Inflammatory breast cancer

This is a rare type of 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. This blockage causes the skin to become red and inflamed. 

Between 1 and 5 out of 100 breast cancers (1 to 5%) are inflammatory breast cancers.

Symptoms of inflammatory breast cancer

Because the lymph channels are blocked, the breast might become:

• swollen
• red
• 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 aren't pregnant or breast feeding and it is particularly rare in women who have had their menopause.

Your doctor might give you a course of antibiotics if they think that you could have mastitis. But they will refer you to a specialist if they think you are unlikely to have an infection or if 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.

Make an appointment to see your doctor if you notice any change in the look or feel of your breasts.

Diagnosing inflammatory breast cancer

Your GP usually refers you to a breast clinic for tests.

You might have a:

• mammogram, which is an x-ray of the breast (for some women, it is not possible to do a mammogram because the breast is swollen and painful)
• breast ultrasound
• biopsy of the skin in the breast
• biopsy of a breast lump (if felt or seen on ultrasound scan)
• MRI scan of the breast

Other tests may include a CT scan or PET-CT scan, and bone scan

You doctor may take photos of your breast to keep in your medical records. These can be helpful to see how well you respond to treatment.

Treatment for inflammatory breast cancer

The treatment for inflammatory breast cancer can be slightly different to other types of breast cancer.

Chemotherapy

You usually have chemotherapy as your first treatment. This is called neo adjuvant chemotherapy. It helps to control the cancer cells in the breast and reduces the swelling. It also aims to destroy any cancer cells that might have spread elsewhere in the body.

Surgery

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).

Some women might be able to have breast conserving surgery. For this type of surgery, the surgeon removes the area of cancer and a surrounding area of healthy tissue. But for most women, mastectomy is the best option. 

The surgeon usually removes the lymph nodes under your armpit.

Radiotherapy

After surgery you have radiotherapy to the remaining breast tissue. This is to help stop the cancer coming back.

Other drug treatment you may have

You have hormone therapy tablets for some years if your breast cancer has hormone receptors. Your doctor might recommend that you also have targeted cancer therapy, such as trastuzumab and pertuzumab, if your cancer has receptors for those drugs. 

Breast reconstruction

You may be able to have breast reconstruction after you have finished your treatment (delayed reconstruction). Do ask your surgeon, they can tell you whether this is suitable for you.

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. 

Survival for inflammatory breast cancer

Many factors can influence life expectancy 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 may spread to other parts of the body. So, in general, the outlook 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.

Follow up

After treatment you usually have regular check ups. At the check ups your doctor or a breast care nurse will examine you and ask about your general health. This is your chance to ask questions and to tell them if anything is worrying you.

How often you have check ups depends on your individual situation but you might have them for at least 5 years. This might include yearly mammograms. 

It’s important to remember that you can contact your doctor or nurse between appointments if you are worried about a symptom or have questions. You don't have to wait for your next appointment. You can also speak to your GP.

In some hospitals you don't have regular appointments after treatment. But if you have new symptoms or are worried about anything you can phone your doctor or breast care nurse or make an appointment to see them. 

UK 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 you will have, and signs and symptoms to look out for. It will also include contact details for specialist staff, such as your breast care nurse.

Trials and research

It is difficult to carry out clinical trials for 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.

Research has already shown that most women should have chemotherapy before their surgery. Women whose cancers have particular receptors might also have treatment with targeted cancer drugs. Doctors are trying to improve this treatment and look at whether adding other types of targeted cancer drugs could help.

International trials are also looking at ways to improve treatment for people with inflammatory breast cancer that has spread.