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Inflammatory breast cancer does not usually form a lump. The breast becomes red, swollen, warm and heavy over weeks, with skin thickened like orange peel, because cancer cells have blocked the lymph channels in the skin. It is often mistaken for infection, is always at least stage III, and needs chemotherapy first, then mastectomy and radiotherapy, with HER2 or immune drugs added by subtype.
Inflammatory breast cancer is a clinical diagnosis, staged T4d: rapid onset over six months or less of erythema and oedema covering at least a third of the breast, often with warmth, heaviness and peau d'orange, with or without a palpable mass. Tumour emboli in the dermal lymphatics on a skin punch biopsy support the diagnosis but are not required, and their absence does not exclude it. Because the picture mimics mastitis, women are often given antibiotics first; any presumed infection that does not settle within a week or two in a woman who is not breastfeeding needs imaging and biopsy. Staging includes PET-CT or CT and bone scan, because roughly a third of patients in registry series have distant metastases at diagnosis. Compared with other breast cancers a higher share are HER2-positive or triple-negative and fewer are hormone receptor-positive, and no mutation unique to the inflammatory phenotype has been found.
Treatment is trimodality and the order is fixed. Systemic therapy comes first: an anthracycline and taxane, with trastuzumab and pertuzumab throughout for HER2-positive disease and a pembrolizumab-based regimen for triple-negative disease by extrapolation from KEYNOTE-522, since inflammatory cases were few in the landmark trials. Response on examination and imaging then permits a modified radical mastectomy with axillary dissection; breast conservation, sentinel node biopsy alone, skin-sparing incisions and immediate reconstruction are avoided because the disease is in the skin lymphatics. Post-mastectomy radiotherapy to the chest wall and regional nodes follows in every patient, with bolus to bring the dose to the skin and a higher dose for poor responders. Endocrine therapy, completion of a year of HER2 therapy with trastuzumab emtansine or trastuzumab deruxtecan if disease remained, and olaparib or capecitabine for residual triple-negative disease follow the rules of non-inflammatory cancer.
Outcomes have improved but remain the worst of any breast presentation: before chemotherapy almost no patient lived more than a few years after surgery, and even with trimodality treatment well under half of patients are alive at five years in registry series, with pathological complete response the strongest predictor of who will be. The MD Anderson programme that began giving chemotherapy before surgery in the 1970s and the dedicated inflammatory breast cancer clinics that followed have defined the standards, and an international expert consensus in 2011 fixed the diagnostic criteria; trials restricted to inflammatory disease remain scarce, so most evidence is borrowed. Whether immunotherapy and antibody-drug conjugates close the gap, whether radiotherapy can be intensified safely, and what drives the inflammatory phenotype are the open questions.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Skin punch biopsy and core biopsy with receptor testing, clinical photography, bilateral mammography and ultrasound, and PET-CT or CT with bone scan because distant spread is common at presentation.
Anthracycline and taxane chemotherapy; trastuzumab and pertuzumab throughout for HER2-positive disease; pembrolizumab-based chemotherapy for triple-negative disease by extrapolation from KEYNOTE-522.
Modified radical mastectomy with axillary dissection after response to chemotherapy; breast conservation, sentinel node biopsy alone and skin-sparing approaches are avoided, and reconstruction is deferred until after radiotherapy.
Post-mastectomy radiotherapy to the chest wall and regional nodes in every patient, with bolus and often a higher dose for poor responders.
Endocrine therapy for hormone receptor-positive disease; trastuzumab emtansine or trastuzumab deruxtecan for residual HER2-positive disease (KATHERINE, DESTINY-Breast05); olaparib or capecitabine for residual triple-negative disease as in non-inflammatory cancer.
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For stage II-III triple-negative breast cancer, chemotherapy plus pembrolizumab before surgery and pembrolizumab alone afterwards is now the standard approach worldwide, and the survival gain is real, not just a surrogate. It does not apply to stage I disease or to hormone-receptor-positive or HER2-positive cancers. The price is a year of immunotherapy with a meaningful chance of a permanent endocrine side effect such as hypothyroidism or adrenal insufficiency.
The gap between guideline and practice in inflammatory breast cancer is large; this paper is the reason guidelines insist on referral to centres that deliver the full sequence.
The definition used in trials and clinics, and the insistence on systemic therapy first and mastectomy rather than breast conservation, come from this document.
Query for this cancer: (TITLE:"Inflammatory breast cancer" OR ABSTRACT:"Inflammatory breast cancer" OR TITLE:"IBC" OR ABSTRACT:"IBC" OR TITLE:"T4d breast cancer" OR ABSTRACT:"T4d breast cancer" OR TITLE:"Inflammatory carcinoma of the breast" OR ABSTRACT:"Inflammatory carcinoma of the breast") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Inflammatory breast cancer, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Breast Cancer Now lists headache, sickness and vomiting especially on waking, weakness or numbness down one side of the body, unsteadiness or loss of balance, seizures, difficulty with speech, vision problems, and changes in behaviour, mood or memory among the signs that breast cancer may have spread to the brain. A seizure, a sudden severe headache or new one-sided weakness is 999 whatever the cause.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
The NHS says to call 999 or go to A and E if you have cellulitis with a very high temperature or you feel hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on the skin which may be less obvious on brown or black skin, feeling dizzy or faint, confusion or disorientation, cold, clammy or pale skin, or unresponsiveness. These are symptoms of serious complications, which can be life threatening.
Breathing very fast; confused, slurred speech or not making sense; blue, pale or blotchy skin, lips or tongue; a very high or very low temperature, feeling hot or cold to the touch, or shivery; a rash that does not fade when pressed: the NHS says call 999 or go to A and E, and do not drive yourself, ask someone to drive you or call 999.
A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
NICE NG234 says to immediately contact the metastatic spinal cord compression coordinator if a person with a past or current diagnosis of cancer presents with bladder or bowel dysfunction, gait disturbance or difficulty walking, limb weakness, neurological signs of spinal cord or cauda equina compression, numbness, paraesthesia or sensory loss, or radicular pain, and to treat this as an oncological emergency. If you cannot reach anyone, go to A and E and say you have breast cancer and symptoms of spinal cord compression.
See all on the product pages:Bone metastases and skeletal-related eventsBrain metastases (intracranial disease)CapecitabineCompression, decongestive therapy and exercise for lymphoedemaDoxorubicinFebrile neutropeniaLetrozole (and other aromatase inhibitors)Lymphadenectomy (lymph node dissection)Lymphoedema after breast cancer treatmentMetastatic spinal cord compression (MSCC)Neutropenic sepsis: the temperature rule and the 999 signsPaclitaxel / nab-paclitaxelSeroma after breast surgerySurvivorship care and late-effects surveillanceTamoxifen·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Inflammatory breast cancer, then print the one-page appointment sheet with room for the answers.
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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