July 24, 2016
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Inflammatory Breast Cancer (cont.)

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How do health-care professionals diagnose inflammatory breast cancer?

Mammography and imaging tests

Screening mammography has made it possible to detect many breast cancers before they produce any signs or symptoms. However, inflammatory breast cancer produces symptoms, so in the case of this cancer, mammography may be used to evaluate the breast when symptoms are present or to determine the location for a breast biopsy. Due to the rapid spread of the cancer, this cancer is sometimes found between the routine mammogram exams. Other imaging tests, including MRI, ultrasound, PET scans, and CT scans may be used to evaluate the breast if inflammatory breast cancer is suspected. A bone scan to look for spread (metastasis) to the bones may also be performed if a diagnosis of inflammatory breast cancer is confirmed.

Definitive diagnosis

Even if imaging tests show an abnormality or are suspicious for breast cancer, definitive diagnosis requires a tissue sample, or biopsy. A biopsy may be taken of a small area of the abnormality (an incisional biopsy), or the entire abnormal area may be removed at the time of biopsy (excisional biopsy). Biopsy allows the pathologist (a physician with special training in the diagnosis of diseases based on tissue samples) to determine if cancer is present, and if so, what type of cancer. Biopsy also provides a tissue sample for further tests that are done (see below) to determine the best type of treatment. If a mass is not identified in the breast, a skin biopsy can sometimes be used to establish the diagnosis of inflammatory breast cancer. The diagnosis of inflammatory breast cancer can be challenging.

The diagnostic guidelines for inflammatory breast cancer require that the following factors are present:

  • A rapid onset of erythema (redness), edema (swelling), and a peau d'orange appearance and/or abnormal breast warmth, with or without a lump that can be felt
  • These symptoms have been present for less than six months.
  • The redness covers at least one-third of the breast.
  • A biopsy from the affected breast reveals invasive cancer.

Specialized testing on breast cancer samples

Certain laboratory tests are typically performed on all breast cancer tumor samples to help determine the optimum treatment. These include:

  • Hormone receptor status: Breast cancer tissue is tested for the presence of receptors for the hormones estrogen (estrogen receptor or ER) and progesterone (progesterone receptor or PR). If these receptors are present, the tumor is referred to as hormone receptor-positive. This means that hormone-directed therapies may be effective in stopping tumor growth.
  • HER2: Another test performed on breast cancer tissue measures the overexpression of a protein called HER2. If a tumor is HER2-positive (HER-2+), drugs that target this specific protein may be given. About 15% of women have so-called triple-negative breast cancers. This means that they do not express any of these tumor markers (ER, PR, or HER2). As mentioned before, inflammatory breast cancers often do not express the hormone receptors ER and PR. Newer laboratory tests may be useful for some types of tumors to help determine the prognosis and treatment plan. These include, for example, studies of gene expression in the particular tumor or tests to look for the presence of circulating tumor cells or tumor DNA.
Medically Reviewed by a Doctor on 2/6/2015

Source: MedicineNet.com

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