Breast Cancer - Inflammatory

ON THIS PAGE: You will find a drawing of the main body parts affected by inflammatory breast cancer. Use the menu to see other pages.

The next section in this guide is Risk Factors . It explains the factors that may increase the chance of developing inflammatory breast cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for inflammatory breast cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

The screening methods for inflammatory breast cancer are similar to those used for other types of breast cancer. Learn more about recommendations for breast cancer screening and the basics of cancer screening .

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems inflammatory breast cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy of the tumor is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. This is the most important step to make a diagnosis and to plan treatment. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How inflammatory breast cancer is diagnosed

There are many tests used for diagnosing inflammatory breast cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

Inflammatory breast cancer is usually diagnosed through a physical examination of the breast and nearby lymph nodes and based on a person’s symptoms. Breast imaging tests and a biopsy of the breast and/or skin are also needed to confirm a diagnosis of inflammatory breast cancer.

How inflammatory breast cancer is diagnosed

Breast imaging tests

Imaging tests show pictures of the inside of the body. They can show if cancer has spread.

• Diagnostic mammography. A diagnostic mammogram is an x-ray of the breast. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. It is similar to a screening mammography, which is used to look for a possible breast tumor in people who have no symptoms. Diagnostic mammography is often used when a person is experiencing signs, such as nipple discharge or a new lump. It may also be used if something suspicious is found on a screening mammogram.

• Ultrasound. An ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound can distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given into the patient’s vein before the scan to help create a clear picture of the possible cancer. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. A breast MRI may be used after a diagnosis of breast cancer to check the other breast for cancer or to find out how much the disease has grown throughout the breast. It may also be used for screening, along with mammography, for those with a very high risk of developing breast cancer.

Surgical tests

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. There are different types of biopsies, classified by the technique and/or size of the needle used to collect the tissue sample.

• A fine needle aspiration biopsy uses a thin needle to remove a small sample of cells.

• A core needle biopsy uses a wider needle to remove a larger sample of tissue. This is usually the preferred way to find out whether an abnormality on a physical examination or an imaging test is cancer. For inflammatory breast cancer, there may be no single, main tumor, so more than 1 core biopsy may be needed to diagnose the cancer.

• A vacuum-assisted biopsy removes several large cores of tissue. Local anesthesia, which is medication to block pain, is used to lessen a patient’s discomfort during the procedure.

• A skin biopsy is often used to help diagnose inflammatory breast cancer, but it is not always needed. Inflammatory breast cancer cells can travel through lymph vessels in the skin, so a skin biopsy can help find out if there are inflammatory breast cancer cells in the skin.

• A surgical biopsy removes the largest amount of tissue. This biopsy may be incisional or excisional. An incisional biopsy is the removal of part of the lump. An excisional biopsy is the removal of the entire lump. Because surgery is best done after a cancer is diagnosed, a surgical biopsy is usually not the recommended way to diagnose breast cancer. Most often, non-surgical core needle biopsies are recommended to diagnose breast cancer. This means that only 1 surgical procedure is needed to remove the tumor and to take samples of the lymph nodes. An incisional biopsy is rarely used to diagnose breast cancer, but it may be needed if the core needle biopsies (see above) were not helpful to diagnose the cancer.

• An image-guided biopsy is used when a distinct lump cannot be felt, but an abnormality is seen with an imaging test, such as a mammogram. During this procedure, a needle is guided to the location with the help of an imaging technique, such as mammography, ultrasound, or MRI. A stereotactic biopsy is done using mammography to help guide the needle. A small metal clip may be put into the breast to mark where the biopsy sample was taken, in case the tissue is cancerous and more surgery is needed. This clip is usually titanium, so it will not cause problems with future imaging tests, but check with your doctor before you have additional imaging tests. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy (see above), depending on the amount of tissue being removed. This approach may be useful to diagnose inflammatory breast cancer, as imaging may help identify the best place to take a biopsy sample when a distinct mass is not felt.

• Sentinel lymph node biopsy is a way to find out if there is cancer in the lymph nodes near the breast. This type of biopsy is not usually used for inflammatory breast cancer. The preferred way to examine lymph nodes for inflammatory breast cancer is with an axillary lymph node dissection. If there is cancer in the lymph nodes, the cancer is called “lymph node-positive breast cancer” or “node-positive.” If there is no cancer in the lymph nodes, the cancer is called “lymph node-negative breast cancer” or “node-negative.” Learn more about sentinel lymph node biopsy and axillary lymph node dissection in the Types of Treatment section.

Analyzing the biopsy sample

Analyzing the sample(s) removed during the biopsy helps your doctor learn about the specific features of a cancer and determine treatment options.

• Tumor features. Examination of the tumor under the microscope is used to find out if it is invasive and has spread to the lymph nodes. Inflammatory breast cancer is always invasive.

