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Tag Archives: women’s health

  •
    October 25, 2022

    Inflammatory Breast Cancer 

    Inflammatory Breast Cancer 

    By: Mona Williams-Gregory, PhD, DNP, APRN

           Inflammatory breast cancer is a rare, very aggressive cancer that accounts for up to 5% of all breast cancers in the US1. At the time of diagnosis, inflammatory breast cancer is usually stage III or IV1. As many as 30% of cases involve metastasis2. Identifying inflammatory breast cancer can be challenging because symptoms emerge rapidly and may be mistaken for an acute inflammatory process like mastitis3. It is more common among African American women, women under 40, and women who are overweight or obese2. As a result of lymphatic fluid buildup within the breast, clinical manifestations include bruising or redness, swelling, warmth, pain, itching, dimpling of the skin, or pulling of the nipple1-3.  Traditional mammography may not be useful in diagnosing inflammatory breast cancer. Most women with inflammatory breast cancer do not have a lump and their breast tissue is dense1. These factors make mammography less definitive, but it can be useful in identifying lymph node involvement. An ultrasound, PET scan, CT scan, or bone scan can also be used to evaluate metastasis1. A breast biopsy is used to definitively diagnose inflammatory breast cancer1-3. The standard of care for nonmetastatic inflammatory breast cancer employs a trimodal approach of systemic chemotherapy followed by modified radical mastectomy and radiation1-3. The survival rate for women with inflammatory breast cancer is lower than that of women with other types of breast cancer1-4. But outcomes associated with this trimodal approach have favorable control rates4, which highlights the importance of early detection and prompt treatment of inflammatory breast cancer. Let’s use breast cancer awareness month as an opportunity to educate our patients about inflammatory breast cancer.

    References

    1. National Institute of Health (NIH). (2016, January). Inflammatory breast cancer. https://www.cancer.gov/types/breast/ibc-fact-sheet
    2. American Cancer Society. (2022, March). Inflammatory breast cancer. https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/inflammatory-breast-cancer.html
    1. Susan G. Komen. (2022, May). Inflammatory breast cancer. https://www.komen.org/breast-cancer/treatment/by-diagnosis/inflammatory-breast-cancer/
    1. Hester, R. H., Hortobagyi, G. N., Lim, B. (2021). Inflammatory breast cancer: Early recognition and diagnosis is critical. American Journal of Obstetrics & Gynecology, 4, 392-396. DOI: https://doi.org/10.1016/j.ajog.2021.04.217
  • September 30, 2022

    Vulvar Cancer

    Vulvar Cancer

    By: Suzanne Garcia, CRNP, BSN

    Johns Hopkins School of Medicine & Baltimore City Health Department

            Vulvar cancer includes cancer of the mons pubis, labia majora, labia minora, clitoris, vestibular bulb, and greater vestibular glands. Geographically, it’s most common in Europe, North and South America, and Oceania.1 Women between the ages of 60 and 80 years old are more likely to develop vulvar cancer; however, it may occur in younger women as well.

         The etiology of the disease process is different in these two groups. In younger women, especially those who smoke, have a history of sexually transmitted infections, are immunodeficient, or have a low socioeconomic status are more like to have HPV associated vulvar cancer.1  These women experience the precursor lesion, vulvar intraepithelial neoplasia (VIN) that is HPV dependent and seldom progresses to squamous cell carcinoma (SCC).2 Women over 60 years old typically develop VIN that is HPV independent and progresses to warty/basaloid SCC.2 HPV independent vulvar SCC arises from lichen sclerosus, lichen planus, or another form of chronic dermatitis.3 From inflammation, to cellular atypia with advancement to VIN and squamous cell carcinoma1, SCC is usually diagnosed early and may present as a mass, scaly patch, plaque, pruritis, or ulcer.3

         Although women between 60-80 years old typically develop HPV independent neoplasia, recommendations for examination and diagnosis include vaginal and cervical colposcopy3 because HPV is present in 86% of precancerous changes in the vulva.1 Cystoscopy and/or proctoscopy may be indicated for invasive disease.3

         Surgery is the mainstay of treatment for early stage disease.3 Evaluation of lymph nodes is necessary if the lesion is >1mm deep, or ≥2 cm from vulvar midline. Furthermore, biopsy of the sentinel node is warranted according to Wohlmuth and Wohlmuth-Wieser (2019) “. . . if the tumor is unifocal, has a diameter of less than 4 cm, and the lymph nodes are clinically negative.” 3(p1260)

        Nodal disease is a predictor of outcome. If the sentinel node is positive, treatment with external beam radiation therapy (EBRT), and possibly chemotherapy with dissection of the inguinal node is preferred.3 Although these patients are less likely to have progressive disease, involvement of at least one node drops the 3-year overall survival rate to 56.2% from the 90% of negative nodal disease per the retrospective AGO-CaRE-1-multi center study. Additionally, the five-year recurrence rate is 37% treatment completion.4

         Vulvar cancer is often diagnosed in women over 60, but some younger women may be affected. HPV is a factor in this group, while it typically arises from prolonged inflammation later in life. However, colposcopy is a mainstay of diagnosis in both groups. Nodal involvement forecasts outcomes.

    References

    1. Merlo, S. (2020). Modern treatment of vulvar cancer. Radiol Oncol, 54(4), 371-376. doi: 2478/raon-2020-0053
    2. van der Avoort, I. A. M., Shirango, H., Hoevenaars, B. M., et al. (2006). Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol, 25(1), 22-29. doi: 10.1097/01.pgp.0000177646.38266.6a
    3. Wohlmuth, C., & Wohlmuth-Wieser, I. (2019). Vulvar malignancies: An interdisciplinary perspective. Journal der Deutschen Dermatologischen Gesellschaft, 1257-1273. doi: 10.1111/ddg.13995
    4. Te Grootenhuis, N. C., van der Zee, A. G. J., van Doorn, H. C., et al. (2016). Sentinal nodes in vulvar cancer: Long-term follow-up of the Groningen International. Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol, 140(1). 8-14. doi: 10.1016/j.ygyno.2015.09.077

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