Inflammatory Breast Cancer - What Is It?

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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.

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Christina Applegate and Breast Cancer

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In 2008, the 36-year old actress and already established breast cancer advocate, Christina Applegate found herself being diagnosed with breast cancer with a very important decision to make. Her cancer was found during a routine breast MRI that's able to find cancer cells earlier than mammograms can.

Her mother, singer Nancy Priddy, fought breast cancer twice and carries the BRCA1 breast cancer gene. Christina chose a double mastectomy even though her cancer was found in only one breast because the statistics were against her. Luckily, chemotherapy and radiation were not necessary.

Returning to work and future reconstructive surgery are in her future. She says she looks forward to have "great boobs" when she's in the "old folks home." By then, I don't think she'll be alone in that physical attribute!

Now Christina is focused not only on breast cancer awareness, but also to encourage early detection and help women get the tests they need and finances to pay for them.

Not all health insurers cover breast MRI's which can be quite expensive, so Applegate created the "Right Action for Women" organization aka the Christina Applegate Foundation. Its goal is to help women who have a higher risk for breast cancer receive and pay for breast MRI's. One of her fundraising efforts is to auction off ribbon roses, made from the ribbons of Christina's get-well-soon bouquets while she was in the hospital.

Applegate appeared on The Tonight Show, stating "If I can just save one person. That’s why I am doing this.”

"I'm going to face challenges, but you can't get any darker than where I've been," she said on Good Morning America. "So, just knowing that in my soul gave me the strength to just say, 'I've got to...I have to get out there and...and make this positive."

On the Oprah Winfrey Show, Applegate shared, "This is my opportunity now to go out and fight as hard as I can for early detection...there is this need and this desire to make every single day count...I used to say … 'Don't sweat the small stuff, not even the big stuff.' At the end of the day, none of it matters but your own joy, your own spiritual journey that you go on. God, your loved ones, your friends, your animals - these are the things you've got to cherish and love and embrace."

For more information of BRCA genes, click on http://breastcancerisabitch.blogspot.com/2008/12/genetic-hereditary-breast-ovarian.html#links

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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

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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.
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WEIRD SIDE EFFECTS FROM CHEMO...

Losing my taste during the summer was weird. I couldn't taste strawberries or cherry pie! The only thing I could taste was salty stuff so that's what I ate- Mexican food, eggs with salt on top, chips, mashed potatoes, tuna sandwiches. I guess it's like having a cold and you can't taste anything. It's been a year now and I'm still not back 100%, especially with fruit flavors.

I was old enough that chemo put me into permanent menopause. I was happy to see Aunt Flo go away forever but the price was nuclear hot flashes! If I move around too much doing housework, let alone anything that actually qualifies as exercise, I get too warm and sweat covers my whole body in an instant. I have to wear summer jammies in the winter and be ready to throw off the blankets at a moment's notice. In the summer, it's a losing battle. Just breathing makes me get a hot flash. It's been a year and I am still "flashing."

I was so sleepy for about a week after each chemo treatment. It was the killed off red blood cells that made me anemic and tired. I'd get up for breakfast, go back to bed, get up for lunch, go back to bed, help my daughter with home and eat dinner, go back to bed until the next morning. Thank goodness my mom lived with us for 4 months to help out. XOXOXO to my "mommy."

How do I put this delicately? Let's just say "things" become thin and delicate as if I were 30 years older. The permanant menopause effect threw me into the world of geriatric intimate issues. It would have been nice to ease my way into this arena slowly over the years but unfortunately I was suddenly thrown into the deep end of this pool. The doctor wants me to try estrogen cream. Hope I didn't make you blush!

I usually did my chemos on Mondays. I received an IV bag of anti-nausea medicine there and pills for home and "tolerated" my treatments pretty well except for one thing - travel sickness - I would get car sick before even going a mile for the rest of the week. So even if I felt great and wanted to make a quick dash to the store, I stayed home for the next few days.

HAIR LOSS =:-O

I read that it's good to get a short haircut before you even start chemo. Then as soon as the hair starts coming out, shave the head. This lets you be in charge of when the hair comes out. It's an important thing to do for your sanity. You are going through a "no sense of control" stage in your life with all the testing, surgeries, and treatments. All that poking and prodding! At least you can be in charge of the hair issue.

