How to manage inflammatory breast cancer in a 72-year-old?

Question

Hello doctor,

My 72-year-old grandmother has been diagnosed with inflammatory breast cancer. Her breast looks very different; it is red, swollen, and painful. Her mammogram shows diffuse changes and skin thickening, and a PET scan suggests potential lymph node involvement. She also has diabetes and heart issues, which makes us even more concerned.

How aggressive is inflammatory breast cancer, and what treatment options are available?
The doctors seem worried about her overall health, and we are still determining if she can tolerate intensive treatments.
What is the typical progression of this cancer?
How can we best manage her other health conditions during treatment?

Your guidance would be greatly appreciated.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Inflammatory breast carcinoma falls into stage 3B, which is advanced breast cancer, characterized by skin changes with brawny induration, erythema with raised edges, oedema (peau d'orange), with almost 75 % of axillary lymph nodes palpable, and distant metastases.

A punch biopsy should be done to confirm, a PET CT scan to confirm distant metastases, and also HER2 receptors and ER PR hormones should be checked.

Neoadjuvant chemotherapy should be given perioperatively, as it shows regression of the tumor in about 75 % of cases, then a modified radical mastectomy followed by chemotherapy with adjuvant radiotherapy. The five-year survival rate is about 30 % after these aggressive treatments.

As your mom had stage 2 breast cancer (invasive lobular), I need to know the status of ER, PR, HER2 neu receptors, and if lymph nodes are involved or not.

BRCA1 is associated with a 50 to 85% lifetime risk of developing breast cancer, and up to 40 % risk of ovarian cancer, while BRCA2 is associated with up to 50 to 60% lifetime risk of developing breast cancer and 20 % ovarian cancer. It is also associated with cancers of the gall bladder, colon, bile duct, and stomach.

Women with a BRCA mutation may be offered bilateral risk-reducing mastectomy with immediate breast reconstruction. This will reduce the risk of breast cancer by 90 %.

Chemoprophylaxis with Tamoxifen or Anastrozole may reduce the risk by 50 %. Premenopausal women may be offered bilateral salpingo-oophorectomy after they have completed their family at around 40 years of age. So, as your mother got diagnosed with a BRCA2 mutation, it's better to opt for the above-mentioned treatment if she has completed her family.

For you and your sister, you need to do a screening in order to detect the disease at its early stage. Breast cancer can be genetically inherited, and it needs family screening to detect the disease in its early stages.

Breast clinical exams should be done every three months for two years, then every six months for three years. Thereafter, follow-up is scheduled yearly, followed by a yearly mammogram.

I hope I have answered your query.

Let me know if I can assist you further.

Thank you.