Inflammatory breast cancer

Inflammatory breast cancer is a rare, fast-growing type of invasive breast cancer.

It’s called inflammatory because the skin of the breast usually looks red and inflamed.

This is caused by the breast cancer cells blocking the tiny lymph vessels in the breast and the skin. The lymph vessels are part of the lymphatic system.

The symptoms of inflammatory breast cancer can develop quickly.

Symptoms can include:

• Redness, warmth or swelling of the breast

• The colour of the skin on your breast looking different or bruised (this may be harder to see on darker skin tones)

• Ridges or thickening of the skin

• The skin looking pitted like the skin of an orange (known as peau d’orange or orange peel)

• An increase in breast size

• An itchy breast

• An inverted (pulled-in) nipple

• Swelling or lumps in the armpit or around the collarbone

• Pain or tenderness in the breast

You may or may not have a lump.

Inflammatory breast cancer can be difficult to diagnose. This is because the symptoms are similar to some benign (not cancer) conditions such as a breast infection (mastitis) or a breast abscess.

These conditions are usually treated with antibiotics.

If you're prescribed antibiotics but your symptoms do not improve, your GP will refer you to a breast clinic.

At the breast clinic you may have several tests, including:

• A mammogram 

• An ultrasound scan

• An MRI scan

• A biopsy 

• A punch biopsy – removal of breast tissue and a small circle of skin

If you're diagnosed with inflammatory breast cancer, you may have more tests to check whether the cancer has spread outside the breast. These may include:

• A PET (positron emission tomography) or CT (computerised tomography) scan

• A bone scan

You may also have medical photographs taken of your breast to see how you respond to treatment.

If you need to have any of these tests, your treatment team will explain more about them.

Your treatment team will discuss your treatment options with you and prepare a treatment plan. The plan will be based on your test results.

Depending on your situation, you may have a combination of drugs that treat the whole body (systemic treatment) and treatment to a specific area of the body (local treatment).

Inflammatory breast cancer can develop quickly, so you’ll usually start treatment as soon as possible.

Chemotherapy

Chemotherapy destroys cancer cells by affecting their ability to divide and grow.

It’s given to reduce the risk of breast cancer returning or spreading.

Chemotherapy is usually the first treatment recommended for inflammatory breast cancer, before any surgery. This is called primary or neo-adjuvant chemotherapy.

Surgery

Most people will have surgery after chemotherapy.

Usually the whole breast is removed, including the nipple area (mastectomy).

Your surgeon will normally remove the lymph nodes from under your arm (axilla) at the same time.

If you’re able to have breast reconstruction after a mastectomy, you’ll usually be offered this when you have completed all your treatment. This is called delayed breast reconstruction.

Radiotherapy

Radiotherapy uses high energy x-rays to destroy cancer cells. It’s often used after chemotherapy and surgery.

You will usually have treatment to the whole breast area.

Depending on your situation, you may be offered radiotherapy above your collarbone (clavicle), under your arm (axilla) and occasionally to the lymph nodes behind the breastbone (sternum).

Hormone (endocrine) therapy

Some breast cancers use oestrogen in the body to help them grow. These are known as oestrogen receptor positive or ER-positive breast cancers.

Hormone therapies block or stop the effect of oestrogen on breast cancer cells. Different hormone therapy drugs do this in different ways.

Hormone therapy may be given alongside targeted therapy.

If your cancer is ER-positive, your treatment team will discuss with you which hormone therapy they think is most suitable. 

If oestrogen is not helping your breast cancer grow, it’s ER-negative and hormone therapy will not benefit you. 

Breast cancers are tested to see if they’re ER-positive using tissue from a biopsy or after surgery.

You may also have tests to see if a hormone called progesterone is helping your breast cancer grow. If it is, it’s called progesterone receptor positive or PR-positive.  

The benefits of hormone therapy are less clear if your breast cancer is PR-positive but ER-negative. Very few breast cancers fall into this category. But if this is the case, your treatment team will discuss with you whether hormone therapy is suitable.   

If you haven’t been through the menopause (pre-menopausal) and have ER-positive breast cancer, you may also be offered ovarian suppression. Ovarian suppression is the term used to describe treatments that stop the ovaries from making oestrogen, either permanently or temporarily.

Targeted therapy

Targeted therapy drugs block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow. 

The type of targeted therapy you're given will depend on the features of your breast cancer.

The most widely used targeted therapies are for HER2-positive breast cancer. HER2 is a protein that makes cancer cells grow more quickly.

If your cancer is HER2-negative, targeted therapies for HER2-positive breast cancer won’t benefit you.

Other targeted therapies

Other targeted therapies you may have include:

• Abemaciclib and ribociclib – used in combination with hormone therapy to treat HER2-negative, ER-positive primary breast cancer which has a high risk of returning

• Olaparib – may be used if your primary breast cancer is HER2-negative, has an altered BRCA gene and has a high risk of returning

• Pembrolizumab – an immunotherapy drug used to treat triple negative breast cancer

Immunotherapy

Immunotherapy cancer treatments use the body’s natural defence system (immune system) to help them fight cancer. 

Immunotherapy is used alongside chemotherapy to treat triple negative breast cancer.

Speak to your treatment team to see if immunotherapy is suitable for you.

Bisphosphonates

Bisphosphonates can reduce the risk of breast cancer spreading if you’ve been through the menopause. 

They may also be used: 

• If you’re at risk of or have osteoporosis (when bones lose their strength and are more likely to break) as bisphosphonates slow down or prevent loss of bone tissue 

• As treatment for metastatic (secondary) breast cancer in the bone – when cancer that started in the breast has spread to the bones 

Your treatment team can tell you if bisphosphonates would be suitable for you.

Clinical trials

Clinical trials are research studies that aim to improve treatment or care for patients. Studies into treatments for inflammatory breast cancer are ongoing.

If you’re interested in taking part in a clinical trial, you can discuss this with your treatment team.

Read more general information about clinical trials, or visit the Cancer Research UK website for listings of current UK trials.

At the end of your hospital-based treatment, your treatment team will continue to monitor you. This is known as follow-up.

How you’re followed up will depend on your individual needs and the hospital where you were treated. You may find you have more contact with your treatment team at first, and less as time goes on.

Your treatment team will give you a name and contact number you can use if you have any questions or concerns between appointments. This is usually for a breast care nurse. You can also talk to your GP about any concerns you have.

It’s normal to be worried when you’re diagnosed with inflammatory breast cancer.

There are people who can support you, so don’t be afraid to ask for help if you need it.

Some people find it helpful to discuss their feelings and concerns with their treatment team. If you’d like to talk through how you are feeling in more depth, you may want to see a counsellor or psychologist. Your breast care nurse, specialist or GP can arrange this.

You can also call our helpline on 0808 800 6000 and talk through your diagnosis, treatment and how you are feeling with one of our expert nurses.

The Inflammatory Breast Cancer Network UK is a charity that supports people who've been diagnosed with inflammatory breast cancer and campaigns for better information and research into the condition.