Breast Cancer, Inflammatory

• • Rapidly growing, painful mass of the breast

  • No distinct mass as tumor infiltrates breast diffusely

  • Name refers to clinical appearance not specific histologic subtype of mammary carcinoma

Epidemiology

• • 3% of all breast cancer cases

  • Average age of diagnosis is 55

  • Rarely occurs in men or children

  • No predisposition conferred by pregnancy or lactation

Symptoms and Signs

• • Breast mass

  • Erythematous, edematous, warm skin on breast

  • Failure to respond to antibiotics (if initially diagnosed as breast cellulitis) within 1-2 weeks

  • Peau d'orange changes, most notable over dependent portions of the breast

Laboratory Findings

• • Biopsy shows invasion of subdermal lymphatics

Imaging Findings

• • Mammography can demonstrate a mass, stromal coarsening, increased parenchymal density, or skin thickening

• • Metastases tend to occur early and widely

  • Skin changes may precede palpable breast mass

  • Tumors are more likely to be estrogen receptor negative compared with tumors that do not have an inflammatory component

Rule Out

• • Mastitis/breast abscess

• • Complete history (including family and reproductive) and physical exam

  • Bilateral mammography

  • Breast biopsy

• • Rarely curable

  • Mastectomy rarely indicated alone

  • Multimodal therapy with radiation, chemotherapy, and hormonal therapy

Surgery

Indications

• • Mastectomy for local control of disease

Medications

• • Anthracycline-based combination chemotherapy

  • External beam radiation

Treatment Monitoring

• • Self breast exams

  • Semiannual clinical breast exam

  • Annual bilateral mammogram

Complications

• • Edema of the arm

  • Metastatic spread

  • Local chest wall involvement

Prognosis

• • Rarely curable as metastases occur early and widely

  • 5-year survival about 50%

References

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.nccn.org/