M. D. Anderson Cancer Center
Duration: 0 / 12:43
Inflammatory breast cancer is an extremely rare and fast growing cancer.
They call it the silent killer.
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This is a disease where time does matter and unfortunately it's a disease where there's often confusion about the diagnosis.
I had been tested for rheumatoid arthritis, all sorts of things.
And she said, well, I'm not feeling anything, but let's go ahead and put you on antibiotic and see, you know if that help clears it up.
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For a unique team of specialists at the University of Texas M. D. Anderson Cancer Center stopping this silent killer and making this rare form of cancer history is their only goal. The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic is the only clinic in the world solely dedicated to treating and studying IBC. The clinic opened in October of 2006.
Our goal is to better understand the disease, increase the referral of patients, so we can improve on the knowledge, understand through the epidemiology, as to the way to which women are at risk, be able to develop better tools to evaluate patients, improve the understanding of the biology of the disease that will allow us to develop specific therapy for IBC that would be most successful in improving the prognosis of these patients.
As a physician, diagnosing and referring treatment for this rare form of breast cancer may be one of the most difficult tasks you face. So let our multidisciplinary team of specialists at the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic help you collaborate with medical oncologists, radiation therapists, surgeons, pathologists and breast imaging radiologists who work everyday with patients from around the world to better understand and treat this disease.
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In about one third of patients with inflammatory breast cancer, there is no lump or discrete mass palpable on clinical examination. When symptoms appear they may be mistaken for a rash or an infection. It's important that inflammatory breast cancer is diagnosed early, so that your patient has a better chance of survival. Here are some clinical signs and symptoms to look for: Erythema. The skin overlying the breast shows a pink hue or peau d'orange. Color quickly changes to dark red or purple and spreads over the entire breast. Rapid Breast Enlargement. Sometimes the breast increases two to three times in size in a period of a few weeks. Lymph node involvement. Fifty five percent to eighty five percent of patients will present with metastases that may be detectable on clinical examination.
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Based on your clinical examination several tests can help to diagnose and stage your patient's IBC. All women start with mammography, but there can be challenges.
The problem with inflammatory breast cancer patients undergoing mammography is that with a swollen breast that's red, tender and painful, that can pose a huge challenge both for the technologist and the patient.
In many cases the compression of a mammogram can be so uncomfortable the imaging cannot be completed. While a mammogram is done standard it has proven to not be the best form of imaging inflammatory breasts.
In our review of up to eighty patients with inflammatory breast cancer we found that mammography didn't find any focal cancer in these breasts in up to fifteen percent of women.
The next method routinely performed on all women is breast sonography. It is a little more comfortable for the women than a mammogram. The focus is more on the regional nodal staging of the nodes, which includes four areas: Axillary, infraclavicular, internal mammary, and supraclavicular. To help see the extent of the skin thickness and lesions within the breast and skin itself, an MRI is given. This imaging method also plays an important role in diagnosing and treating IBC.
You can see that the affected breast is much larger than in the unaffected breast, there is multiple lesions inside the breast. The skin is also diffusely thickened and there's increased blood vessel within the breast. This is the exam after we give chemotherapy. You can see that there has been complete response to therapy. The lesion inside the breast is no longer seen and the size of the affected breast is the same as the unaffected breast or normal breast.
All patients are also given a PET scan. The PET scan can help evaluate the breasts and the lymph nodes.
Many of these patients, approximately forty-five -- fifty percent have disease in the lymph nodes in the contralateral side of the bump and it's important to detect upfront in order to make a better treatment plan.
The PET scan can also passively detect metastases.
In our recent publication we demonstrated that forty-nine percent of women who underwent the study showed distant metastases and this is an impact on the management and the outcome.
The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic has an on-site PET CT facility, suite of MRI imaging units, as well as a full suite of digital mammographic imaging units allowing all images to be read immediately. During the diagnostic exam process pathology intervenes at different steps. Two types of biopsies help determine what type of treatment a patient will undergo.
Most of the routine conventional of breast cancer, majority, about seventy percent of the breast cancer are ER Positive. However, for the inflammatory breast cancer, probably more than fifty percent of them are ER Negative. And also PR tended to be negative and HER-2/neu, another marker, tended to be more frequently amplified or over-expressed.
