Treatment of inflammatory breast cancer
The treatment lines used for a case of breast cancer can be divided into surgery, chemotherapy, radiotherapy, immunotherapy, and hormonal therapy.
Although inflammatory breast cancer is a very aggressive disease, and its prognosis is less favourable than the other types of breast cancer, there is a treatment regimen that has been associated with the best possible outcome. This consists of a course of chemotherapy, followed by a surgical procedure, then postoperative radiotherapy.
Chemotherapy is the use of very strong drugs that are given either orally or by injection, which move through the circulatory system until they reach the tumor, and they then attack and destroy the tumor cells. These drugs have a predilection for tumor cells, but are so powerful that they usually cause some undesirable side effects, like nausea and vomiting. A patient may be prescribed one or more of these drugs depending on what the physician decides is the best regimen to maximize the effectiveness and minimize the side effects.
Surgery for inflammatory breast cancer usually follows chemotherapy, where the drugs reduce the size of the tumor, allowing for an easier operation. The goal of any cancer surgery is to remove as much tumor tissue as possible, while preserving the largest amount of normal tissues possible.
The surgical procedure used is often a modified radical mastectomy, where the entire breast is removed. In this operation, the patient is put to sleep using general anesthesia. The patient lies on her back, with her arms forming a right angle with the body. The boundaries and landmarks of the breast are delineated using a marker. The incision is then made in such a way so as to allow the surgeon to close the wound after the operation with minimal difficulty. An important step in this surgery is the dissection of the lymph nodes present under the arm. These lymph nodes are commonly hiding cancer cells, which are often responsible for inflammatory breast cancer recurrence if only the breast is removed. All in all the breast tissue, skin, areola, nipple, and the axillary lymph nodes are removed, while the large pectoralis major muscle is preserved. This is why the operation is called a “modified” radical mastectomy. A radical mastectomy involves removing the pectoralis major chest muscle as well. The patient is usually discharged the next day, and encouraged to move her arm since lymph node removal leaves the arm somewhat sore and stiff. Some arm exercises may be arranged for the patient. The surgeon will usually place small plastic tubes called drains to remove any excess fluid present in the surgical site, which usually remain in place for one or two weeks.
Less invasive surgeries such as removing the tumor alone have not been proven to be effective.
After the operation has been carried out and the breast removed, the patient may undergo breast reconstruction surgery later or in the same operation. This restores the cosmetic appearance of the breast and improves the patient’s psychological well-being after the mastectomy. One method to reconstruct the breast is to use the body’s own tissues, while preventing any loss of function. The surgeon may use a nearby body structure and mobilize it to occupy the area of the breast, while still being connected to its original blood supply. An example of this is to use a large back muscle called the Latissimus Dorsi, which has enough volume to mimic the normal appearance of the breast while minimising the loss of function. The second option is for the surgeon to use a far away piece of tissue whose original blood supply cannot be maintained, so the physician must cut the original arteries and veins, then use a type of microscope to connect the tissues to the arteries and veins present in the breast area, which requires great expertise and skill. The second method used for breast reconstruction is to use an artificial implant, which is the more common procedure.
Radiotherapy is often used after the surgical removal of the breast, and aims to kill any remaining tumor cells and prevent future cancer recurrence. This line of treatment uses powerful radiation waves aimed at the tumor, which are strong enough to destroy cancer cells.
Immunotherapy is the use of certain drugs that stimulate the body’s immune cells in order to attack the cancer cells with increased effectiveness.
Hormonal therapy, while a great treatment modality for most types of breast cancer, is unfortunately ineffective in managing inflammatory breast cancer. Normally, the female gonads (the ovaries) produce estrogen and progesterone, the two female sex hormones, from the onset of puberty till the onset of menopause. They help give rise to the female sexual characteristics such as a high pitched voice and a feminine body shape. However, some types of breast cancer, termed hormone receptor positive breast cancers, have the ability to utilize these two hormones for growth and proliferation through tiny receptors that bind to the estrogen and progesterone molecules. This feature can actually be used against the tumors by using drugs that mimic the two female sex hormones, which bind to and block the hormone receptors present on the surface of the tumor cells, preventing the cancers from growing. Most cases of inflammatory breast cancer are found to be of a variant called “Triple negative breast cancer”, which does not possess estrogen or progesterone receptors, and therefore cannot be attacked using hormonal therapy. This characteristic also does not bode well for the patient’s prognosis, since triple negative breast cancer generally has a higher mortality rate than hormone positive breast cancer.
If the tumor is found to be particularly resistant to standard treatment modalities, the patient may choose to enter into a clinical trial. Clinical trials are done to test out new lines of treatment that have not yet been authorized to use on a mass scale. These trials are performed to check the effectiveness and safety of new experimental drugs, and are the best way to bring novel, lifesaving new treatments to patients worldwide.
