘just in case’. He diagnosed an infection and prescribed antibiotics and told me to come back if it didn’t clear up. Nothing changed so I went back to him and he performed a surgical biopsy. My breast became so inflamed that it swelled up to double its size and constantly oozed for 6 weeks. This time I did have an infection – the result of the procedure- so I went back onto antibiotics. The biopsy came back negative which was good news but I was still concerned. The breast remained inflammed so I went for a second opinion in September - the surgeon I consulted was horrified at what she saw. She immediately told me she suspected Inflammatory Breast Cancer (IBC) and that I should never have been cut. I underwent a core needle aspiration and this time the diagnosis came back positive. I was in tears and total shock: I’d been worried and concerned but I never suspected cancer – there was no lump. My first thoughts were for my children, what if I was to die? I’d never even heard of IBC and what I learnt filled me with terror: it’s extremely fast growing and very aggressive - a very rare form of breast cancer that’s often misdiagnosed. I started chemotherapy right away. To some extent there was also a certain relief at finally knowing what I was dealing with and no longer being in the dark but then came the anger - I wanted to nail the surgeon who’d missed my cancer but didn’t know how to go about it. How many other women are there like me? The scary thing is that if I hadn’t persisted and gone for a second opinion, I have no doubt I’d be in my grave by now…. I had my mastectomy and reconstruction in April this year followed by radiation and was given the all clear in July. Today I feel great. I’ve just turned 30 - a brand new decade for a brand new me - and plan on spending the second chance I’ve been given taking Life by the horns!

SUE PLUMB (36), married, 2 sons, aged 2 and 4
At the end of March this year, having just relocated from Durban to Johannesburg, I noticed the redness on my left breast that I’d been aware of for a while was still present, and that one of the veins underneath my skin seemed infected. I knew no doctors and was referred to a gynae by a friend. Deep down, in my subconscious I was concerned about breast cancer - when it comes to breasts what else can it be? When I mentioned the possibility the gynae said no, it was an infection. I insisted on going for a mammogram even though he felt it wasn’t necessary, and when the mammogram picked up something I was sent for a scan. The radiographer was uncertain and gave me the option of going onto antibiotics to treat an infection or having a core biopsy. I chose the biopsy. He was very quiet during the procedure which made even more anxious because deep down I knew. Yet it was still a huge shock when I got the diagnosis of IBC – I never knew there were different types of breast cancer and I kept thinking I was going to die. Being new to the city we knew no specialists and had no idea what to do until someone mentioned the Breast Clinic at Netcare Milpark Hospital which made sense to me. My husband drove me there immediately and I sat in the waiting room without an appointment crying until the specialist could see me. She knew exactly what it was, what the vein was, what the redness was, why the one breast was larger than the other which is when I began to realise it wasn’t the beginning of the end. But the thought of the treatment and its challenges terrified me, while the fact that I was going to lose my hair was a major issue – I’ve had long hair all my life and couldn’t believe I was going to be bald. I’m still having chemo, and am due to have surgery this month (October) – a mastectomy with reconstruction. Obviously I have my good days and bad days and I do at times feel rough around the edge which due to the cumulative effects of the treatment. I really enjoy my work which helps, keeping me busy, and I cope by staying positive, motivated and determined to beat this, which is what I’m going to do because I’ve got a hell of a lot to live for.

JILL HAYES (66), married, 4 children, 6 grandchildren, 2 great grandchildren
I’ve always been for regular checkups and have always had sonar scans with my mammograms as I had very  large breasts - size 34G! I also had very dense tissue. In August 2004 I had a mammogram which was fine but one month later I noticed a red rash around my right nipple. There was no roughness, no discharge, just the sort of blush you get on your face. I left it for a couple of days and then went to see my gynae who took one look at it and personally accompanied me to a general surgeon. I was sent for another mammie and sonar but nothing showed up so they redid it. The surgeon then told me he was booking me in – the next day- to have a biopsy under general anaesthetic and that if he discovered it was breast cancer he was going to remove my breast. I nearly had a fit - all I could think about was that I was going to be completely lopsided. When I mentioned my fears  I was told there was nothing he could do and that I could come back to him one year later to sort it out. I wasn’t sure I’d even be able to walk without falling over with only one breast so I went for a second opinion.