The first type of biopsy a patient may be given is an ultrasound-guided core-needle biopsy.
This is a core-needle biopsy, so the needle directly goes to the mass lesion. You are not going to see the skin change. So this is the tissue showing infiltrating tumor cells everywhere.
The skin punch biopsy should show if there is extensive dermal lymphatic invasion by cancer cells
So this is a classical picture of the skin punch biopsy of the inflammatory breast cancer. This is the epidermis and this is the dermal area and as you can see here there is some edema here and that the tumor cells are scattered around in this area.
The information learned from these biopsies is not only important for a clinician to treat your patient now, but will help to provide better answers for treating IBC in a more efficient way in the future. All biopsy material is collected, analyzed and catalogued into an IBC registry.
The most important thing that we want to stress is that this is the only place where you have an IBC registry, so that we collect blood, tissue and information, so that we can gather as much as knowledge as possible from the patient we can get.
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Because of its aggressive nature IBC requires immediate treatment. Managing IBC involves a multidisciplinary team approach including chemotherapy, surgery and radiation.
Chemotherapy can go throughout the bloodstream and attack those potential areas of disease on the whole body's basis. It's less effective in preventing local recurrence meaning that the cancer comes back right where it originated from or in lymph nodes.
So what we learned from the past is that standard chemotherapy achieves complete disappearance of the tumor in fifteen percent of the cases. And for the patient who does not achieve that pathologic complete remission, the prognosis is very poor with high recurrence in the first two or three years and the five-year survival approximately forty percent.
Chemotherapy is given with taxanes, an anthracycline-based therapy typically for up to six months. Surgery is recommended for all patients since cancerous cells may still remain hidden from view.
We actually probably operate on at least three to five patients per week. A lot of these operations are much more extensive and require a more radical mastectomy. Many of them require extended lymph adenectomies with removal of level three lymph nodes and many of them will require plastic surgery to be present at the same time.
For optimal local control, mastectomy is recommended prior to radiation therapy. Radiation is delivered to the area where the breast used to be and some lymph nodes that are inaccessible to surgeons to help reduce the probability of the cancer coming back.
The types of radiations we use are x-rays and electrons, and we're able to use these very sophisticated machines to really safely deliver the dose to the specific targets that we identify in three dimensional treatment planning. There had been a number of advances over the years with radiation for inflammatory breast cancer that allow it to be more effective and also safer to the normal tissues as well.
A course of radiation can extend from 6 weeks to up to eight weeks. Radiation can be given once a day for about 15 minutes or sometimes even twice a day.
By treating twice a day rather than once a day, we can compress the overall treatment course and give it at a shorter period of time and really minimize the risk of the phenomenon of tumor regrowth during the actual treatment course.
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When you get here, you know from the moment that you walk in that you're not alone.
And I tell everybody, M. D. Anderson is the place you wanna go.
The people here are so, so loving, you know, they just -- like family. A close-knit family.
M. D. Anderson’s strength has been always to bring together a clinical team. We are able to evaluate the patient in a short period of time from a clinical point of view, addressing the diagnosis and they work out for detecting metastatic disease and medical treatment, radiation therapy and surgery.
Many of those patients will require special therapies that aren't available. In fact, many of them, they need to be on clinical trials for new agents since many of those patients will not respond to conventional therapy.
So that one aspect that we want to stress with this research program is that our team of basic researchers is constantly interacting with the clinicians in order to develop better treatment. We are indentifying new targets. We have cell lines and animal models and we are testing new drugs. They eventually in short period of time will become innovative treatment for IBCs.
A particular medicine that was FDA approved that I know that my doctor here had a hand-in with the research was approved two days before my visit. My visit was on a Wednesday, on Wednesday I was on that medication. If you are a physician, then you care and you want your patients to survive and you want them to go on, then, why not collaborate with the clinic here and the doctors here who have the research and the knowledge and learn from that and share that with your patient and it can't be anything but a positive for everybody involved.
If you'd like to refer your patient to the Morgan Welch Inflammatory Breast Cancer Clinic call 713-792-4124. Or visit the Internet site at www.mdanderson.org/ibc.
© 2009 The University of Texas M. D. Anderson Cancer Center
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