Inflammatory breast cancer information

What is inflammatory breast cancer?

Inflammatory breast cancer is when cancer cells spread into tiny channels in the skin of the breast. These channels are called lymph vessels. They are part of the lymphatic system. They drain fluid from tissue. This allows them to collect and filter out bacteria and any waste material from the body’s cells.

The breast cancer cells block the lymph vessels. It is called inflammatory breast cancer because the breast becomes inflamed and swollen. This is because the body is reacting to the cancer cells in the lymph vessels.

Inflammatory breast cancer is rare. About 1 in 5 breast cancers (20%) are inflammatory. Unlike other breast cancers, you may not feel a lump.

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Symptoms of inflammatory breast cancer

Symptoms usually develop suddenly. The breast may become:

red if you have white skin
darker than your usual skin tone if you have black or brown skin
firm
swollen
hot to touch
itchy.

Other symptoms may include:

ridges or raised marks on the skin of the breast
pitted skin, like the peel of an orange – this is called peau d’orange
a lump or thickening in the breast
pain in the breast or nipple
the nipple turning inward (becoming inverted)
discharge from the nipple
swelling or a lump in the armpit.

The symptoms of inflammatory breast cancer are similar to an infection of the breast called mastitis.

If your GP thinks that you could have mastitis, they may give you antibiotics to see if symptoms improve. It is not common to get mastitis if you are not pregnant or breastfeeding. It is also rare to get mastitis if you have been through the menopause.

Mastitis symptoms usually improve quickly with antibiotics. If this does not happen, your GP will refer you to a specialist breast cancer doctor. This is who mean when we mention cancer doctor on this page.

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Do I have cancer?

Diagnosis of inflammatory breast cancer

The cancer doctor may suspect inflammatory breast cancer from the way your breast looks. But you will need to have tests to confirm the diagnosis and to find out whether the cancer has spread:

Breast biopsy

You will have a breast biopsy. Your cancer doctor or a nurse will take small samples of skin or cells from the breast, nipple and armpit. The samples are looked at under a microscope to check for cancer cells. Your cancer doctor may also take a biopsy from the lymph nodes under the arm.

Breast cancer cells are also checked for receptors and proteins called ER and HER2. These can encourage breast cancer cells to grow.
Mammogram

A mammogram is an x-ray of the breast.
Ultrasound scan

Ultrasound scans uses sound waves to produce a picture of the breast tissue and the lymph nodes (glands) in the armpit.

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Stages of inflammatory breast cancer

If you have inflammatory breast cancer, you will have other tests. These may include:

This is to find out more about the size and position of the cancer. It is also to find out whether the cancer has spread to other parts of the body. The results will help you and your doctor decide the best treatment for you.

Number staging system

Doctors often use the number staging system to describe the size and position of the cancer. Breast cancer can be divided into 4 number stages. Stage 1 cancer is very small and has not spread to the lymph nodes in the armpit. Stage 4 is when the cancer has spread to other parts of the body.

Early-stage breast cancers usually affect only 1 small area of the breast. But inflammatory breast cancer usually affects the whole breast and the skin. So, it is not usually staged as early.

Inflammatory breast cancer is either stage 3B, 3C or 4:

Stage 3B – the cancer has spread into tissue nearby, such as the skin of the breast and the chest muscle underneath. It may have spread to lymph nodes in the armpit.
Stage 3C – the cancer has spread to lymph nodes in the armpit, or below the breastbone. This could be either above or below the collarbone.
Stage 4 – the cancer has spread beyond the breast and nearby lymph nodes.

Treatment for inflammatory breast cancer

Inflammatory breast cancer can spread more quickly than other types of breast cancer. This means you often start treatment straight away.

You will usually be offered a combination of treatments. These treat both the breast area (local treatment) and the body as a whole (systemic treatment).

For most types of breast cancer, surgery is usually the first treatment. But for inflammatory breast cancer, you usually have chemotherapy first. Chemotherapy before surgery is called neo-adjuvant treatment.

We have more information about treatment for breast cancer.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy for inflammatory breast cancer helps treat and control the cancer and reduces swelling. As the chemotherapy travels around the body, it can also treat cancer cells that may have spread.

You usually have chemotherapy as a session of treatment, followed by a rest period of a few days or weeks. The rest period allows your body to recover from the side effects. The chemotherapy session and the rest period together are 1 cycle of treatment. Your cancer doctor will explain how many cycles you will need.

Treatment for inflammatory breast cancer usually includes chemotherapy drugs called anthracyclines, such as epirubicin or doxorubicin. You usually have 3 or 4 cycles of treatment with an anthracycline.