My new surgeon initially treated it as an infection and then sent me for another two rounds of mammies and sonars followed by a core needle biopsy which is when I discovered I had IBC. I was devastated - it’s difficult to describe what it feels like to find out you have cancer. What was even tougher to comprehend was the fact that I had no lump. When you talk about breast cancer that’s what you talk about - lumps- not a rash or a blush. Because IBC is so progressive, I was hit very hard with 5 months of chemo and then we discussed a mastectomy. My reaction was oh, no, not again, but my surgeon assured me that she would never ever let a woman walk out of hospital lopsided which to her was the cruelest thing to do. That put my mind to rest. I had a very  deep mastectomy followed by radiation 2 years ago and haven’t looked back. Today I’m absolutely fine. I love my new breasts and am sorry I didn’t have them done years ago. I’m on medication - a hormone blocker- which does have its side effects but I’m not complaining because going through something like this gives you a different outlook - you appreciate things more and Life becomes more precious. And right now I’m enjoying every single minute of mine!

Inflammatory Breast Cancer : The Facts
Inflammatory Breast Cancer, says Dr Carol Ann Benn, a surgeon with a special interest in breast cancer, is a rare, particularly virulent form of breast cancer that grows so quickly that the breast looks red and swollen (like inflammation) and feels warm. It was once universally fatal within a short time as it metastasizes (spreads) so rapidly. “The problem with IBC,” she explains, “Is that it’s often mistaken for a breast infection either in women who are pregnant or breastfeeding, or in older women. And it’s particularly difficult to detect on mammogram and ultrasound as it has a ‘white out’ appearance so the tissue looks dense, and individual lumps are not seen. My current recommendation is that any woman who has a mastitis that does not settle on antibiotics within 2 weeks must have a repeat mammogram, ultrasound, possibly an MRI , and core needle biopsies of the inflamed area. Fine needle aspiration (FNA) is highly inaccurate as it’s a blind surgical biopsy. FNA is a type of needle biopsy that is done with a fine (small gauge) needle and only picks up cells. A core biopsy is a wider bore needle that takes a sample of tissue (a thin sliver) and is more accurate as it gives you cells and tissue. Core needle biopsy is essential and may need to be repeated. Chemotherapy is the mainstay of treatment for IBC and should be given primarily, followed by surgery and radiation. Breakthroughs in chemotherapy and the use of target therapies such as Herceptin (a target therapy that is given to women with aggressive breast cancers that are carry a Her 2 neu “marker ”on the cells in a large percentage so that the drug can attach at that receptor ( Her2 neu receptor) and kill the cancer cells (if the tumour is sensitive) has resulted in ever-increasing better responses from this ugly tumour to chemotherapy. Response rates of over 70 percent are now being seen to chemotherapy as well as 5 year survival rates of 10-55 percent. Hopefully these statistics will continue to improve with the opening in America last year of the University of Texas M.D.Anderson Inflammatory Breast Cancer Clinic and Research Program, the world's first clinic devoted solely to research, diagnosis and treatment of IBC.

Inflammatory breast cancer isnot a common presentation of breast cancer and that is why so few women have heard about it.
All doctors (particularly gynaes, GP’s and surgeons) treating breast problems should be on the look out for women presenting with breast infections that don’t settle.

Symptoms of IBC

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Swelling, usually sudden, sometimes a cup-size in a few days.

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Itching.

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Pink, red, or dark colored area (called erythema) sometimes with texture similar to the skin of an orange (called peau d'orange).

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Ridges and thickened areas of the skin.

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What appears to be a bruise that does not go away.

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Nipple retraction.

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Nipple discharge, may or may not be bloody.

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Breast is warm to the touch.

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Breast pain (from a constant ache to stabbing pains).

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Change in color and texture of the areola.