Have you read Heidi Loughlin’s blog? Heidi is a young mother who has breast cancer.

She was pregnant when diagnosed, so treatment was started with chemotherapy drugs which were relatively safe for her unborn baby. The birth was to be brought forward, when she would switch to more effective drugs.

However her cancer progressed quickly, requiring an earlier delivery than planned, to allow Heidi to start Herceptin treatment sooner. Devastatingly, her baby daughter died shortly after the birth, just before this Christmas.

Heidi has inflammatory breast cancer (IBC). Although rare  (1-4% of all breast cancers), it is important for two reasons— (1) it grows and spreads rapidly and (2) the appearance may mimic infection or injury (often there is no lump), and so breast cancer may be overlooked and life-saving treatment delayed.

IBC invades the breast skin, and blocks the lymph vessels within it. It tends to spread in sheets, rather than forming a lump.

This results in an unusual picture. The lymph blockages cause fluid build-up, so the skin swells and discolours, and hair follicles enlarge, forming multiple pits. The resulting skin resembles that of an orange (and is called ‘peau d’orange’).

However this classical appearance isn’t always seen either.

The breast may become red, hot and swollen, resembling infection, and if ‘mastitis’ doesn’t respond to antibiotics, IBC should be considered urgently.

Sometimes the skin appears bruised, or ridges or welts appear. There may be ulceration. Sometimes the nipple inverts or leaks fluid/blood, and there may be enlarged lymph nodes in the armpit or collar bone area.

If any of these changes occur, you must see a doctor without delay.

Because there may be no lump, and because it often occurs in younger women, with denser breast tissue, it may not be picked up on a mammogram.

Biopsy of the affected skin is key to diagnosis. AS IBC spreads early, PET or CAT scans of the body, and bone scans will also be needed.

The outlook for IBC used to be very poor. It is still not as good as for other breast cancers, but with modern treatment it has improved, and recent genetic research has yielded potential new hope.

Chemotherapy is usually started before surgery. Afterwards a full mastectomy is generally needed, removing more body tissue than normal, including armpit lymph nodes. Breast reconstruction isn’t normally possible until later on.

Radiotherapy follows surgery, then often more chemotherapy. If the cancer is HER2 positive, Herceptin will be given. If it is sensitive to female hormones, anti-oestrogens, either tamoxifen or an aromatase-inhibitor, such as letrozole will be prescribed.

Treating any cancer during pregnancy involves balancing risks to baby and mother, and, as in Heidi’s case, can involve bitter disappointments.

If you notice any unusual and persistent changes in your breast—not necessarily a lump, you must see your doctor without delay. Unless there is a good explanation for the changes, you should be referred to a breast clinic. Do push for this if you are concerned.

By Dr K Thompson, author of From Both Ends of the Stethoscope: Getting through breast cancer – by a doctor who knows

http://www.amazon.co.uk/dp/B01A7DM42Q

Further information:

http://storminatitcup.blogspot.co.uk/2015_12_01_archive.html

http://www.cancer.gov/types/breast/ibc-fact-sheet

http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/about/types/inflammatory-breast-cancer

http://jnci.oxfordjournals.org/content/101/19/1302.full

Note: These articles express personal views. No warranty is made as to the accuracy or completeness of information given and you should always consult a doctor if you need medical advice