Inflammatory Breast Cancer - What Is It?

,

Inflammatory Breast Cancer develops rapidly. It accounts for up to 6 percent of all breast cancer cases in the USA. Survival rates are lower than those of other locally advanced breast cancers. The exact cause of IBC is unknown.

Different from other breast cancers that have a lump, Inflammatory Breast Cancer has the breast appearing normal in the beginning until tumor cells get into and block lymphatic vessels in the skin. This lymph fluid gets backed up causing the breast to swell up and become red, swollen and sore.

Here are some symptoms of IBC:

• Sudden, fast change in the appearance of one breast, over the course of days or weeks


• Thickness, heaviness or visible enlargement of one breast


• Discoloration, giving the breast a red, purple, pink or bruised appearance


• Unusual warmth of the affected breast


• Dimpling or ridges on the skin of the affected breast, similar to an orange peel


• Itchiness


• Tenderness, pain or aching


• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone


• Flattening or turning inward of the nipple


• Swollen or crusted skin on the nipple


• Change in color of the skin around the nipple

If the breast becomes red, swollen or sore, see a doctor immediately (I mean the same week!) to rule out Inflammatory Breast Cancer. If the breast fails to improve despite a week of antibiotics, ask your doctor to do more like ordering an ultrasound, mammogram or MRI and a biopsy of the skin. You might ask for a referral to a breast specialist.

Inflammatory Breast Cancer can easily be confused with a breast infection but it won't go away with antibiotics. A breast infection also causes redness, swelling and pain, but breast infections usually develop only during breast-feeding. You will probably have a fever with an infection.

Another cause of breast changes are breast surgery and radiation therapy. These might block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. These changes will gradually go away.

The average women with IBC is 59 years. Black women are slightly more likely than are white women to get it. Men can develop IBC, too.

If the biopsy confirms IBC, the next step is to see how advanced the cancer is. The doctor might order a CT scan of your chest and abdomen, chest X-ray, and bone scan. The biopsy will be tested for the presence or absence of hormone receptors and to see if the cancer produces too much of a protein called HER2. Inflammatory breast cancers are often hormone receptor negative and HER2-positive.

Inflammatory breast cancer is classified as stage III-B or stage IV breast cancer. Stage III-B is locally advanced cancer — meaning it has spread to nearby lymph nodes and to the fibrous connective tissue inside the breast. Stage IV cancer has spread to other parts of your body, beyond the breast. About two-thirds of newly diagnosed inflammatory breast cancers are stage III-B.

Treatment for IBC involves chemotherapy, surgery and radiation therapy. About half the women diagnosed with the condition survive five or more years, and nearly one-third are alive 20 years after diagnosis.

Chemotherapy is done first to shrink the cancer and resolve skin problems before surgery. This allows proper healing of the skin. Most ladies receive more chemotherapy after healing. Radiation (it's like getting an x-ray, very easy!) is given to kill any remaining cancer cells in the breast and under your arm. Typical RT is 30 to 35 treatments, once a day, on week days.

The doctor might recommend further treatment to prevent cancer from returning. If the cancer tested positive for estrogen receptors, then you'll take hormone pills that are engineered to kill the cancer cells (they like to "eat" hormones). If the cancer is HER2-positive, the doctor will prescribe a pill for that, too.

.

CANCER CAUSES HYPOCHONDRIA

I am finished with my treatments. Now it's just follow-up visits with the surgeon and the oncologist. Both want me to get mammograms and MRI's done before each visit, the out-of-pocket cost being about $250 each time. I am done with going every three months, thank goodness, and will graduate to the once every 6 months schedule for the next 4 years.

We do not know if every single cancer cell was killed off by the chemo and radiation so I will be watched for 5 years, then put on the once-a-year schedule which all women my age should be on anyway. I do not know if it'll just be mammograms or if MRI's are going to continue as well.

I have a bomb inside me and we don't when or if it'll go off. The tumor was like having a dandelion inside me that started to go to seed. Did the surgeon get all of the root out? Did the radiation kill off any fine root hairs that were left behind in the soil? Did the chemo kill every single last seed that the wind blew into my lymph nodes.

According to the charts and the treatment I chose, my Stage 2A breast cancer gives me a 90% chance of living another 5 years and a 65% chance of making it 10 years. To some that might sound okay, but at the time of diagnosis I was only 47 and had a 10 year old daughter. Another 5 or 10 years is not acceptable. There is no data for 15 or 20 years, perhaps because most breast cancer patients are in their 60's when diagnosed and die of some other natural cause.

Every time I visit the doctor he asks me if any of my bones are hurting. I've read that bones are a popular place for the little escaped cancer cells to set up a new residence. I am fine-tuned into my bones, now.

During the summer of my chemo, I developed a very sharp pain in my right big toe that would suddenly come and go, sometimes making driving dangerous. It's a strange place for cancer to spread to and it's embarrasing to say "I have cancer in my toe" to people, but I asked the doctor about it anyway. I was referred to an orthopedist who order a million x-rays of my toe and foot. Nothing there but the normal things a 47-year old foot could have and nothing to explain the location of the pain. The orthopedist suggested it might be nerve damage, caused by the chemo. My two visits to the orthopedist cost $20 each. Can't recall what the x-rays cost - I probably blocked it out!

I also have a new pain in my left wrist. The orthopedist found nothing in the x-rays or his manipulation of my wrist to explain the pain. Once again, it might be nerve damage from the chemo. Maybe it's too much typing at my computer. Or it could just be that I am weird.

