Inflammatory breast cancer

Inflammatory breast cancer develops when cancer cells block the lymph vessels in the skin of the breast. It is called inflammatory because the breast becomes red and swollen.

Inflammatory breast cancer develops more often in younger women and women of African ancestry.

Inflammatory breast cancer is rare and aggressive, which means that it grows and spreads quickly. In most cases, inflammatory breast cancer has already spread to the lymph nodes or other organs when it is diagnosed.

Inflammatory breast cancer starts to cause symptoms soon after it develops. Many of the symptoms appear at the same time.

The most common symptom of inflammatory breast cancer is a change to the colour of the skin on at least one-third of the breast. The skin becomes very red or purplish in colour.

Other symptoms of inflammatory breast cancer include:

• a swollen breast
• dimpled or pitted skin that looks like an orange peel (called peau d’orange)
• thickened skin or breast tissue
• a breast that feels warm to the touch
• an increase in the size of the breast
• changes to the nipple such as a nipple that suddenly starts to point inward (called an inverted nipple)
• tenderness or pain in the breast
• itching or burning
• a lump in the armpit (called the axilla), or near the collarbone

The symptoms of inflammatory breast cancer are very similar to the symptoms of infection in the breast tissue (called mastitis) , which is more common in breastfeeding women. Doctors may prescribe antibiotics to treat mastitis, but waiting for the antibiotics to work may delay the diagnosis of inflammatory breast cancer. As a result, it is often diagnosed at an advanced stage. Inflammatory breast cancer is considered stage 3B breast cancer, or locally advanced breast cancer, which means that it has started to grow into surrounding tissues.

Inflammatory breast cancer can be difficult to diagnose. This is because this type of cancer doesn’t usually cause a lump in the breast that can be felt by the doctor, or seen with mammography. An important part of diagnosing inflammatory breast cancer are the signs and symptoms, and how quickly they start.

The following tests are usually used to diagnose breast cancer, including inflammatory breast cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

• physical exam
• clinical breast exam
• diagnostic mammography
• biopsy
• hormone receptor status testing
• HER2 status testing

Find out more about diagnosis of breast cancer.

If you have inflammatory breast cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer.

Chemotherapy is the first treatment given for inflammatory breast cancer. It is used to destroy cancer cells in the breast and anywhere else they may be in the body. It is given before surgery (called neoadjuvant therapy). It is also given for a period of time after surgery (called adjuvant therapy).

Chemotherapy for inflammatory breast cancer is usually given as a combination of drugs because research shows that this is more effective than single drugs on their own. The types of chemotherapy used include an anthracycline and a taxane drug. These drugs are given one after another because giving them at the same time can increase the risk for heart problems.

The following combinations of chemotherapy drugs may be used:

• CEF – cyclophosphamide (Cytoxan, Procytox), epirubicin (Pharmorubicin) and 5-fluorouracil (Adrucil, 5-FU)
• AC & Taxol – doxorubicin (Adriamycin) and cyclophosphamide, followed by paclitaxel (Taxol)
• Taxol & FAC – paclitaxel followed by cyclophosphamide, doxorubicin and 5-fluorouracil

After several rounds of chemotherapy, you will have a mammography to find out how well the treatment is working. If the first combination of chemotherapy drugs doesn’t work, you may be given other combinations of drugs.

Find out more about chemotherapy for breast cancer.

Up to 60% of inflammatory breast cancers are HER2 positive. These targeted therapy drugs may be used to treat HER2-positive inflammatory breast cancer:

• trastuzumab (Herceptin) is given in combination with chemotherapy

• pertuzumab (Perjeta) may be given with chemotherapy before surgery to remove the cancer

Phesgo combines pertuzumab and trastuzumab into a single dose. It is given by a needle just under the skin (subcutaneously) instead of through a needle in a vein (intravenously). This means that treatment can be given more quickly and easily than giving the 2 drugs separately. Phesgo may be combined with chemotherapy for inflammatory breast cancer.

Find out more about HER2 status testing and targeted therapy for breast cancer.

Surgery is offered if chemotherapy shrinks the tumour. The following types of surgery are used for inflammatory breast cancer.

Modified radical mastectomy is used to treat inflammatory breast cancer that has not spread to other parts of the body. Doctors need to remove all of the breast because there is a high risk that this cancer will come back (recur). This is why breast-conserving surgery is not offered for inflammatory breast cancer.

Axillary lymph node dissection is used to remove lymph nodes under the arm (called the axilla). This surgery is done because inflammatory breast cancer has often already spread to these lymph nodes when it is diagnosed.

Find out more about surgery for breast cancer.

Radiation therapy is usually given after surgery for inflammatory breast cancer. It is used to lower the risk that the cancer will come back in the area where the breast was removed. External beam radiation therapy is directed at muscles on the chest and lymph nodes in the chest, shoulder and underarm.

Find out more about radiation therapy for breast cancer.

Hormonal therapy may be offered to women who have inflammatory breast cancer that has certain hormone receptors( called a hormone receptor–positive tumour). The type of hormonal therapy offered will depend on whether or not you have reached menopause.

Tamoxifen( Nolvadex, Tamofen) is offered to women who have not yet reached menopause (they are premenopausal).

Anastrozole( Arimidex) and letrozole( Femara) are aromatase inhibitors. Post-menopausal women (those who have gone through menopause) will be offered one of these drugs.

Find out more about hormonal therapy for breast cancer.

If you have inflammatory breast cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.