How Long Does Stomach Bug Last In 3 Year Old Inflammatory Breast Cancer (IBC): When a Red Breast Means Cancer

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Inflammatory Breast Cancer (IBC): When a Red Breast Means Cancer

The Story of Jesse

A 44-year-old professional horse trainer, Jesse has been extremely active throughout his life. She had no medical problems other than a broken leg as a young girl. One day, after several hours of riding, she noticed in the shower that her right breast was quite red. Jesse didn’t remember falling or hitting his chest. She examined herself and felt no lump. However, the chest skin looked different, thicker and a bit warm. She saw her gynecologist, who immediately sent her for a mammogram, which confirmed only a thickening of the breast skin.

Jesse was sent to a breast cancer surgeon who biopsied her breast, confirming inflammatory cancer. She was seen by a medical oncologist who ordered a PET/CT scan which revealed no signs of cancer spread. Jesse underwent 6 cycles of chemotherapy which immediately reduced the redness and discomfort in her chest after the first 2 cycles. She underwent a mastectomy followed by 6 weeks of radiation therapy. Jesse tolerated her treatment well. During follow-up with her 3 cancer specialists over the past 3 years, she has been doing well, with no signs of recurrence of her cancer. She returned to train her horses regularly and enjoy life.

Possible Causes of Red Breast

There are several reasons why a woman or a man may develop acute (rather sudden onset of) breast redness. Infection and inflammation are the two most common causes. Both of these conditions must be treated in a timely manner to improve health and minimize pain. They usually resolve over a week or two. However, there is one cause of breast redness that is always life-threatening: inflammatory breast cancer (IBC).

Warning Signs

IBC is a particularly aggressive form of breast cancer. Among every 100 patients diagnosed with breast cancer, about 2 – 5 will have IBC. It is more often diagnosed in younger women and the redness can literally appear for a few days. While most people who develop a red breast will NOT have IBC, both patients and their primary care providers should be aware of the possibility. This diagnosis should be especially suspected in patients who still have a red breast after treatment with antibiotics or anti-inflammatories for suspected infection or inflammation. The classic description of the appearance of IBC is peau d’orange (orange peel) skin.

Diagnosis and Staging

The diagnosis is confirmed by a biopsy of the breast skin, usually by a breast surgeon or radiologist. Pathologists, the specially trained doctors who look at the biopsy tissue under the microscope, will usually describe tumor cells in the lymphatic channels of the breast tissue and breast skin. The blockage of these channels is usually the cause of the chest redness in IBC. Often there is no specific mass or lump in the breast, just diffuse red, thickened breast skin. Evaluation of the breast itself should include a mammogram, often an ultrasound (if a mass is felt), and sometimes an MRI. All patients with IBC are considered to have aggressive disease. In this regard, unless the patient is in very poor condition and would not tolerate treatment, staging studies should be performed to assess whether the cancer has visibly spread elsewhere. These scans would include a PET/CT or CT of the chest and abdomen and a bone scan. Patients with symptoms such as severe headache, nausea and vomiting should also have an MRI of the brain.

Treatment & Outcome

As with all breast cancers, the treatment for IBC can be divided into two categories: locoregional (breast and lymph nodes) and systemic (all over the body). A common mistake a surgeon can make is to recommend a mastectomy (removal of the breast) first. Patients who are in acceptable disease should almost always have chemotherapy first, then a mastectomy, then radiation therapy (RT) to the chest wall and regional lymph nodes. All three treatments, chemotherapy, surgery and RT, are required to provide the best chance for a cure. Hormonal and targeted therapies (such as Herceptin) may also be recommended, depending on the specific tumor biology. Among patients who do not have signs of metastasis (disease spread to distant areas in the body) at the time of diagnosis and are potentially curable, 40-50% live 5 years later. Awareness of this particularly aggressive form of breast cancer and its treatment is critical to ensuring the best chance for a cure.

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