Podcast: IBC clinical trials at MD Anderson
Inflammatory Breast Cancer (IBC) Treatment
For people whose cancer has not spread, or metastasized, treatment usually begins with chemotherapy to shrink the tumor followed by a mastectomy. Patients then receive radiation treatment to kill any cancer cells that were not visible to the naked eye during surgery. Depending on the disease¡¯s molecular subtype, patients may also receive targeted therapy, including hormone therapy.
If a patient¡¯s IBC has metastasized, or spread, she typically undergoes chemotherapy. If the tumor responds well to this treatment, she may then be eligible for a mastectomy. Additional treatments may include immunotherapy, radiation therapy and targeted therapy.
Chemotherapy
Chemotherapy uses powerful drugs to directly kill cancer cells, control their growth or relieve pain. It is often given to inflammatory breast cancer patients before surgery to shrink the tumor and simplify the procedure. It can also be given after surgery to kill any remaining cancer cells.
Learn more about chemotherapy.
Surgery
Because inflammatory breast cancer may not have a distinctive breast lump, surgery to remove just the cancerous tissue (lumpectomy) is not possible. A complete mastectomy (removal of the entire breast) usually is needed to remove all the affected areas, including the previously involved skin.
The surgeon looks at lymph nodes close to the breast during surgery, and nearby lymph nodes are removed in most cases. Breast reconstruction usually is not recommended initially after surgery for IBC. It is best to wait until therapy has been completed and there is no evidence of disease.
Radiation therapy
Radiation therapy uses powerful beams of energy to kill breast cancer cells.
After chemotherapy and surgery, IBC patients may receive radiation therapy on the chest wall and lymph nodes. This treatment can reduce the risk of the disease coming back. Radiation therapy also may be used to treat IBC that has spread, to manage pain or to improve quality of life for patients who cannot have surgery. Typically post-mastectomy radiation for IBC is one to two times a day for 22-33 days, depending on the patient¡¯s age and how well the chemotherapy worked.
Learn more about radiation therapy.
Targeted therapies
Cancer cells rely on specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules or the genes that produce them.
In recent years, targeted therapy has become a major weapon in the fight against breast cancer. Breast cancer subtypes that once had poor prognoses are now highly treatable.
One type of targeted therapy is endocrine therapy, which is given to patients with hormone receptor-positive breast cancer. It is given after surgery for five to 10 years to prevent recurrence. Patients with the metastatic form of this disease are also given endocrine therapy in order to prevent disease progression.
Patients with HER2-positive breast cancer also receive targeted therapies. These patients may receive a different set of targeted therapy drugs both prior to and after surgery. Since about half of patients with HER2-positive breast cancer also have hormone receptor-positive tumors, they are also given endocrine therapy.
Metastatic triple-negative breast cancer can be treated with a targeted therapy focused on the TROP-2 protein produced by cancer cells.
Learn more about targeted therapy.
Immunotherapy
Many cancer drugs directly kill cancer cells. Immunotherapy is different. It improves the ability of the patient¡¯s own immune system to fight cancer.
At this time, immunotherapy has only been approved to treat breast cancer in limited cases. Studies are underway to learn how to use immunotherapy in additional situations.
Learn more about immunotherapy.
Our treatment approach
Like all cancers, inflammatory breast cancer treatment is most successful when patients have an experienced care team. IBC makes up only 1%-5% of all breast cancer cases, so many doctors see only a handful of IBC patients during their career.
However, IBC is not rare to MD Anderson. As members of a top-ranked cancer center, our doctors treat hundreds of IBC patients every year, from the newly diagnosed to patients with metastatic or recurrent disease. This gives them incredibly deep skill and expertise to draw from when caring for patients.
This clinical experience and emphasis on research is leading to advances in the care of IBC. At MD Anderson, 98% of IBC patients who undergo a mastectomy have no detectible cancer cells in the margins of the surgical site. This greatly lowers the chances of the disease recurring locally. Combined with advances in medical oncology and radiation oncology, this level of care can lead to improved survival rates, studies indicate.
As a leading cancer center, MD Anderson can also offer clinical trials for patients at all stages of IBC, including those who are newly diagnosed and with previously treated/recurrent disease. Trials may offer patients drugs, such as targeted therapy and immunotherapy options.
Surgical Expertise
Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. MD Anderson¡¯s breast surgeons are among the most skilled and renowned in the world. They perform a large number of surgeries for inflammatory breast cancer each year, using the most-advanced techniques.
