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This information is about a rare type of breast cancer called inflammatory breast cancer. It should ideally be read with our general information about breast cancer|.
In inflammatory breast cancer, the cancer cells| may not grow as a lump that can be felt in the breast. They grow along the tiny channels (lymph vessels) in the skin of the breast. This blocks the vessels.
The body reacts to the cancer cells in the lymph vessels and the breast becomes inflamed and swollen (which is how the condition gets its name). Lymph vessels are part of the lymphatic system|. They drain fluid from tissues and collect and filter out bacteria and any waste materials from the body’s cells.
Symptoms often develop quite suddenly. The breast| looks red and inflamed and feels firm, warm and swollen. Ridges or raised marks may appear on the skin of the breast, or the skin may look pitted, like the peel of an orange (known as peau d’orange).
Other symptoms may include a lump or thickening in the breast, pain in the breast or nipple, or a fluid (discharge) leaking from the nipple.
The appearance of the breast may suggest the diagnosis to your doctor. Certain tests will be needed to help make the diagnosis definite and to find out whether the cancer has spread.
Mammograms| may be used to look for changes in the affected breast, and to check the other breast.
This test uses sound waves to produce a picture of the breast tissue. A gel is spread onto the breast and a small device (like a microphone) emits sound waves as it is rubbed over the area. The sound waves are converted into a picture using a computer. The test is completely painless and takes 5–10 minutes.
If you have inflammatory breast cancer, you will have further tests to find out the extent (stage) of the cancer. You may have a CT (computerised tomography) scan and a bone scan to find out if the cancer has spread outside the breast. There’s more information about these tests in our booklet section onUnderstanding breast cancer.
Breast cancer is often staged using a number system, which goes from stage one to four. The number describes the size of the cancer. of stages one to four. Inflammatory breast cancer is never stage 1 or stage 2 because these describe the size of the cancer. In inflammatory breast cancer there may not be a lump and the whole breast is usually affected. As a result, inflammatory breast cancer starts at stage 3b in the number staging system. This means the cancer involves the skin, and may or may not have spread into surrounding muscle or to the lymph nodes in the armpit.
Breast cancer can also be staged according to the TNM system. TNM describes the tumour (T), whether it has spread to the lymph nodes (N), and whether it has spread to or to anywhere else in the body, known as metastasis (M). In the TNM system, inflammatory breast cancer has its own ‘T’ stage because it affects the breast differently fromto other breast cancers. It is always stage T4d.
If the cancer has not spread to the lymph nodes, N0 is added to this the stage, and if there is no spread to anywhere else in the body M0 is also added. The number 1 or 2 is added rather than 0 if there is spread to these areas.
Inflammatory breast cancer can spread more quickly than other types of breast cancer, so treatment is often started straight away. You are likely to be offered a combination of different treatments that treat both the body as a whole (systemic treatment) and the breast area individually (local treatment).
These may include: chemotherapy|, surgery|, radiotherapy|, biological therapy| and hormonal therapy|. For most types of breast cancer, surgery is usually the first treatment. But, with inflammatory breast cancer, chemotherapy is given first. Giving chemotherapy before surgery is known as neo-adjuvant treatment.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy helps treat and control the disease in the breast and reduces swelling. As the chemotherapy travels around the body, it treats any cancer that may have spread beyond the breast to other parts of the body.
Chemotherapy for inflammatory breast cancer is often given for about 4-6 months.
A combination of two or more chemotherapy drugs| are usually given.
Following chemotherapy, most women have surgery. Usually the whole breast is removed, including the nipple area and the lymph nodes in the armpit (a mastectomy|).
Breast reconstruction (where a new breast shape is formed) is not usually done at the same time as a mastectomy in women with inflammatory breast cancer. However, it may be done at a later time when treatment is over.
Radiotherapy| uses high energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It is usually given to the chest after a mastectomy to reduce the risk of the cancer coming back in that area.
Targeted therapies (sometimes called biological therapies) are drugs that recognise and lock onto specific proteins (receptors) that are present in particular cancer cells. There are different types of targeted therapies, which work in slightly different ways.
More than half of women with inflammatory breast cancer (about 60%) have cancer cells that have a large amount of a protein called HER2| on their surfaces, which can encourage the cancer to grow. This is called HER2 positive breast cancer|. The doctors will do tests to find out whether you have this type of breast cancer.
There are treatments specifically designed to treat HER2 positive breast cancer. The most widely used is trastuzumab (Herceptin®|). It works by locking onto the HER2 on the cancer cells so that they can't be stimulated to grow.
Herceptin is given as a drip into a vein (intravenous infusion). It can be given with or after chemotherapy. It may also be given after breast cancer surgery, once a month for a year.
Another treatment that may be used to treat HER2 positive breast cancer is a tablet called lapatinib| (Tyverb®). This works in a different way from Herceptin. It's a newer drug and is most likely to be given within a clinical trial.
Some breast cancer cells have oestrogen receptors on their surfaces. This is known as oestrogen receptor positive (ER positive+) breast cancer. This means that the cells rely on the hormone oestrogen to grow. Oestrogen is a female hormone that is naturally produced in the body.
If you have ER positive+ breast cancer, you'll be prescribed hormonal therapy to counteract the effects of oestrogen. There are different types of hormonal therapy that work in different ways. Some hormonal therapies reduce the amount of oestrogen made by the body. Others stop oestrogen from reaching the cancer cells.
Your doctor or breast care nurse will give you more information about the hormonal therapy you will be taking and any possible side effects it may have.
Research into treatments for inflammatory breast cancer is ongoing. Cancer specialists use clinical trials| to assess new treatments. Before any trial is allowed to take place, an ethics committee must have approved it and agreed that the trial is in the interest of the patients.
You may be invited to take part in a clinical trial. Your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.
You may experience many different emotions|, including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their condition.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists| can give you information about counselling in your area.
This section has been compiled using information from a number of reliable sources, including:
Thank you to Professor Stephen Johnston, Consultant Medical Oncologist, and all of the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network|.
Thank you to Professor Stephen Johnston, Consultant Medical Oncologist, and all of the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices| network.
Content last reviewed: 1 January 2013
Next planned review: 2015
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© Macmillan Cancer Support 2013
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