Writing Your Way Through Cancer, Part II: Sharing Your News

Thanks for sharing your experience.  My husband did some of the emailing too, especially immediately after my surgery.  Our far flung support system was crucial to our well-being during that traumatic time.  I'm glad you're still writing.

The standard protocol for treating inflammatory breast cancer (IBC) is to do chemo before mastectomy.  The diagnosis for IBC is based on finding cancer in the lymph vessels in the skin of the breast with a biopsy.  Of course, there will probably be more cancer in other places in the breast, but it's those cancer cells that have already moved into the lymphatic system where they can have a free ride to vital organs that worry the doctors.  To kill any of those escaping cancer cells, chemo is given first.  The death rates for IBC didn't go down until the chemo, surgery, radiation treatmen was done in that order.  When I was diagnosed, usually four treatments of chemo were given before surgery and then four more after surgery, followed by radiation.  Now I notice more and more patients get all the chemo first.

Of course, there are some variations in treatment depending on special circumstances in a patient's situation.  However, if your friend has a definite IBC diagnosis and the doctor is recommending surgery before chemo, I'd recommend that she get a second opinion and find out if there is some unusual feature of her case that would warrant not following the standard protocol. 

HELLO PHYLLIS, THANKS FOR RESPONDING.  IS MASTETOMY THE SAME AS REMOVING THE MASS/LUMP IN THE BREAST.  MY FRIEND DOCTOR WANTS TO REMOVAL THE MASS/LUMP WITH BIOPSY.  IS THAT THE NORMAL PROCEDURE WHEN YOUR'RE DEALING WITH IBC.  HOW WOULD SHOULD KNOW FOR SURE THAT SHE HAS IBC.  SHE WAS GIVEN A RADIOLOGIST REPORT, THEY DID A PHYSICAL EXAM, MAMMOGRAM, AND ULTRA SOUND AND IT STATES PRIMARY CONSIDERATION IS EXTENSIVE IMFLAMMATORY PROCESS WITH INFLAMMATORY BREAST CARCINOMA.  WILL THE BIOPSY ITSELF CONFIRM THE IBC.  ALSO WHAT TYPE OF DOCTOR TREATED YOU.  SHE IS BEING SEEN BY A GENERAL/VASCULAR SURGERON.  SHE DOESN'T HAVE A BREAST SPECIALIST YET.  SHOULD SHE SEE A BREAST SPECIALIST BEFORE SHE LET THIS SURGERON REMOVE THE LUMP.  HER ONLY VISIT FROM A DOCTOR WAS FROM THE EMERGENCY ROOM DOCTOR, THANKS FOR YOUR TIME AND RESPONSE, IMINA

Removing a mass is not the same thing as a mastectomy.  A mastectomy is removing the entire breast.  Removing a mass could be removing any amount of tissue.  In this case, "mass" isn't a very precise term.  The term "primary consideration" in the radiology report means that the most likely cause of what they are seeing in the films is inflammatory breast cancer, but it will take a biopsy to say for sure what is causing your friend's problem.

Because doctors know that IBC is very dangerous, they are not likely to proceed with treatment without doing a little research into the latest studies.  The fact that the radiologist raised the possibility of "inflammatory breast carcinoma" suggests to me that your friend is fine with going ahead with her current doctors.  Obviously these doctors know what IBC is and what it often looks like on a mammogram or ultrasound.  

The information you read at the Mayo website is correct that the entire breast shouldn't be removed before chemo, so she needs to clarify with the surgeon exactly what will be removed with the biopsy.