Surgeons at MD Anderson also are pioneering the use of specialized procedures for preventing/reversing lymphedema, a common side effect of standard surgery and radiation in breast cancer patients. IBC patients are at higher risk for lymphedema than the general breast cancer population.
Learn about our reconstructive surgeons.
Learn more about inflammatory breast cancer (IBC):
What is a double mastectomy?
When cancer is found in both breasts or there¡¯s a high risk of developing breast cancer, a double mastectomy may be an option to treat or prevent breast cancer.?
This surgery removes all breast tissue. It can be performed with or without breast reconstruction surgery, either at the same time or as a separate procedure. ?
We spoke to surgical oncologist , to learn more about this procedure and what patients can expect before, during and after a double mastectomy.?
Who needs a double mastectomy??
Very few patients need a double mastectomy, but there are some cases where patients and their care teams may decide to seek this treatment option, if they meet certain requirements.
The National Comprehensive Cancer Network¡¯s guidelines outline which patients may benefit from double mastectomy. These include patients who have:
certain genetic mutations, like BRCA1 and BRCA2, that put them at increased risk for developing breast cancer,?
cancer in both breasts,??
several close family members who¡¯ve been diagnosed with breast cancer at a young age, and/or
a history of radiation therapy to the chest. ?
Patients with a tumor in one breast may consider a double mastectomy, also called a bilateral mastectomy, for cosmetic reasons to achieve symmetry in the other breast. ?
What are the alternatives to double mastectomy??
When you have breast cancer, your first instinct may be to remove all potential for it to grow or spread. But surgery isn¡¯t the only option for many patients. Even if you¡¯re at high risk for developing breast cancer, there are non-surgical treatment options that don¡¯t require a double mastectomy. These include more frequent screenings and surveillance.?
MD Anderson patients can seek care from our High-Risk Screening and Genetics Clinic, where they¡¯ll receive frequent mammograms and/or breast MRIs to detect cancer early, when it¡¯s easiest to treat.?
Talk to your care team to see if you¡¯re eligible for more frequent screenings instead of surgery.
What are the different types of double mastectomy??
There are several different surgical techniques that can be used during a double mastectomy. These include:?
Total mastectomy: This surgery removes all the breast tissue, including the skin and nipple.?
Skin-sparing mastectomy: Breast tissue is removed along with the nipple and areola, but the skin around the breast is saved. This leaves a ¡°skin envelope,¡± which allows for breast reconstruction surgery at the same time, either with implants or your own tissue. This approach offers a more natural appearance after patients recover.?
Nipple-sparing mastectomy: This technique is the most complex option for mastectomy; it saves the skin as well as the nipple-areolar complex. Nipple-sparing mastectomy is performed with reconstruction at the same time, similar to a skin-sparing mastectomy. Surgeons remove tissue inside the breast but save the skin, nipple and areola. ?
Your recovery time will depend on which surgical approach you receive and whether you undergo breast reconstruction. This can range from two weeks for total mastectomy with no reconstruction to 4 to 8 weeks after mastectomy with reconstruction using your own tissue.
What are the risks associated with double mastectomy?
As with any surgery, there are risks associated with double mastectomy. And, because the treatment involves two different spots on the body, that risk is doubled.?
With skin-sparing and nipple-sparing mastectomy, there¡¯s risk that the skin and nipple will lose blood supply and die or lose sensation. Bleeding and infection are also possible side effects of surgery. That¡¯s why it¡¯s so important to seek care from a surgeon with experience performing this specialized surgery to get the best result and minimize risks.
Anything else patients should know about double mastectomy??
A double mastectomy can be beneficial for some patients, but it¡¯s not right for everyone. Having both breasts removed is a big decision, and you want to make sure that it¡¯s the right one for you based on your quality of life and personal treatment goals.?
Talk to your care team to see if a double mastectomy makes sense for you and your breast cancer treatment goals.?
or by calling 1-877-632-6789.?
Mastectomy recovery: What to expect after breast removal surgery
Mastectomy is the scientific term for the surgical removal of the breast. It is frequently used to treat and prevent breast cancer. It can be performed on just one side of the body or on both at the same time.??
But how long does it take to recover from a mastectomy fully? How long will you have to stay in the hospital? And, will you ever really feel normal again???
Here are the answers to these and other questions I sometimes hear about what to expect after a mastectomy.?
How long does it take to recover from a mastectomy fully?
The recovery time is similar for all types of mastectomy: 3 to 4 weeks. But there are three different kinds.?