So I got a "long" pixie cut about a week before my first chemo. It was kind of cute. I've had my hair halfway down to my elbows for over 30 years. I decided I was going to do something similar once I got my hair back and not go back to super long.

About 2 weeks after my 1st chemo my hair started coming out in the shower. It creeped me out. I took maybe 2 or 3 more showers and finally got annoyed and had my mom cut my hair short with scissors and then my husband shaved my head. We did it outside in the backyard, leaving the hair for birds to use in their nests that summer.

I avoided looking in the mirror for a few days. It was hard to get used to. I signed up for a "Look Good Feel Better " class They teach you that now is a very important time to take care of your self esteem by taking the time to dress nice, use makeup and jewelry, and they showed tricks on wearing caps, hats, beanies and turbans as well as wig care. They gave each of us a tote bag that I swear was filled with quality cosmetics worth $200! When I was shopping at Kohl's a lady approached me and complimented my hat. It felt so good and I was feeling quite stylish that day!

My eyelashes and brows didn't come out until after my last chemo. The Looks Good Feel Better lady showed us how to do eyebrow pencil and eyeliner. Would you believe people said "at least you didn't lose your lashes" to me when I didn't have any lashes! That goes to show the wonders of makeup. I never opted for fake lashes, just used liner the right way.

My last chemo was October and my hair started coming back in December. It took another month to "fill in" and it wasn't until about March or April that I went out in public with nothing on my head. My hair was very short but I've seen women wear their hair that short so I felt confident that no one would think I was bald. It worked out fine. Nobody stared at me. I was so self-conscious. I continued to do the makeup and always wore earrings.

Some people's hair comes back different than it used to be. Curly, straight, slightly different color... Mine came in the same but there was more white than I remember. Perhaps I was just in denial of how much white I really had because I had been dying it for so many years!

So it's been almost exactly a year since my last chemo. My hair has grown about 4 inches.

The eyebrows didn't come all the way back. I have "glorified peachfuzz" but nothing you could actually call a hair. Who knows, maybe some of my peachfuzz hairs will mature into real hairs in the next year. My hair is thinner on crown. Some pink skin shows through. This is probably how I would look as an "old lady" but time got accelerated for me because of the chemo.

Summer was best. I wore a beanie/skull cap my friend made from t-shirt fabric (much better than wig liners) with either a pretty scarf or hat. I loved my hat. Wigs are no fun in the hot, sweaty summer! When the colder weather set in, wearing a scarf or summer style hat just didn't look right. At restaurants I wanted to dress up more. I started wearing my wig which is extra time and bother. Because I was trying to deceive people with fake hair, I was insecure and often worried whether people believed it was my own hair.

For unknown reasons my bald skin reacted whenever I wore anything on my head. Wig days were the worst. I got painful pimples on my head, even though I wore the cotton beanie/liner. I guess the rubbing did it. Every night I showered or bathed using facial acne soap on my head. My husband would dab acne medicine on the spots I couldn't reach. I was really disgusted with my appearance - bald and pimply! Once I figured out to use the acne treatments and to go bald around the house, my skin got better. I warned my daughter's friends who would come to visit for hours on end. I took some bravery to allow 10 and 11 year olds to see me, but I did it and they were very cool about it.

Footnote- enjoy not having to shave your pits and legs for as long as possible, ladies!

Here's my picture, taken about 6 months after my last chemo:

My Lumpectomy

The surgeon skipped doing a needle biopsy and went straight for a lumpectomy. I went to the hospital very early in the morning as an outpatient. The morning wait was long - one person had the operating room ahead of me and then there was an emergeny appendectomy. The doctor shook me to wake me to say it was cancer. I rolled onto my side, pulled my knees up in fetal position, and cried and cried. I don't remember thinking anything, no words. Just emotion. Later on I cried, thinking to myself my daughter is too young (10) for her mommy to die.

I would have to return in about a week to have the margins and lymph nodes checked. For now it's up to the lab to test the lump for the individual characteristics of my cancer.

My tumor was about 10mm. My scar is about 2 inches long.