During the research for my article on Chemo Brain, I read that chemo can cause nerve damage, so that makes sense. I've been taking Aleve, 3 pills each day, for a month for my toe and wrist. They are feeling better lately so I'll consult a neurologist only if they start bothering me again.

This past fall, a tiny area on the inside of my ribs was sharply sore one night when I rolled over in bed. OMG - has it spread? The doctor kept asking me about bone pain and now I have it! After running around in circles with my hands waving in the air, I calmed down and told myself to give it one more day of pain before calling the doctor.

I called my oncologist on the second day and they got me in that afternoon. The doctor poked and prodded me and ordered x-rays, which cost me another $200. The x-rays came out negative for a long list of rib, chest and lung issues. Okay, now I can stop hyperventilating, and start feeling like a fool. A few weeks later, a friend told me that the area of my pain is near the gall bladder and perhaps I had a tiny stone that got expelled before the x-rays were taken.

I have friend, who died from breast cancer this past summer. She had headaches which her GP was treating as a sinus and migraine issue. Ended up the cancer had spread to her brain as well as the liver and lungs. Radiation and some chemo pills were able to zap the brain and liver but the lungs remainded cancerous.

I am so paranoid of this happening to me, getting treated for something else when it's really cancer that has spread. If I get anything that I can't explain I run to one of my cancer doctors rather than my GP. I want to rule out cancer first, before assuming it's something else. If cancer comes back a second time, the odds of winning are very low. It can be won but it depends how soon you catch it and where it is.

So my plan is, for the rest of my life, I am going to panic and run to the doctor for every last little thing. I don't know if they are laughing at my sense of humor, hypochondria, or all the way to the bank!

CHEMO BRAIN

.

Chemo Brain is a strange thing. Doctors don't really know what to make of it or what to do. Is it physical, psychological or imagined? It's definitely "in your head" no matter how you look at it. Is it even related to chemotherapy? It's not on any list of side effects from chemotherapy drugs.

One thing is agreed. Many chemo patients have complained about impaired thinking and assumed it had something to do with the chemo drugs. Studies are just now starting to investigate this strange complaint.

Here are some of the documented complaints in these new studies:

• Forgetting things that one shouldn't forget
• Trouble concentrating on tasks
• Forgetting names, dates, memorable events
• Difficulty multi-tasking
• Slower thinking, processing and completion of mental tasks
• Forgetting common words

Personally, after my 1st chemo treatment, back home that night, I received calls from relatives and friends wanting to see how I fared. For the life of me, I could not concentrate on their words or answer simple questions, let alone carry on a conversation. It was like I had a buzz from a drink or cold medicine. As soon as I felt my mind wandering (to nowhere) I handed to phone to my mom and said, "You take it." I felt bad brushing off my sister's call but I could not function! Luckily this only happened for that one night. I put myself to bed the other nights, not trying to socialize. I was always fine the next day.

According to recent studies, "mild cognitive impairment" ranges from a one-time-only event to long term condition. Some people complain of slight changes in ability while others are hit harder, like I was. It appears more often in patients with higher doses of chemotherapy drugs.

Experiments have linked nerve damage to some chemotherapy drugs but the effect on the brain cells is too new for results. Experts are concerned about chemotherapy treatments that are aggressive and high dosed. Possible treatment options that protect the brain are being studied as are existing medications that might also help treat chemo brain.

The causes and triggers of chemo brain are unknown at this time. Pictures of brain activity show changes in chemo patients that don't show up in non-chemo cancer patients. For some participants, these differences are still showing up 5 to 10 years after treatment ends.

Right now the best guesses as to the cause of chemo brain include the cancer itself, chemotherapy drugs, medication used to manage side effects of chemo drugs, patient age, stress, low blood counts (chemo kills off blood cells), depression, fatigue (chemo makes one anemic), and hormonal changes. Both men and women complain of chemo brain. About 25% of chemo patients report having thinking problems.

Personally, I think my chemo brain was a combination of things:

• I had to suck down 5 bags of drugs.


• I was in a strange place with people I didn't know fussing over me - poking a needle into my chest for the IV hookup, all of which was overwhelming and stressful.
  
• I definitely think depression is a part - surgery, tests, poking and prodding, chemo...it's a sudden loss of control over one's life.


• Fatigue - chemo kills off the red blood cells and makes you anemic and tired. After my subsequent chemo's I pretty much slept for a week, getting out of bed for meals and helping my daughter with schoolwork only.


• Hormonal changes were definitely part of my experience. Ladies' ovaries are shut down by the chemo. Younger ladies bounce back after the treatments are over. I was old enough to be thrown into permanant menopause. I don't know about guys' hormones. I am relatively young so I don't think advanced age is on my list of possible causes. Most of my "mates" were old enough to be my parents or grandparents. The nurses called me "The Kid."

So what do us foggy-headed people do about this? Well, here is a list of what might help out:

• Write down your schedule rather than try to remember everything


• Make to-do lists
  
• Do puzzles and other thinking games or exercizes


• Get lots of rest


• Exercise to help improve mood and decrease fatigue


• Eat vegetables (studies show it helps the brain)


• Create routines and rituals


• Forget trying to multi-task for awhile


• Keep a diary of times you have trouble thinking (times, food, meds, activity etc)


• Accept the problem as temporary and have a sense of humor about it. Give yourself permission to be a little kooky.


• Tell friends and family about it so they are aware of what you are going through

If chemo brain gets too severe, meet with a neurologist, psychoneurologist, or psychologist. These experts can test brain function and suggest mental activities to help you overcome or lessen the effect of chemo brain. Hopefully in the next few years, more will be known and more can be done to avoid or treat chemo brain.
.
.