Inflammatory breast cancer is one of the most aggressive types of breast cancer that can occur in women of all ages (and, very rarely, in men). This is called inflammation because it often comes with symptoms resembling inflammation. Regardless of its name, whether inflammation contributes to the development of "inflammatory breast cancer" remains an ongoing field of research. However it can present with very varied signs and symptoms, often without detectable tumors and therefore often undetected by mammography or ultrasound.
Typical presentation is rapid swelling, sometimes associated with skin changes (peau d'orange), and nipple retraction. Other symptoms include a rapid increase in breast size, redness, itching constantly, the skin feels hot to the touch. IBC often resembles mastitis initially.
Only about 50-75% of cases have a distinctive presentation. Symptoms can be completely atypical such as acute central venous thrombosis as the only symptom that appears.
IBC only makes up a small proportion of cases of breast cancer (1-6% in the US). IBC is often diagnosed in younger women even though the mean age of presentation does not differ greatly from other types of breast cancer (mean age 57). African-Americans are usually diagnosed at a younger age than Caucasian women, and also have a higher risk of acquiring IBC. Recent advances in therapy have significantly improved prognosis and at least one third of women will survive the diagnosis for up to 10 years or more.
Video Inflammatory breast cancer
Symptoms
Symptoms vary widely and may be absent in occult breast cancer occult inflammation. The first rapid symptoms are typical, the breasts often look swollen and red, or "inflamed", sometimes overnight, and easily misdiagnosed as mastitis. The invasion of the local lymphatic drain destroys drainage and causes breast engorgement. Because breast skin is moored by the Cooper suspensorium ligament, fluid accumulation can cause breast skin to have a dimpled appearance similar to that of peel d'orange (peau d'orange). Tumors that are palpable are often unclear as in other breast cancers.
Symptoms may include:
- Sudden swelling of the breast
- Breast skin changes
- Red area with orange peel skin texture (peau d'orange)
- Put retraction (flat view) or exit
- Pain in the breast
- Breast itch
- Swollen lymph nodes under the arm or on the neck
- Unusual warmth of affected breasts
- Breasts are harder or firmer
Other symptoms may rarely include:
- Swelling arm
- Breast size may decrease rather than increase
- Although the dominant mass exists in many cases, most inflammatory cancers appear as diffuse infiltration of the breast without a well-defined tumor.
- A lump can appear and grow quickly
Most patients do not experience all IBC symptoms. Not all symptoms need to be present for diagnosis.
Maps Inflammatory breast cancer
Diagnosis
The only reliable diagnostic method is a full-thickness skin biopsy. Mammography, MRI or ultrasound often show signs of suspicion; But in a significant proportion of cases, they will lose the diagnosis.
Typical clinical presentation in only 50-75% of cases; and many other conditions such as mastitis or even heart insufficiency may mimic the typical symptoms of Inflammatory Breast Cancer.
Temporary regression or fluctuation of symptoms, spontaneous or in response to conventional treatment or hormonal events should not be considered significant in diagnosis. Treatment with antibiotics or progesterone has been observed to cause temporary symptoms regression in some cases.
Characterization
Inflammatory breast cancer is a high-grade aneuploid cancer, with p53 mutation and overexpression, high E-cadherin levels and abnormal cadherin function. Often regarded as systemic cancer. A large number of IBC cases are present as triple negative breast cancer (TNBC). Similar to TNBC as opposed to estrogen receptor positive breast cancer, there is a high rate of recurrence and metastasis within the first 3 years after presentation but some late events (5 years or more).
It is characterized by the presence of cancer cells in subdermal lymphatics in skin biopsy. Consequently, IBC is always staged at stage IIIB or above as advanced local disease is a classical prognostic indicator.
The search for biomolecular characteristics generates a large number of possible markers, such as loss of LIBC and WISP3 expressions. Inflammatory breast cancer is in many ways very similar to late-stage or metastatic breast cancer; However, it can be distinguished from the types of cancer both by molecular traces and clinical presentation. At the molecular level some similarities exist with pancreatic cancer.
