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  • • 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

Barni S et al: Locally advanced breast cancer. Curr Opin Obstet Gynecol 2006;18:47.  [PubMed: 16493260]
Cristofanilli M et al: Inflammatory breast cancer (IBC) and patterns of recurrence: understanding the biology of a unique disease. Cancer 2007;110:1436.  [PubMed: 17694554]
Dawood S et al: What progress have we made in managing inflammatory breast cancer? Oncology (Williston Park) 2007;21:673.  [PubMed: 17564325]

Practice Guidelines

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