- Total mastectomy?
- Skin-sparing mastectomy?
- Nipple-sparing mastectomy?
In a total mastectomy, the entire breast is removed, including the skin, areola and nipple. So, the procedure will leave you totally flat on one side. The other two kinds allow you to retain some portion of the breast skin. They are also coupled with reconstruction, so they involve either an implant, a tissue expander, or your own tissue (autologous reconstruction).?
No matter what type of mastectomy you have, you will leave the hospital with at least one drain hanging from your side.? ?
Why would I need a drain after a mastectomy?
Once a breast is removed, there is an empty space left under the skin. The body fills up that empty space with fluid as a response to the inflammation caused by surgery. We insert drains to remove that fluid as it forms.?
How many drains will I need after a mastectomy and how long must they stay in?
Patients typically need one drain per side for mastectomies. Some patients may have two. ?It depends on your particular situation and what your surgeon thinks is most appropriate.??
The average amount of time a drain stays in place is 2-3 weeks. But a drain¡¯s removal is not determined by time. It¡¯s based on the amount of fluid coming out of it. Once a drain¡¯s output drops below 20-30 mL/day for two days in a row, it can usually be removed. Some surgeons use different criteria, though, so ask your doctor what you can expect.?
How long will I have to stay in the hospital after a mastectomy?
It¡¯s a pretty well-tolerated procedure that only takes 1-2 hours to complete. So, some patients can go home that same day. Others might need to stay overnight at the hospital, but typically no longer than that.?
The only exception is a mastectomy with an immediate autologous reconstruction (e.g. DIEP flap reconstruction). This procedure involves taking tissue from other areas of the body to reconstruct the lost breast. Depending on where that tissue comes from and how much of it is used, you might end up with drains in other locations, too. You¡¯ll also likely need to stay in the hospital longer ¡ª up to four or five days.?
How painful is the aftermath of a mastectomy, and how long does it last??
Surgeons inject a lot of numbing medication into the surrounding tissues during a mastectomy, so when most patients wake up from general anesthesia, they¡¯re not usually in any pain.??
That being said, you might feel some tightness or pressure in the chest area if you have immediate reconstruction. That¡¯s because an implant or tissue expander is sitting right on top of your chest wall.?
Most patients can control their pain with over-the-counter pain relievers like acetaminophen or ibuprofen. Some people might also need a narcotic. But patients often mention that the drain is what bothers them most, not pain from the healing incision.?
Is a mastectomy considered a serious procedure??
Mastectomies are considered major surgeries. But they are well-tolerated and most of the time, there is minimal blood loss.? ??
What¡¯s the hardest part of recovering from a mastectomy?
In my experience, the drains are what often bother people the most. Finding a comfortable position to sleep in can be challenging. Some people like specially designed wedge pillows for support and comfort.?
Another complaint I hear often is tightness in the chest or arm area on the same side as the mastectomy. We provide patients with week-by-week instructions for range-of-motion exercises and stretches to counteract that, so their chest doesn¡¯t feel tight.?
Are there any other restrictions after a mastectomy that I should know about?
- No heavy lifting: at least, not until after your drains are removed ?
- No arm lifts, either: If you lift your arm above your head on the same side that your surgery was performed, you run the risk of dislodging a drain or spacer. Follow the instructions given by your physician. Our surgeons have created detailed guides on what movements patients can and cannot do.?
- No driving: at least, not until released by your surgeon. Additionally, you should not drive if you are still taking pain medication.?
- No swimming or bathing: for at least six weeks, or until your incision has completely healed. You can still take showers and pat the surgical site dry after letting water run over it.?
Are there any downsides to a mastectomy??
You won¡¯t be able to breastfeed on that side anymore, even if you have a nipple-sparing mastectomy. You will also lose sensation in the breast skin because we have to sever some nerves to completely remove a breast.??
You might also develop a side effect called post-mastectomy pain syndrome, a type of nerve pain that develops in the chest wall, inner arm and armpit.?
Any other tips to make mastectomy recovery easier?
- Get a mastectomy bra: These are specially designed to have drains pinned to them, which may keep you more comfortable. You can also purchase soft sports bras for when the mastectomy bra is being laundered.?
- Consider other wardrobe adjustments: Keep any button-front shirts and slip-on shoes handy. You won¡¯t be able to wear pullovers for a while, and tying your shoes might be a challenge.?
