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العنوان
Update on the Management of Inflammatory Breast Cancer /
المؤلف
Mustafa, Mustafa Sultan.
هيئة الاعداد
باحث / مصطفي سلطان مصطفي
مشرف / خالد عبدالله الفقي
مشرف / محمد عطية محمد
تاريخ النشر
2019.
عدد الصفحات
193 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - الجراحة العامة
الفهرس
Only 14 pages are availabe for public view

from 193

from 193

Abstract

Inflammatory breast cancer is a rare but highly aggressive form of locally advanced breast cancer. Inflammatory breast cancer accounts for about 5% of all cases of breast cancer. In general, women with inflammatory breast cancer present at a younger age, and with high prevelange among black races.
IBC is more likely to have metastatic disease at diagnosis, and have shorter survival than women with non-inflammatory breast cancer.
The characteristic pathologic finding is dermal lymphatic invasion by carcinoma, which can lead to obstruction of the lymphatic drainage causing the clinical picture of erythema and edema.
Inflammatory carcinoma of the breast has distinct biological characteristics that differentiate it from non-inflammatory carcinoma. These tumors more often have a high S-phase fraction, are high-grade, are aneuploid, and lack hormone receptor expression and her2neu overexprestion.
In addition, inflammatory carcinomas are more likely to have mutations in p53 and to have high levels of vascular endothelial growth factor (VEGF) which account for tumor neovascularization and the lymphotactic process in inflammatory breast cancer.
Also IBC are more likely to express E-cadherin, a trans-membrane glycoprotein that mediates cell-cell adhesion, and may contribute to the aggressive lymphovascular invasion seen in inflammatory cancers.
Recently several genes have been identified that might contribute to the aggressive clinical behavior of inflammatory breast cancer. The overexpression of RhoC GTPase and the loss of expression of LIBC (lost in inflammatory breast cancer) were highly correlated with an inflammatory carcinoma phenotype.
LIBC, a novel gene, was lost in 80% of inflammatory specimens in comparison with 21% of non inflammatory tumors. RhoC GTPase, a gene involved in cytoskeletal reorganization, was overexpressed in 90% of inflammatory tumors in comparison with 38% of non-inflammatory cancers. Furthermore, when a stable RhoC transfectant cell line was created, RhoC behaved as a transforming oncogene conferring a highly invasive phenotype similar to that seen in inflammatory breast cancer. These genes remain a promising avenue for future investigation.
The most significant prognostic factor for women with inflammatory breast cancer is the presence of lymph node involvement. Patients with lymph node involvement have shorter disease-free and overall survival than patients with node-negative disease.
The second most important is the response to induction chemotherapy; extensive erythema, the absence of estrogen receptor, and the presence of mutations in the p53 gene have also been associated with poorer outcomes in patients with inflammatory carcinoma of the breast.
Because most women with inflammatory carcinoma do not have discrete masses, tumor size does not have the same prognostic value as in women with non-inflammatory carcinoma.
The optimal therapeutic approach is preoperative cheamotherapy with an anthracycline based regmen with or without taxanes for initial treatment of patient with IBC. Inclusion of trastuzumab in the chemotherapy regimen is recommended for patients with HER-2 positive disease. Patients with a clinical and pathological diagnosis of IBC should not be treated with pre-chemotherapy surgery.
Patient responding to pre-oprative chemotherapy should undergo mastectomy with axillary lymph node dissection; Breast-conserving therapy is not recommended for patient with IBC.
Any remaining planned chemotherapy should be completed.
Postmastectomy followed sequentially by endocrine therapy in the patient with hormonal receptore positive disease, if the IBC is HER-2positive, completion of one year of trastuzumab is recommended.
Finally, post mastectomy chest wall and regional nodes irradiation is recommended following the completion of any planned chemotherapy.
Mastectomy is not recommended for patient with IBC who do not respond to preoperative chemotherapy.
Additional systemic chemotherapy and or radiation should be considered for these patients, and patients responding to this secondary therapy should undergo mastectomy and subsequent treatment as described above.
Patients with meatstatic or recurrent IBC should be treated according to the guideline for recurrent or metastatic breast cancer.