Inflammatory Breast Carcinoma

Inflammatory Breast Carcinoma (IBC) is a subtype of invasive ductal carcinoma presenting with different clinical symptoms due to blockage of lymphatic vessels by cancerous cells resulting in inflammation . It is a rare and aggressive breast cancer accounting for roughly 5%of all breast cancers

Epidemiology

Inflammatory Breast Carcinoma (IBC) is more prevalent in younger women with age < 40 years old. Higher incidence is seen in women who are obese or overweight with an increased prevalence in women of African or African-American descent. [1]

Symptoms & Signs

IBC often presents differently than other breast-related conditions:

Skin Changes

Peau d'orange:
- thickened pitted skin like an orange peel
- without mastitis (breast inflammation) it is not IBC
Redness and Swelling due to lymphatic obstruction by the tumour

Breast Changes

Due to inflammation in the breast:

Tender, painful or itchy breasts

Uneven breast size, temperature and weight due to swelling

Nipple Changes

Nipple appears either inverted or retracted into the breast.

Lymph Nodes

The inflammation can cause swollen lymph nodes in one of these places:
- under the arms
- near the collarbone.

Peau d'orange

Screenshot 2025-04-01 at 16.00_edited.jp

Inflamed Breast

Inverted Nipple

Screenshot 2025-04-01 at 15.59_edited.jp

[2]

Histology

This is an example of what a pathologist might observe in a case of IBC:

There is dermal lymphatic invasion with numerous inflammatory cells present.

However, the presence of inflammatory cells is not a defining feature, as IBC can present clinically without significant inflammatory infiltration. [5]

Diagnosis

Diagnosing inflammatory breast carcinoma (IBC) can be challenging as it does not typically present with distinct breast lumps or nodules.

While diagnostic imaging tests can be used such as mammograms, breast MRIs, and breast ultrasounds these also may not be indicative in the diagnosis as it becomes difficult to distinguish it from other breast inflammatory conditions such as mastitis. They are still used to identify and affirm certain features of IBC such as:

Biopsies are particularly used because they provide more specific details about the carcinoma:

Mammograms

Detect skin thickening and increased breast density

Breast MRIs

Detect extent of disease through lymph node and skin involvement

Breast Ultrasound

Visualize redness and inflammation as well as any underlying abnormalities

Check for cancer cells

Determine grade of cancer

Check for HER2 /neu overexpression

[4]

Treatment

Due to the aggressive nature of IBC, the treatment is multimodal:

First line of treatment

Chemotherapy
- to shrink the tumour and control the metastasis
Surgery
- This can include a mastectomy (complete removal of the breast) and dissection of the lymph nodes

Hormone therapies are usually not considered because most IBCs are considered hormone receptor negative – they do not produce estrogen receptors (ER) or progesterone receptors (PR).

[4]

Prognosis

IBC is typically diagnosed at an advanced stage due to its aggressive nature and subtle presentation and is usually associated with a poor prognosis.

Before assessing the prognosis based on the outcomes, it would be helpful to know how we classify the stages of the cancer.

STAGING

PROGNOSIS

IBC prognosis is dependent on the presence and absence of some key receptors. While most breast-related conditions show an over expression of hormone receptors such as the estrogen receptor, IBC is the opposite.

Estrogen receptor positive is a good prognostic factor because it points to hormone related therapies.
IBC is usually hormone receptor negative with no estrogen or progesterone receptors indicating a poor prognosis.
Additionally, IBC presents with an overexpression of the HER2/neu receptor allowing the cancer to be more aggressive which is associated with a poor prognosis

LOCAL

REGIONAL

DISTANT

Within the breast

Metastasis to lymph nodes

Metastasis to distant organs

STAGE III
- Local/Regional - All IBC cases are initially classified at Stage II at diagnosis indicating the cancer is present within the breast and/or nearby lymph nodes.
STAGE IV
- Distant - metastasis of cancer to distant organs

[4]