Inflammatory Breast CA

Question 1

How do patients present with Inflammatory Breast ca?

• Breast changes (4)

Answer 1

1. Erythematous
2. Warm
3. Edematous breast w/ peau d’orange
4. Rapid onset

• Often initially diagnosed as mastitis

Question 2

Percentage axillary involvement at time of diagnosis

Answer 2

100% at presentation

Question 3

What is the cause of peau d’orange?

Answer 3

Plugging of the dermal lymphatics with subsequent edema of the tissues around exaggerated hair follicles

Question 4

What is the 5-year survival for pts with inflammatory breast cancer compared to all pts with invasive breast CA?

Answer 4

Inflammatory breast CA: 40%. All pts with invasive dz: 87%

Question 5

T/F: Inflammatory breast CA is seen more often in blacks than in whites?

Answer 5

TRUE

Question 6

What is the differential dx of inflammatory breast cancer?

Answer 6

Mastitis, abscess, lymphoma, venous congestion, dermatitis, and locallly advanced breast CA

Question 7

Do women with suspected inflammatory breast CA still need a mammogram?

Answer 7

Yes

Question 8

How does one confirm the dx of inflammatory breast CA?

Answer 8

Punch bx of skin. Seeing tumor emboli in the dermal lymphatics

Question 9

What is often the receptor status of inflammatory breast CA?

Answer 9

ER-/PR-, 50% of cases HER2/neu+

Question 10

Inflammatory breast cancer is automatically what breast CA stage?

Answer 10

IIIc (T4d, N0-N3, M0)

Question 11

What fraction of pts with inflammatory breast CA will have distant metastatic spread?

Answer 11

1/3

Question 12

What is the metastatic work-up for breast CA?

Answer 12

CBC, LFTs, whole-body bone scan, CT C/A/P +/- PET scan

Question 13

What is the first-line therapy for inflammatory breast CA?

Answer 13

Neoadjuvent chemotherapy

Question 14

What neoadjuvent chemo is used for inflammatory breast CA?

Answer 14

Anthracycline-based regimens +/- taxane

Question 15

Trastuzumab cannot be given concurrently with what chemotherapy agent? Why?

Answer 15

Anthracycline because it can potentiate cardiotoxicity

Question 16

If a pt with inflammatory breast CA responds to neoadjuvent chemo, what is the next step?

Answer 16

Surgery

Question 17

If a pt w/ inflammatory does not respond to neoadjuvent chemo, what is the next step?

Answer 17

XRT

Question 18

What are the response rates for neoadjuvent chemotx for pts with inflammatory breast CA?

Answer 18

Clinical response rate 86%. Pathologic complete response: 12-33%.

Question 19

When should surgery be done after chemotherapy for inflammatory breast CA?

Answer 19

3 weeks to allow the cytotoxic effects to normalize

Question 20

What is the surgery for inflammatory breast CA?

Answer 20

modified radical or total mastectomy with complete axillary node dissection

Question 21

Are breast conservation or SLNBx ever indicated for inflammatory breast CA?

Answer 21

No

Question 22

Tissue reconstruction of the breast following a mastectomy for inflammatory breast CA is delayed how long after XRT?

Answer 22

6-12 months

Question 23

After a mastectomy for inflammatory breast CA XRT is recommended for which pts?

Answer 23

All, regardless of response to chemotherapy

Question 24

What endocrine therapy is indicated for pts with ER+ inflammatory breast CA following adjuvent therapy?

Answer 24

Tamoxifen for premenopausal women and an aromatase inhibitor in postmenopausal women