Breast: Inflammatory Breast Cancer

Basics

• Very Aggressive Locally Advanced Breast Cancer
• Highly Angiogenic & Angioinvasive (High Metastatic Potential)
• Almost All Have Lymph Node Involvement
• Almost 1/3 Have Distant Metastases
• Automatically T4 Staging

Types

• Primary Inflammatory Breast Cancer: De Novo Inflammatory Breast Cancer
• Secondary Inflammatory Breast Cancer: An Inflammatory Recurrence of a Noninflammatory Primary Breast Cancer
  • Often Occurs on the Chest Wall at the Site of Prior Mastectomy

Presentation

• Breast Pain
• Rapidly Growing Mass (Weeks-Months)
• Warmth
• Erythema & Edema
• “Peau d’Orange”: Lymphedema from Dermal Lymphatic Invasion

Diagnosis

• Initial Evaluation: Physical Exam, Imaging & Biopsies
• Biopsies:
  • Core Needle Biopsy – To Establish Invasive Carcinoma
  • Full Thickness Punch Biopsy of Skin (Usually ≥ 2 Biopsies) – To Establish Dermal Lymphatic Invasion
  • US-Guided FNA of Suspicious Lymph Nodes
• Diagnostic Criteria:
  • Rapid Onset of Erythema, Edema, Warmth and/or Peau d’Orange
  • Duration ≤ 6 Months
  • Erythema Occupying ≥ 1/3 the Breast
  • Pathologic Confirmation of Invasive Carcinoma

Treatment

• Primary Treatment:
  • Neoadjuvant Chemotherapy
  • Modified Radial Mastectomy (MRM)
  • Adjuvant Radiation Therapy
• If Tumor Remains Inoperable with Minimal Response After Multiple Rounds of Neoadjuvant Chemotherapy: Avoid Surgery & Treat with Radiation Therapy Alone