Inflammatory breast cancer
Inflammatory breast cancer is a clinically diagnosed, rapidly progressive form of locally advanced breast cancer causing diffuse erythema, edema, and peau d'orange from dermal lymphatic tumor emboli, often mistaken for mastitis. It is at least T4d (stage IIIB) at diagnosis and requires neoadjuvant chemotherapy followed by modified radical mastectomy and postmastectomy radiation; breast-conserving surgery is contraindicated.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Inflammatory breast cancer (IBC) is an aggressive, clinically defined form of locally advanced breast cancer in which tumor cell emboli obstruct the dermal lymphatic vessels of the skin overlying the…
- Epidemiology
IBC is uncommon, roughly 1% to 5% of all breast cancers, though it causes a disproportionate share of breast cancer deaths.
- Risk factors
Obesity: a high body mass index is disproportionately common in patients with IBC compared with other breast cancer subtypes.
- Pathophysiology
Malignant tumor emboli invade and plug the dermal lymphatic channels overlying the breast.
- Clinical features
Formal clinical diagnostic criteria: rapid onset, typically no more than 6 months, of breast erythema, edema, warmth, and/or peau d'orange, with erythema involving at least one third of the breast…
- Differential diagnosis
Lactational or non-lactational mastitis: tender, warm, erythematous breast, often with fever and leukocytosis, improving within 48 to 72 hours of antibiotics, unlike IBC's diffuse, afebrile course.
- Diagnosis
The diagnosis is established clinically by the criteria above, confirmed by core needle biopsy of the breast parenchyma showing invasive carcinoma; a skin punch biopsy demonstrating dermal lymphatic…
- Management
First, every patient with IBC receives neoadjuvant systemic therapy; upfront surgery is never the initial step, and breast-conserving surgery is contraindicated regardless of how well the tumor responds.
- Complications
Locoregional recurrence: the highest rate of any breast cancer subtype despite complete trimodality therapy, most often within 2 to 3 years.
- Prognosis
Even with complete trimodality therapy, IBC carries a worse prognosis than any other locally advanced breast cancer, with an approximate 5-year relative survival of 40% across all stages.
- Prevention
Prompt biopsy of unresolving breast erythema: diffuse erythema, edema, or peau d'orange that fails to improve within 48 to 72 hours of antibiotics should proceed directly to biopsy, not a second antibiotic course.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Breast cancer
Breast cancer is a malignancy of ductal or lobular epithelium, most often presenting as a firm, painless mass in the upper outer quadrant. Diagnosis rests on core needle biopsy with estrogen, progesterone, and HER2 receptor testing, and first-line treatment pairs breast-conserving surgery or mastectomy with sentinel node biopsy, radiation, and receptor-guided systemic therapy such as tamoxifen or trastuzumab.
- Evaluation of a breast mass
Evaluation of a palpable breast mass follows an age-stratified imaging algorithm rather than a single test: women under 30 start with ultrasound, women 30 and older get mammography plus ultrasound, and the resulting BI-RADS category channels management toward observation, antibiotic therapy for mastitis, or core needle biopsy and surgical excision.
- Benign breast disease
Benign breast disease covers the nonmalignant conditions, fibrocystic change, fibroadenoma, phyllodes tumor, intraductal papilloma, and fat necrosis, that present as a breast mass, cyclical pain, or nipple discharge. Age-based imaging and, when indicated, core needle biopsy establish the diagnosis; most lesions are observed, while a fibroadenoma over 3 cm, a phyllodes tumor, or a papilloma is treated with surgical excision.
- Paget disease of the breast
Paget disease of the breast is an intraepidermal adenocarcinoma of the nipple that signals an underlying ductal carcinoma in nearly every case. Diagnosis is confirmed by full-thickness nipple biopsy, and first-line treatment is surgical excision of the nipple-areolar complex with radiation and, for hormone-receptor-positive disease, adjuvant tamoxifen or an aromatase inhibitor.
- Mastitis
Mastitis is inflammation of the breast parenchyma, most often infective and lactational, caused by milk stasis behind a blocked duct with secondary invasion by Staphylococcus aureus through a cracked nipple. Diagnosis is clinical; first-line treatment is continued milk removal plus an oral antibiotic such as dicloxacillin, with ultrasonography reserved for suspected abscess.
- Lymphedema
Lymphedema is chronic tissue swelling from impaired lymphatic drainage, primary (developmental) or secondary (from surgery, radiation, infection, or malignancy). It causes progressive non-pitting edema that involves the toes, and management is decongestive therapy with compression, skin care, and cellulitis prevention, since there is no curative drug.
- BRCA1 and BRCA2 mutations
Germline BRCA1 or BRCA2 mutation is an autosomal dominant tumor-suppressor defect that markedly raises lifetime risk of breast, ovarian, and other cancers. Management centers on risk assessment, genetic counseling and testing, and a structured program of enhanced screening, chemoprevention, and risk-reducing surgery timed to age and childbearing.
- Chemotherapy-induced nausea and vomiting
Chemotherapy-induced nausea and vomiting (CINV) is emesis triggered by cytotoxic therapy through serotonin, substance P, and dopamine pathways converging on the brainstem chemoreceptor trigger zone. Risk is stratified by the emetogenic potential of the regimen, and high-risk regimens such as cisplatin or anthracycline-cyclophosphamide combinations are prevented with a four-drug regimen of an NK1 antagonist, a 5-HT3 antagonist, dexamethasone, and olanzapine.