- Plan ahead for accessibility: Some patients find that putting frequently used items at waist level in their living spaces is helpful. That way, you won¡¯t have to reach for them after surgery.?
- Enlist temporary aid: You might need help with everyday tasks, such as getting dressed and showering. Start lining up your caregivers now. You may also want to sign up for a meal delivery service or ask friends for help with your grocery shopping.?
Will I ever feel normal again after a mastectomy???
The way people react to a mastectomy is a very individual process. It¡¯s different for everyone. And the concept of ¡°normal¡± is so subjective, making that hard to answer. But what I can tell you is that people can and do live normal, happy lives after a mastectomy.??
Most women don¡¯t look forward to losing a breast. But they understand the need for it when it¡¯s being recommended by an oncologist. Some will mourn the loss of their breast differently than others. But most eventually begin to feel more like themselves. And there is so much support available to help patients look and feel their best ¡ª especially here at MD Anderson.??
, is a surgical oncologist specializing in the treatment of breast cancer.
or call 1-877-632-6789.
How to relieve nerve pain after a mastectomy
Between 25% and 60% of people who have surgery as part of their breast cancer treatment will also experience a side effect known as post-mastectomy pain syndrome (PMPS). This type of nerve pain develops in the chest wall, armpit, and inner arm.
Sometimes, discomfort caused by PMPS is minor and only considered a nuisance. Other times, it can be a real problem that affects a patient¡¯s whole life.
Why nerve pain after a mastectomy happens?
The main reason PMPS happens is that nerves must sometimes be cut in the process of removing cancerous breast tissue during surgery. Depending on the location of the lump or tumor, this could happen during a full mastectomy or a partial or segmental mastectomy.
Breast cancer patients who receive both surgery and radiation therapy are more likely to experience PMPS. That¡¯s because any nerves not damaged by the surgery could subsequently be ¡°burned¡± by the radiation.
Certain factors increase your risk of nerve pain after a mastectomy
Fortunately, severe cases of nerve pain after mastectomy don¡¯t happen very often. But you¡¯re more likely to face this side effect if you have both radiation therapy and surgery.?
Other risk factors include:
- having an axillary (or armpit) lymph node dissection
- age: younger women seem to develop it more frequently than older women?
- a history of depression or anxiety
Here at MD Anderson, we do our best to think about these risk factors before patients begin treatment. We send them to pain specialists if any risk factors are identified before surgery to make sure that any pre-existing pain and mental health issues are well-managed. If pain and anxiety are not well-controlled, they can sometimes make people more likely to have this side effect.
How to distinguish nerve pain after mastectomy from regular healing pain
We don¡¯t consider nerve pain chronic unless it lasts at least three months beyond the date of surgery. Nerves grow back at a really slow pace ¡ª only about one millimeter a day. So, it can take up to a year for patients to heal completely.?
That being said, the ¡°normal¡± healing pain after breast cancer surgery is typically described as sharp and stabbing. It also gradually improves over time.
To that list, patients with PMPS often add:
- numbness in the chest wall, armpit or inner arm
- a burning sensation in those same areas
- extreme skin sensitivity?
Nerves that are cut surgically can sometimes grow back abnormally, leading to a condition known as hyperalgesia. That means light touching or putting on clothes can be painful. Even something as gentle as a breeze blowing by might be enough to cause some people pain in an affected area.
There¡¯s also a kind of ¡°phantom¡± breast pain, similar to phantom limb syndrome, in which patients perceive pain in a breast that is no longer there.
It¡¯s important to seek help from a doctor if your nerve pain has these qualities, as it is unlikely to go away on its own.?
How we treat nerve pain after a mastectomy
We generally use some combination of oral medication and topical cream to relieve nerve pain after a mastectomy. These medications are designed specifically to address nerve pain. We consider nerve blocks after surgery as a last resort.?
But we also use special techniques during mastectomies to prevent post-operative pain in the first place. We might inject a local anesthetic near the incision, for instance, or a nerve block during surgery to numb the chest wall and axilla.?
We also try to minimize the extent of the surgery itself. The more tissue you touch, the more pain a patient can experience as a result. So, if we can get the same results from a smaller or less-invasive surgery and adjuvant treatments, we will consider that approach.?
Finally, we send almost everyone through physical therapy after surgery. If you keep moving, it decreases your chances of getting pain and stiffness. We also encourage patients to consider integrative therapies, such as acupuncture and oncology massage.
,?is an anesthesiologist who specializes in perioperative medicine.??
or call 1-877-632-6789.