Metastatic inflammatory breast cancer is a rare, aggressive disease where cancer that formed in the breast has spread to distant parts of the body, making it an advanced, or Stage IV, cancer. The term “inflammatory” refers to its distinct symptoms, caused by cancer cells blocking lymph vessels in the skin of the breast. While this diagnosis is serious, dedicated treatments can manage the disease and extend life. These therapies are tailored to the cancer’s specific characteristics and the patient.
Identifying Symptoms of Metastatic Disease
Inflammatory breast cancer (IBC) has distinct signs in the breast. A primary symptom is significant swelling or enlargement of one breast, which may feel warm, heavy, or tender. The skin often develops a red or purplish hue covering more than a third of the breast. A pitted or ridged skin texture known as “peau d’orange,” resembling an orange peel, is also a feature. Unlike other breast cancers, IBC often does not form a distinct lump.
When IBC is metastatic, symptoms depend on where the cancer has settled. If cancer spreads to the bones, it can cause persistent pain in the back, neck, or joints not related to injury. Bone metastases also weaken the bones, increasing the risk of fractures.
Spread to the lungs may cause a chronic, dry cough, shortness of breath, or wheezing. Individuals might also experience chest pain or cough up bloody mucus. If the cancer metastasizes to the liver, symptoms can include jaundice (a yellowing of the skin and eyes), persistent abdominal pain or swelling, and a lack of appetite.
Brain metastases can produce a range of neurological symptoms, including:
- Severe or persistent headaches
- Unexplained changes in vision or hearing
- Problems with balance or coordination
- Seizures, confusion, or memory problems
- Noticeable changes in mood or personality
The Diagnostic and Staging Process
The diagnostic process begins with a physical examination of the breast to look for signs of IBC, like redness and skin thickening. A mammogram and breast ultrasound will be performed, though IBC can be difficult to see on these scans. A definitive diagnosis requires a biopsy, where a small sample of breast tissue or skin is removed for analysis. A core needle biopsy or a skin punch biopsy are common procedures.
A pathologist examines the tissue sample to confirm the presence of cancer cells. The biopsy tissue is also tested for biological markers that guide treatment. These tests determine if the cancer cells have hormone receptors for estrogen (ER) and progesterone (PR), or if they overproduce a protein called HER2. This information helps in planning therapy.
Because IBC is aggressive, it is considered at least Stage III at diagnosis. To determine if the cancer has spread and is Stage IV, doctors use advanced imaging. A PET scan is frequently used to highlight cancer activity throughout the body. CT scans of the chest, abdomen, and pelvis, as well as bone scans, are also employed to create detailed images of organs and bones.
Systemic Treatment Strategies
Treatment for metastatic IBC relies on systemic (whole-body) therapies. Chemotherapy is often the initial treatment used to shrink cancer throughout the body, which can reduce the tumor burden and alleviate symptoms. The specific combination of drugs is chosen based on the patient’s overall health and prior treatments.
Targeted therapy is a primary treatment for HER2-positive IBC. Medications like trastuzumab and pertuzumab block the signals that tell cancer cells to grow and divide. These drugs have greatly improved outcomes and can be used in combination with chemotherapy.
For hormone receptor-positive cancers (ER-positive and/or PR-positive), hormone therapy is another systemic treatment. These medications work by blocking or lowering estrogen levels in the body to slow or stop cancer cell growth. Immunotherapy, which helps the body’s immune system fight cancer, may also be an option in certain situations.
While systemic treatments are the focus, local therapies may be used for palliative purposes. Radiation can be directed at specific tumors, such as those in bone, to relieve pain and prevent fractures. Surgery is less common but might be used to manage localized symptoms. Clinical trials can also provide access to new treatments.
Prognosis and Palliative Care Focus
The prognosis for metastatic IBC is serious, and survival rate statistics are only averages. An individual’s outlook is influenced by many factors, and many people live for years by managing the disease as a chronic illness. These factors include:
- The cancer’s subtype (ER, PR, and HER2 status)
- The extent and location of metastasis
- The response to treatment
- The person’s overall health
Palliative care is a component of managing metastatic IBC and should be introduced early. Palliative care is not the same as hospice care; it is a specialized approach focused on improving quality of life. It aims to manage symptoms of the disease and side effects of treatment, such as pain, fatigue, nausea, and emotional distress.
Palliative care is given alongside active cancer treatments. The care team, which can include doctors, nurses, and social workers, provides an extra layer of support for the patient and their family. Connecting with support groups and using mental health resources can also be beneficial for coping with the challenges of living with metastatic cancer.