Inflammatory breast cancer

Inflammatory breast cancer is a rare type of breast cancer that grows along the lymph vessels in the skin of the breast. Cancer cells may not form a lump but block the vessels.

Symptoms include:

  • redness, swelling or pain in the breast
  • the breast feeling hot to touch
  • skin of the breast looking pitted (like orange peel)
  • ridges or raised marks on the skin of the breast
  • pain in or discharge from the nipple.

You might have tests to diagnose the cancer. These include a mammogram, biopsy, fine needle aspiration or an ultrasound scan. Further tests show the stage of the cancer (the size and how far it’s spread). Inflammatory breast cancer is staged using the TNM or number staging system.

Inflammatory breast cancer can spread more quickly than other types of breast cancer so treatment often starts straight away. Treatment may include: chemotherapy, surgery, radiotherapy, targeted therapy and hormonal therapy. Chemotherapy is usually given first to treat and control the disease in the breast and reduce swelling.

You may be asked to join a clinical trial looking at new ways of treating inflammatory breast cancer. You can talk to your doctor about this.

What is inflammatory 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. This 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.


Signs and symptoms of inflammatory breast cancer

Symptoms often develop quite suddenly. The breast may become:

  • red and inflamed
  • firm
  • swollen
  • hot to touch.

Other symptoms may include:

  • ridges or raised marks on the skin of the breast
  • pitted skin, like the peel of an orange (known as peau d’orange)
  • a lump or thickening in the breast
  • pain in the breast or nipple
  • discharge from the nipple.

The symptoms of inflammatory breast cancer are similar to an infection of the breast (mastitis). If your doctor thinks that you could have mastitis, they may give you antibiotics to see whether that clears up the symptoms. Mastitis is uncommon in women who are not pregnant or breast feeding, and particularly rare in women who are past their menopause.


How inflammatory breast cancer is diagnosed

The appearance of the breast may suggest the diagnosis to your doctor. You will need to have certain tests to make the diagnosis definite and to find out whether the cancer has spread.

Biopsy

Your doctor will take small samples of tissue from the breast. These will be examined under a microscope to check for signs of cancer. You may have a local anaesthetic to numb the area before the biopsy is taken.

Your doctor may also take a biopsy from the lymph nodes under the arm to see whether any cancer cells are present there.

Mammogram (breast x-ray)

A mammogram is a low-dose x-ray of the breast tissue. You‘ll be asked to remove the clothes from the top of your body, including your bra. The radiographer will then position you so that each breast is placed in turn on the x-ray machine and gently but firmly compressed (flattened) with a clear, plastic plate.

The breast tissue needs to be compressed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. Most women find this uncomfortable, and for some women it is painful for a short time while the breast is being compressed. You will need to stay still for less than a minute while the x-ray is taken. Usually two mammograms are taken of each breast from different angles. The appointment takes about 30 minutes.

Ultrasound scan

This test uses sound waves to produce a picture of the breast tissue. The person doing the scan puts a gel on to your breast and moves a small hand-held device around the area. The sound waves are converted into a picture using a computer. The test is painless and takes 5 to 10 minutes.


Staging of inflammatory breast cancer

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 whether the cancer has spread outside the breast.

The most common systems to describe the stage of a cancer are the TNM staging system and the number staging system:

TNM staging system

TNM stands for tumour, node and metastases.

  • T describes the size of the tumour.
  • N describes whether the cancer has spread to the lymph nodes.
  • M describes whether the cancer has spread to another part of the body (known as metastatic or secondary cancer).

Number staging system

Number staging describes breast cancer in four stages. From stage 1 (very small and hasn’t spread to the lymph nodes in the armpit), through to stage 4 (the cancer has spread to other parts of the body).

Inflammatory breast cancer affects the breast differently from other cancers as usually the whole breast and the overlying skin are affected. As a result, inflammatory breast cancer is either a stage 3 or 4.

  • Stage 3 – The cancer is affecting the breast and nearby lymph nodes.
  • 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, 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, targeted 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 for inflammatory breast cancer

Chemotherapy uses 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 can also treat any cancer that may have spread beyond the breast to other parts of the body.

Chemotherapy is usually given as a session of treatment followed by a rest period of a few weeks. The rest period allows your body to recover from the side effects. Chemotherapy and the rest period together make up a cycle of your treatment. Your cancer doctor will explain the number of cycles you will need. Often the chemotherapy is given over 4 to 6 months.

Treatment of inflammatory breast cancer usually includes chemotherapy drugs called anthracyclines, such as epirubicin or doxorubicin. Often 3 to 4 cycles of treatment with an anthracycline will be followed by 3 to 4 cycles of treatment with another type of chemotherapy called a taxane. Taxane drugs that are used are docetaxel (Taxotere®) or paclitaxel (Taxol®).

Your doctor or specialist nurse will discuss your chemotherapy treatment plan with you.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Surgery for inflammatory breast cancer

Following chemotherapy, most women have surgery. Usually the whole breast is removed, including the nipple area (mastectomy). The lymph nodes in the armpit will also be removed (axillary node clearance).

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. Your doctor will talk to you about the best time to consider having a reconstruction.


Radiotherapy for inflammatory breast cancer

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.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Targeted therapy for inflammatory breast cancer

Targeted therapies (sometimes called biological therapies) are drugs that recognise and lock on to 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 on to the HER2 on the cancer cells so that they can't be stimulated to grow.

Herceptin is usually given as an injection under the skin (subcutaneously) but can also be given as a drip into a vein (intravenous infusion). It is usually started at the same time as the chemotherapy. When given together, the two treatments are better at shrinking the cancer than either treatment alone.

You will usually continue to have Herceptin after the chemotherapy has finished. It will normally be given for a year in total.


Hormonal therapy for inflammatory breast cancer

Hormones help to control how cells grow and what they do in the body. The hormones oestrogen and progesterone can encourage some breast cancer cells to grow (particularly oestrogen).

Hormonal therapies reduce the level of oestrogen in the body or prevent it from attaching to the cancer cells. They only work for women with oestrogen-receptor positive (ER+) breast cancers.

Hormonal treatment is normally started once the chemotherapy part of your treatment is over. It can be given at the same time as other treatments, such as Herceptin and radiotherapy.

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 - clinical trials for inflammatory breast cancer

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 approve it and agree that the trial is in the interest of the patients.

You may be invited to take part in a clinical trial. Your doctor or nurse 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.


Your feelings

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.