The status of estrogen and progesterone receptors is often negative, corresponding to poor survival. The tumors are highly angiogenic and vascular, with high levels of VEGF and bFGF expression.
A number of proteins and signaling pathways exhibit behaviors that can be considered paradoxical compared to their function in normal tissue and other types of breast cancer.
- caveolin-1 and -2 are overexpressed and may contribute to the motility of tumor cells
- E-cadherin is expressed and paradoxically associated with an aggressive type.
RhoC GTPase is expressed, probably related to the overexpression (hypomethylation) of caveolin-1 and -2. Caveolin paradoxically promotes tumors. Expression of NF-B pathway activation may contribute to the inflammatory phenotype.
The EGFR pathway is generally active in inflammatory breast cancer and this has shown some clinical signals that EGFR targeting therapy may be effective in inflaming breast cancer.
Epidemiology
This happens in all adult age groups. While most patients are between 40 and 59 years of age, age predilection is much clearer than in non-inflammatory breast cancers. The overall rate was 1.3 cases per 100,000, black women (1.6) had the highest rates, Asian women and the Pacific Islands lowest (0.7).
The best known predictor of breast cancer risk does not apply to inflammatory breast cancer. This may be somewhat related to the duration of cumulative breastfeeding.
The role of hormone
Distribution of age and its relationship to breastfeeding duration indicates a kind of hormonal involvement in etiology, but there are significant differences compared to normal breast cancer.
Usually IBC shows low levels of estrogen and progesterone receptor sensitivity, according to poor results. In cases with positive estrogen receptor status, antihormonal treatment is believed to improve yield.
Surprisingly, some findings suggest that a very aggressive IBC phenotype is characterized by high levels of NF kappaB target gene expression that can - under laboratory conditions - be modulated by estrogens, but not by tamoxifen.
Staging
Staging is designed to help organize different treatment plans and to understand better prognosis. Staging for IBC has been adjusted to meet specific disease characteristics. IBC is usually diagnosed in one of these stages:
- Stage IIIB - at least 1/3 of the breast skin is affected, and may have 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 in the breast or under the arm.
- Stage IIIC - Involvement of the N3 node with inflamed breast will increase the disease from Stage IIIB to Stage IIIC.
- Stage IV means the cancer has spread to other organs. These can include bone, lungs, liver, and/or brain.
Treatment
Surgery has traditionally played a limited role in IBC care because it is considered a systemic cancer. However, the role of surgical intervention is being reevaluated and is now considered an essential part of the entire treatment process. The standard treatment for newly diagnosed inflammatory breast cancer is to receive systemic therapy prior to surgery. Achieving no disease in the surgical sample provides the best prognosis. Surgery is a modified radical mastectomy. Lumpectomy, segmentectomy, or skin-saving mastectomy is not recommended. Immediate reconstruction is not recommended. Operation ahead is contraindicated. After surgery, all cases are recommended for radiation therapy unless they are contraindicated.
Due to the aggressive nature of the disease, it is highly recommended to be seen by IBC specialists by multidisciplinary teams.
Furthermore, it is essential to seek new targeted therapies in clinical trial settings. Three modalities, surgery, chemotherapy, and radiation are underutilized in the US. Estrogen and Progesterone positive receptors do not show a better prognosis. A complete pathological response to preoperative chemotherapy provides a better prognosis than a pathologically incomplete response. The loss of extensive heterozygosity and breast inflammation in the first clinical examination had a much poorer prognosis. Premenopausal cases have a much poorer prognosis. In postmenopausal cases, skinny women have a much better prognosis than obese women. Among patients with distant metastases at diagnosis (stage IV disease), overall survival (OS) was worse in patients with IBC than in those with non-IBC.
See also
- Inflammatory Breast Cancer Associates
References
External links
- Inflammatory Breast Cancer Research Foundation
- MD Anderson Inflammatory Breast Cancer Clinic and Research Program
- Inflammatory Breast Cancer Foundation
Source of the article : Wikipedia
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