Inflammatory Breast Cancer, often shortened to "IBC", is an aggressive form of breast cancer. Thankfully it is not very common. It is characterized by distinct symptoms and requires specific expertise to diagnose and treat successfully.

The symptoms of IBC can be striking but sometimes start out as a subtle difference from the normal appearance of the breast. However, IBC progresses quickly (over the course of days to a few weeks) and very early on can break away from the initial tumor site and invade local lymphatic and blood vessels. However, with prompt diagnosis and treatment, inflammatory breast cancer is treatable, and the number of long-term survivors is steadily increasing. This type of cancer is called “inflammatory” because the cancer cells block the lymph vessels in the skin over the breast, giving the breast a swollen and reddened appearance.

The following is a list of the potential signs of IBC – note however that not all of these signs must be present for IBC to be correctly diagnosed:

• A palpable breast lump may or may not be found. It is frequently not felt and frequently missed on mammography. Do not ignore the other symptoms below if a lump is not found. More sensitive imaging methods such as MRI can highlight IBC in women who have “clear” mammograms or who have highly dense breasts that show up as white on a mammogram.
• Swollen lymph nodes may also be present under the arm, near the collarbone, or in both places.

The appearance of the breast is distinct from other breast cancers:

• IBC causes a swollen breast (can become 2-3 times the normal size). This can be a rapid change.
• Skin discoloration. Usually redness or even a bruised (blue/purple) appearance is observed. To be viewed as IBC, the extent of the discoloration should be a third or more of the breast (note: locally advanced breast cancer that is neglected can invade the skin. Therefore diagnosis often relies upon the timeline provided by the patient regarding the onset of the redness)
• Peau d’orange skin appearance (like an orange)
• Ridging
• Inverted or flattened nipple
• Skin thickening

During the history and physical examination, these are some of the phrases used by women subsequently diagnosed with IBC to describe how their breast feels:

• A feeling of a heavy breast
• The breast being warmer than usual
• Persistent itching
• Breast tenderness or pain
• A feeling of milk being let down (not during breast-feeding). Liquid may leak out of the breast and then crust over.

Despite lacking a molecular definition, IBC is a distinct clinical entity from regular breast cancers. IBC symptoms start quickly and progress rapidly. Other breast cancers develop over a period of months to years, but IBC can progress much faster, and take over the entire breast in days causing physical discomfort. A portion of women with IBC can have rapidly progressing disease but experience only minor pain. Either way, timely diagnosis and proper workup (staging) is critical for newly diagnosed women to receive proper treatment under the guidance of an IBC specialist as soon as possible.

IBC is usually high grade (aggressive looking) and tumors are intrinsically highly invasive and metastatic. This feature may be noted by a good pathologist as “lymphovascular invasion” on a biopsy or mastectomy sample. This means that delays of weeks to months can allow IBC to spread throughout the body and form micrometastases which decrease the chance for cure. IBC is always diagnosed at stage III or IV, depending on the sites outside of the breast that are impacted.

Histologically IBC tends to be less of a contiguous mass, and more likely to spread throughout the breast in sheets or as small islands of tumor cells surrounded by other normal components of the breast. Molecularly, there are mechanisms employed by IBC cells to survive being separated from neighboring cells much more so than less aggressive breast cancer cells.

Content provided by The IBC Network Foundation