Shanghai Sixth People’s Hospital, early in the morning, the outpatient hall in front of the Breast Disease Specialized Diagnosis and Treatment Center was bustling with patients, but everyone was waiting in an orderly manner to be seen.
“Gee, Dr. Ying, we meet again.” The company’s first-ever “The Best of the Best” is a new product.
The story of Dr. Ying, the primary care physician, is one that made a deep impression on him, starting one afternoon three years ago.
Initial diagnosis, high suspicion of inflammatory breast cancer
That day Dr. Ying was out in the afternoon, and by the end of the day, he was already receiving many new and existing patients. “The company’s main business is to provide a wide range of products and services to its customers. Xiao Min shouted as soon as she entered the consultation room, a very anxious look, so that the original slightly tired Dr. Ying also followed a tight look.
However, after some medical history and physical examination, the experienced Dr. Ying found something unusual. The company’s main goal is to provide the best possible service to its customers.
- Acute mastitis usually occurs in younger women, such as breastfeeding women, due to milk stagnation. Xiao Min is 55 years old, and it is generally unlikely that a woman of that age would have acute mastitis.
- Plasmacytoid mastitis due to bacterial infection? Probably not! While bacterial infection mastitis usually has local symptoms such as fever and pain, Xiao Min’s entire left breast was red and swollen without fever or pain.
- Another important point is that on the outside of the left breast, an egg-sized lump was felt, which was hard to the touch and had unclear borders.
With her extensive clinical experience, Dr. Ying informed Xiao Min that it was likely to be inflammatory breast cancer and asked her to go for a mammogram first.
Breast ultrasound: further diagnosis of inflammatory breast cancer
When she learned that she might have breast cancer, Xiao Min was in disbelief and still insisted that her breast was just inflamed. The first time I saw her, I was able to get a breast ultrasound.
Just after putting the ultrasound probe on Xiao Min’s breast, the examining doctor found an abnormality, “the left breast lump has unclear borders, and there is abundant blood flow, and the skin around the lump is edematous and thickened”, “it could be inflammatory breast cancer, bring the report to the doctor quickly, it may need immediate treatment “.
Since it’s cancer, should we cut it up quickly?
The diagnosis report made Xiao Min even more anxious. Cancer is no joke!
She went to Dr. Ying’s office again and asked him to schedule her for an immediate inpatient surgery to remove the diseased breast.
However, Dr. Ying replied to her, “Inflammatory breast cancer is special in that the lesions are usually large and there are often tumor cells in the lymphatic vessels under the skin, so you are not suitable for direct surgery at this time, and you need to take medication first and wait until your condition is in remission before choosing the right time to have surgery.” After Dr. Ying’s patient explanation, Xiao Min was psychologically prepared.
Because of the urgency of her condition, Dr. Ying quickly arranged for Xiao Min to be admitted to the hospital. After admission, a series of tests were done and a puncture biopsy of the breast mass was done under ultrasound guidance. The pathology results came out quickly and Xiao Min was confirmed to have invasive breast cancer. Fortunately, the test results also ruled out the possibility of metastases elsewhere in the body.
Dr. Ying and his team developed an appropriate chemotherapy regimen for Xiao Min. After several chemotherapy sessions, the treatment showed excellent results: the breast redness and swelling quickly subsided and the breast lumps shrank significantly. After seeing these clear treatment results, Dr. Ying arranged for Xiao Min to be admitted to the hospital again and underwent radical excision of breast cancer at the same time. After the surgery, Xiao Min continued to receive comprehensive treatment.
After the treatment, Xiao Min recovered well without recurrence of metastasis. She has also been going to the hospital for regular outpatient reviews as ordered by her doctor, and the scene at the beginning of this article happened.
Take a refresher course on inflammatory breast cancer
Clinically, inflammatory breast cancer is a specific type of breast cancer that is relatively severe, often rapid in onset and relatively fast in progression. The skin of the breast is red, swollen, thickened, hardened, and has an orange peel appearance as the cancer cells often spread to the subcutaneous lymphatic network and form cancer clots, often leading to obstructed lymphatic flow and capillary expansion. As the engorgement becomes more severe, the skin will gradually change to a purplish red color resembling blood stasis. Localized skin may also become bright red, with edema, blisters, etc., or mottled pigmentation. The temperature of the lesioned skin is often elevated.
In inflammatory breast cancer, the breast becomes rapidly enlarged, red, swollen, painful, and the lesion extends rapidly, much like acute mastitis, but in inflammatory breast cancer enlarged lymph nodes are often palpable in the armpit, whereas in acute mastitis they are usually not.
Different types of breast cancer have different treatment options. In inflammatory breast cancer, if surgery is performed as soon as possible after diagnosis, the tumor often returns and treatment fails because it is likely that the large number of cancer cells in the subcutaneous capillary lymphatic network will not be removed.
In summary, the treatment of inflammatory breast cancer has its own unique characteristics. Several studies have also shown that systemic treatment of inflammatory breast cancer before surgery significantly reduces the local recurrence rate and delays disease progression (improves disease-free survival). For inflammatory breast cancer that has been clinically or pathologically confirmed, physicians usually request chemotherapy first and then consider surgery later to avoid the adverse consequences of blind surgery. (Contributed by Ying Xuexiang, Department of Breast Surgery, Shanghai Sixth People’s Hospital)