For some, it's a red rash on the breast that doesn't go away. Others experience dimpling of the breast, like the peel of an orange.
Rasonda Crandall noticed what appeared to be a 1-by-4-inch bruise under the areola of her left breast. She initially thought that maybe her young son had brushed up against her, causing the discoloration.
Crandall didn't worry until she noticed that it wasn't behaving like a bruise.
"I watched it. It wasn't changing colors," she said.
When it hadn't cleared up after a few days, she saw a doctor that same week.
Her doctor knew immediately it wasn't a bruise. Biopsies confirmed it was an uncommon, aggressive form of breast cancer called inflammatory breast cancer.
Inflammatory breast cancer doesn't usually produce a distinct tumor that can be felt. It might not be detected by a mammogram and that's why Crandall was shocked by the diagnosis.
She'd had a mammogram negative for tumors about a month before her November 2010 diagnosis.
And that's not all. Crandall, now 51, is a presurgical nurse who will mark 30 years in the profession next year. "I've never seen inflammatory breast cancer," she said.
ADVANCED STAGE BREAST CANCER
Inflammatory breast cancer accounts for 5 percent or fewer of all cases, according to the National Cancer Institute.
It spreads rapidly and is usually advanced by the time it's diagnosed, said Dr. Stephanie Hodson, who specializes in breast cancer at Saint Al's. Survival rates are lower than for other breast cancers, and patients have a higher risk of recurrence.
Crandall was told she had Stage 3 breast cancer, which means it might have entered nearby lymph nodes and muscle, but was treatable.
"When you get the diagnosis, the thing you want to hear are your chances," Crandall said. "I remember hearing, 'You have a 25 percent chance of living.' "
Treatment is equally aggressive.
"With inflammatory cancer, we pull out all the stops," Hodson said.
Chemotherapy is first. That's followed by mastectomy and radiation.
Crandall endured six months of chemo. About six weeks later - after her white blood cell counts had rebounded - she had a double mastectomy. Surgeons removed 27 lymph nodes from her left side and tested all for cancer.
"Only one was positive," Crandall said. "That was a miracle right there. If it had only gone to one out of 27, that meant I caught it pretty dang early."
They also tested six lymph nodes on the right side, and all tested negative.
Once she'd recovered from the surgery, she had almost 40 radiation treatments. The radiation made her tired, she said, but that was nothing compared to the side effects of the chemo.
"Chemo affects everything in your whole body," she said. "The last one, I didn't think I would be able to do it. I really thought I was going to die."
In case she didn't survive it, she gave directives to her then-husband and mother.
"I was making my last plans," Crandall said. "I didn't know whether the white count would come back up. I was just down."
The Pocatello native, who grew up in American Falls, is a member of The Church of Jesus Christ of Latter-day Saints. At the time of her diagnosis, she received a blessing from two church elders - that gave her confidence that she would survive the ordeal.
She was able to go back to work in the summer of 2011. To celebrate, her mom paid for a family trip to Hawaii in January 2012.
MOTHER, DAUGHTER HAVE BRCA GENES
Crandall's 75-year-old mother, Sandra Paulene Porter, has survived five bouts of breast cancer. She was tested for the BRCA1 and BRCA2 genes, which are associated with breast cancer.
The timing of the results she was positive for BRCA2 was chilling.
"When she called with the news, I said, 'Mom, I have something to tell you. I have breast cancer now,' " Crandall said.
It wasn't Crandall's first cancer diagnosis.
When she was 40, she had thyroid cancer. She was pregnant with her son, Michael, so she had her thyroid removed in the second trimester and began radiation pills when she was done breast-feeding.
After her mother learned she carried the BRCA2 gene, Crandall got the test, too. She has the gene; her sister does not.
Armed with that knowledge, Crandall opted to have a double, rather than single, mastectomy. She also had her ovaries removed.
She wears prosthetics now, but she plans to have reconstructive surgery.
"I jokingly call them my 'laser boobs,' " Crandall said. "They actually do a laser of your chest, so they form-fit."
They fit into the bra and are more natural than rice or cotton prosthetics used in the past. They compress in a more natural way when the wearer hugs someone.
"We've come a long way," Crandall said.
Crandall does regular checks for lumps on her chest wall and sees her oncologist every three months. She has been cancer-free for almost three years the period in which most recurrences happen.
"I'm actually quite optimistic about how she is going to do long-term," Hodson said.
The five-year survival rate for women with inflammatory breast cancer from 1988 to 2001 was just 34 percent, according to the National Cancer Institute. That compares with 87 percent for women who get other types of breast cancer.
Hodson hopes more women will pay close attention to changes in their breasts: skin color, itchiness or pain, symmetry, dimpling and feeling (heaviness or fullness).
"That's the whole key," Crandall said. "People have to be tuned in to their bodies. If there's something that's not normal, then have it checked out. I was able to catch it early."
Katy Moeller: 377-6413