You may also have 3 or 4 cycles of treatment with another type of chemotherapy drug called a taxane. The taxane drug used is docetaxel or paclitaxel. Your cancer doctor, nurse or pharmacist will explain whether you will have an anthracycline or a taxane first.

If the cancer has HER2 positive, you usually have targeted therapy drugs called trastuzumab and pertuzumab. These may be given with a taxane and another chemotherapy drug called carboplatin.

If the breast cancer is triple negative, you may also be given an immunotherapy drug and other types of targeted therapy.

Your cancer doctor or breast care nurse will talk to you about your treatment plan.
Targeted therapy

Many inflammatory breast cancers are HER2 positive. Certain targeted therapy drugs are used to treat HER2 positive breast cancer. Targeted therapy interferes with the way cancer cells grow.

Targeted therapy drugs used for breast cancer include trastuzumab (Herceptin^®) and pertuzumab (Perjeta^®).

Other drugs called trastuzumab deruxtecan and trastuzumab emtasine are sometimes used.

Your cancer doctor or nurse will explain which targeted therapy drugs will help in your situation.

Targeted therapy drugs can affect the way the heart works. You will have tests to check your heart first. You may also have heart tests during and after your chemotherapy
Surgery

After chemotherapy, you usually have surgery. Usually, the whole breast is removed, including the nipple area. This is called a mastectomy.

Surgeons will also remove lymph nodes in the armpit. This is called axillary node clearance (ANC). The lymph nodes are checked for cancer.

For inflammatory breast cancer, breast reconstruction does not usually happen during a mastectomy. Breast reconstruction is when a new breast shape is formed.

If breast reconstruction is suitable for you, your cancer doctor will talk to you about the best time to have it.
Radiotherapy

Radiotherapy uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. To treat inflammatory breast cancer, you usually have radiotherapy to the chest wall after a mastectomy. This is to reduce the risk of the cancer coming back in that area.

You usually have 5 sessions of radiotherapy over 1 week. This is usually on Monday to Friday, with a break at the weekend. Some people have 15 sessions over 3 weeks. Some people also have an extra dose of radiotherapy. This is called a boost.

Your cancer doctor will tell you how many sessions you will have. Radiotherapy to the chest can cause some side effects. Your cancer doctor, nurse or radiographer will talk to you about how you can manage these. A radiographer is the person who gives you radiotherapy.
Hormonal therapy
If you have ER positive breast cancer, your cancer doctor will prescribe hormonal therapies. Hormonal therapy reduces the amount of oestrogen in the body or stops it attaching to the cancer cells.

Hormonal therapy reduces the risk of cancer coming back. It also protects the other breast. You usually have hormonal therapy for 5 to 10 years. There are different types of hormonal therapy, and they work in different ways. The type you have may depend on whether you have been through the menopause.

The side effects of hormonal therapy depend on the type you have. Some common side effects are:

hot flushes

tiredness

aching joints.

Your cancer doctor or nurse can give more information about hormonal therapy. They can tell you which type is best for you, and what the side effects might be.
Clinical trials

Your cancer doctor may talk to you about having treatment as part of a clinical trial. Clinical trials test new treatments or different combinations of treatment.

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After inflammatory breast cancer treatment

After treatment, you will have regular follow-up appointments. These will include a mammogram.

Your cancer doctor or nurse will explain about your follow-up and what this involves.

Your appointments are a good opportunity to talk about any concerns you have. But if you notice new symptoms between appointments, it is important to contact your cancer doctor or nurse.

Being diagnosed with cancer, and having treatment, can cause lots of different emotions. You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line for free on 0808 808 00 00.
Chat to our specialists online.
Visit our inflammatory breast cancer forum to talk with people who have been affected by inflammatory breast cancer, share your experience, and ask an expert your questions.

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Finishing treatment

About our information

References

Below is a sample of the sources used in our inflammatory breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

BMJ Breast Practice. Primary breast cancer. 2021. Available from: https://bestpractice.bmj.com/topics/en-gb/716/history-exam [accessed 2023].

Chippa V, and Barazi, H. Inflammatory Breast Cancer. 2023. Inflammatory Breast Cancer - StatPearls - NCBI Bookshelf (nih.gov).

ESMO. Early breast cancer clinical practice guidelines for diagnosis, treatment and follow-up. 2019, Vol 30, pp1192–1220. Available from: https://www.esmo.org/guidelines/guidelines-by-topic/breast-cancer/early-breast-cancer [accessed 2023].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.