Inflammatory breast cancer
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Inflammatory breast cancer cells grow along tiny channels (lymph vessels) in the skin of the breast. These cells block the lymph vessels. These vessels are part of the lymphatic system. They drain fluid from tissues, collecting and filtering out bacteria and any waste materials from the body’s cells.
Inflammatory breast cancer is rare. 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.
Unlike other breast cancers, you may not feel a lump.
Symptoms often develop quite suddenly. The breast may become:
- red and inflamed
- 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 GP thinks that you could have mastitis, they may give you antibiotics to see if symptoms improve. Mastitis is uncommon in women who are not pregnant or breast feeding. It is also rare in women who have been through the menopause.
Antibiotics for mastitis normally improve symptoms quickly. If this does not happen, your GP will refer you to a specialist breast cancer doctor.
A specialist breast 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:
You will have a breast biopsy. Your cancer doctor or breast care nurse will take small samples of the skin or cells from the breast. The samples will be looked at under a microscope to check for signs of cancer.
Your cancer doctor may also take a biopsy from the lymph nodes under the arm to check for cancer cells. Breast cancer cells are also checked for receptors for a protein called HER 2. HER2 can attach to receptors and encourage breast cancer cells to grow.
If you have inflammatory breast cancer, you will have other tests. This is to find out more about the size and position of the cancer. It is also to find out if the cancer has spread to other parts of the body.
One of the most common systems to describe the stage of a cancer is the number staging system.
Number staging system
Breast cancer can also be divided into four number stages. Stage 1 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 one small area of the breast. But inflammatory breast cancer usually affects the whole breast and the overlying skin. So it is not usually staged as early.
Inflammatory breast cancer is either a stage 3B, 3C or stage 4. These stages are described below:
- 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 breast bone, either above or below the collar bone.
- Stage 4 – The cancer has spread beyond the breast and nearby lymph nodes.
Inflammatory breast cancer can spread more quickly than other types of breast cancer, so you often start treatment straight away.
You will usually be offered a combination of different 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 with inflammatory breast cancer, you have chemotherapy first. Having chemotherapy before surgery is called neo-adjuvant treatment.
We have more information about treatment for breast cancer.
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 round 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. 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
Treatment of inflammatory breast cancer usually includes chemotherapy drugs called anthracyclines, such as epirubicin or doxorubicin. Often you have 3 to 4 cycles of treatment with an anthracycline first.
Your doctor or breast care nurse will talk to you about your treatment plan.
After chemotherapy, most women 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 (axillary node clearance). The lymph nodes are checked for cancer.
In women with inflammatory breast cancer, breast reconstruction does not usually happen at the same time as a mastectomy. Breast reconstruction is where a new breast shape is formed.
This is because most women have radiotherapy after their mastectomy. If breast reconstruction is suitable for you, your cancer doctor will talk to you about when is the best time.
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 after a mastectomy. This is to reduce the risk of the cancer coming back in that area.
A course of radiotherapy for breast cancer usually lasts 3 weeks. You will usually also have a booster dose of radiotherapy to the area where the cancer was. This may be at the same time as the radiotherapy, or as a few extra treatments. Your doctor will tell you how many treatments you will have.
Radiotherapy to the chest can cause some side effects. Your cancer doctor, breast care nurse or radiographer (who gives the radiotherapy) will talk to you about how you can manage these.
Targeted therapies interfere with the way cancer cells grow. They are sometimes called biological therapies.
Many women with inflammatory breast cancer have HER2 positive breast cancer. Certain targeted therapy drugs are used to treat HER2 positive breast cancer.
The main targeted therapy used in breast cancer treatment is trastuzumab (usually called Herceptin®). Trastuzumab can affect the way the heart works, so you have tests to check your heart first. You may have it with chemotherapy, or after chemotherapy has finished.
If you have ER positive breast cancer, your cancer doctor will prescribe hormonal therapy. Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. This treatment reduces the risk of cancer coming back, and protects the other breast. You usually have it for 5 to 10 years. There are different types of hormonal therapies, and they work in different ways. The type you have may depend on if you have been through menopause or not.
The side effects of hormonal therapy depend on the drug you have. Some common side effects are hot flushes, tiredness and aching joints.
Your cancer doctor or breast care nurse can give more information about the hormonal therapy. They can tell you what therapy is best for your situation, and what the its side effects might be.
After treatment, you have regular follow-up appointments for a few years. Your cancer doctor or breast care nurse will explain what this involves. You will usually have a mammogram every year.
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 breast care nurse.
Some women may have their follow up checks by telephone. You will get information on what to look out for, and when to contact your breast care nurse for advice.
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:
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 firstname.lastname@example.org
Inflammatory breast cancer: Clinical features and treatment https://www.uptodate.com/contents/inflammatory-breast-cancer-clinical-features-and-treatment#H1 [accessed 04 Jan 2018]
ESMO Primary breast cancer guidelines 2015 https://www.esmo.org/guidelines/breast-cancer [accessed Jan 2018]
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.
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.
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