This is a rare type of breast cancer. The breast might look swollen and red (inflamed) and may feel warm.
What inflammatory breast cancer is
In inflammatory breast cancer, the cancer cells block the smallest lymph channels in the breast. The lymph channels (or lymph ducts) are part of the lymphatic system. They normally drain excess tissue fluid away from the body tissues and organs. The lymph channels can’t do this job properly if they are blocked.
About inflammatory breast cancer
This is a rare type of breast cancer. Less than 1 in 10,000 breast cancers diagnosed (0.02%) are inflammatory breast cancer.
Symptoms of inflammatory breast cancer
Make an appointment to see your doctor if you notice any change in the look or feel of your breasts. Because the lymph channels are blocked, the breast might become:
- firm or hard
- hot to the touch
The breast can also be painful in inflammatory breast cancer, but this is not always the case.
Other possible symptoms include:
- ridges or thickening of the skin of the breast
- pitted skin, like orange peel
- a lump in the breast
- a discharge from the nipple
- an inverted nipple – the nipple is pulled into the breast
Inflammatory breast cancer symptoms can appear quite suddenly.
Inflammatory breast cancer is often confused with an infection of the breast (mastitis). This is because the symptoms are very similar. Mastitis is uncommon in women who are not pregnant or breast feeding, and particularly rare in women who are past their menopause.
Your doctor might give you a course of antibiotics first if they think that you could have mastitis. Or they might refer you to a specialist if they think you are unlikely to have an infection, or your symptoms don’t clear up after antibiotics.
While inflammatory breast cancer can cause these particular symptoms, it’s worth being aware of the general symptoms of breast cancer.
Diagnosing inflammatory breast cancer
You go to a breast cancer specialist, who will arrange some tests. The same tests are used to diagnose inflammatory breast cancer as for any other type of breast cancer.
For some women, it is not possible to do a mammogram if the breast is swollen and painful. You may have a different type of scan, such as a breast ultrasound. Or some women might have a CT scan or PET/CT.
Treatment for inflammatory breast cancer
The treatment for inflammatory breast cancer can be slightly different than for other types of breast cancer.
You usually have chemotherapy as your first treatment. This is called neo adjuvant chemotherapy. This is to help control the cancer cells in the breast and reduce the swelling. It also aims to destroy any cancer cells that may have spread elsewhere in the body.
After chemotherapy you have surgery, unless there is a reason why this isn't suitable for you. You are most likely to have your whole breast removed (a mastectomy) for inflammatory breast cancer.
Guidelines say that some women might be able to have a wide local excision in exceptional circumstances. A wide local excision removes the area of cancer, with a surrounding area of healthy tissue (wide local excision). But for most women, mastectomy is the best option.
After surgery you have radiotherapy to help stop the cancer coming back. You have hormone therapy tablets for some years if your breast cancer has hormone receptors. Your doctor might recommend you also have a biological therapy, such as trastuzumab, if your cancer has particular receptors.
The type of treatment you have also depends on your general health and whether you have any other medical conditions. Your team will discuss the pros and cons of the treatment options with you. Do ask questions so that you understand which treatments you are being offered, and why.
Outlook for inflammatory breast cancer
Many factors can influence the outlook for women with inflammatory breast cancer. These include:
- the exact position of the cancer
- how big the cancer is and whether it has spread only to the lymph nodes or to other organs
- how abnormal the cancer cells look under the microscope (the grade)
- your age
- your general health
- whether the cancer cells have receptors for hormone therapies
- how well the cancer responds to treatment
Inflammatory breast cancer can develop quickly and spread to other parts of the body. So, in general, the outlook for women with this type is not as good as for women diagnosed with other types of breast cancer. But doctors think that the outlook is improving as breast cancer treatment improves.
You will have regular check ups once you finish your treatment. Your doctor will examine you and ask about your general health.
This is your chance to ask questions and to tell your doctor if anything is worrying you.
It’s important to remember that you can still contact someone if you are concerned about a symptom and it is a while before your next appointment. Speak to your GP, or contact your consultant or specialist nurse.
How often you have check ups depends on your individual situation.
Guidelines say that everyone who has had treatment for early breast cancer should have a copy of a written care plan.
The care plan has information about tests, and signs and symptoms to look out for. It will also include contact details for specialist staff, such as your breast care nurse.
After your treatment you have regular check ups for at least 5 years. This usually includes yearly mammograms for at least 5 years if you are already part of the national screening programme. Or yearly mammograms until you are able to go for breast screening, at which point they change to every 3 years.
Trials and research
It is difficult to carry out clinical trials in rare types of breast cancer. This is because it is not usually possible to recruit enough people into a trial. If possible, researchers try to co ordinate international trials so there are more people available and the results then have more value.
American researchers have set up the Inflammatory Breast Cancer Registry. The register is collecting blood and tissue samples from people with inflammatory breast cancer. They hope this will help them better understand this disease. Doctors are also trying to find out why this type of breast cancer can be more difficult to treat. And how it might differ from other breast cancers.
Research has already shown that most women should have chemotherapy before their surgery. Those whose cancers have a large amount of protein called HER2 may also have treatment with a drug called trastuzumab (Herceptin). Doctors are trying to improve on this treatment and look at whether adding other types of biological therapy could help.
A European trial showed that adding another biological therapy, called lapatinib, to standard treatment worked better than standard treatment alone. International trials are looking at adding other drugs, such as pertuzumab. Pertuzumab is a type of biological therapy that is already used to treat women with advanced breast cancer.
International trials are also looking at ways to improve treatment for people with inflammatory breast cancer that has spread.