• Estrogen receptors (ER) and progesterone receptors (PR). Testing for ER and PR helps determine both the patient’s risk of recurrence and the type of treatment that is most likely to lower the risk of recurrence. As mentioned in the Introduction section, inflammatory breast cancer is often ER/PR negative. However, many inflammatory breast cancers are ER/PR positive. Learn about ER and PR testing recommendations from the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) .

• Human epidermal growth factor receptor 2 (HER2). The HER2 status helps determine whether drugs that target the HER2 receptor might help treat the cancer. As mentioned in the Introduction section, inflammatory breast cancer is often HER2 negative but can sometimes have these receptors. Learn about recommendations for HER2 testing in the Diagnosis section of the Guide to Breast Cancer .

• Grade. The tumor grade is also determined from the biopsy. The grade describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called "well differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

Your doctor may recommend additional laboratory tests on your tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This helps your doctor find out the subtype of cancer.

Blood tests

Your doctor may also need to do blood tests to learn more about your health:

• Complete blood count. A complete blood count (CBC) is used to measure the number of different types of cells, such as red blood cells and white blood cells, in a sample of a person’s blood. It is done to make sure that your bone marrow is functioning well.

• Serum chemistry. Serum chemistry tests are often done to look at minerals in your blood, such as potassium and sodium. They also evaluate the health of your kidneys and liver.

• Blood tumor marker tests. Serum tumor markers are tumor proteins in a person's blood. Higher levels of a serum tumor marker may be from cancer or a noncancerous condition. Tumor marker testing is typically used to monitor the growth of metastatic breast cancer, along with symptoms and imaging tests. Tumor marker tests are usually not needed for people without metastatic breast cancer and should not be used to monitor for a recurrence, as such testing does not appear to improve a patient’s chance of recovery.

Additional tests

Whether your doctor recommends additional imaging tests to find out if the cancer has spread depends on your medical history, symptoms, how much the disease has grown in the breast and lymph nodes, and the results of your physical examination. These tests are not recommended for all patients.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. A chest x-ray may be used to look for cancer that has spread from the breast to the lungs.

• Bone scan. A bone scan may be used to look for spread of cancer to the bones. A radioactive dye or tracer is injected into a patient’s vein, and then the scan is performed several hours later using a special camera. The amount of radiation in the tracer is too low to be harmful. The tracer collects in areas of the bone that are healing, which occurs in response to damage from the cancer cells. The areas where the tracer collects appear lighter and stand out on the image compared to healthy bone. Some cancers do not cause the same healing response and will not show up on the bone scan. Areas of advanced arthritis or healing after a fracture will also show up on the image.

• Computed tomography (CT or CAT) scan. A CT scan may be used to look for tumors in organs outside of the breast, such as the lung, liver, bone, and lymph nodes. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows abnormalities, including most tumors. A CT scan can be used to measure the tumor’s size and find out if it is shrinking with treatment. A contrast dye may be injected into a patient’s vein before the scan to provide better detail.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan may be used to find out whether the cancer has spread to organs outside of the breast. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into a patient’s vein. This sugar substance is then taken up by cells that use the most energy because they are actively dividing. Because cancer cells tend to use energy actively, they absorb more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. Areas that are most active appear as bright spots, and the intensity of the brightness can be measured to better describe these areas. A PET scan may also be used to measure the size of tumors and to determine the location of the bright spots more accurately. This test will also show abnormalities in the bone, similar to a bone scan.

After diagnostic tests are completed, your doctor will review the results with you. These results also help the doctor describe the amount of cancer in the body. This is called staging. If there are suspicious areas found outside of the breast, at least 1 of these areas may be biopsied if possible to confirm the diagnosis of cancer.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with inflammatory breast cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for inflammatory breast cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How inflammatory breast cancer is treated

In cancer care, doctors specializing in different areas of cancer treatment work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team . Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, genetic counselors, nutritionists, and others.

Inflammatory breast cancer is considered a locally-advanced breast cancer and is typically treated with several types of treatment, including chemotherapy, surgery, radiation therapy, human epidermal growth factor receptor 2 (HER2) targeted therapy, and/or hormone therapy, as appropriate.

Inflammatory breast cancer treatment usually starts with chemotherapy. Chemotherapy before surgery is called neoadjuvant therapy or preoperative therapy. After chemotherapy, people with inflammatory breast cancer usually have surgery to remove the breast. Then, they receive radiation therapy to the chest wall and the nearby lymph nodes. If a patient has metastatic (stage IV) breast cancer when first diagnosed, the main treatment options are systemic therapies, such as chemotherapy. Surgery and/or radiation therapy are less commonly used.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for inflammatory breast cancer because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for inflammatory breast cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Hormonal therapy

• Surgery

• Radiation therapy

• Physical, emotional, and social effects of cancer

• Metastatic inflammatory breast cancer

• Finishing treatment and the chance of recurrence

• If treatment does not work

Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body. This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for inflammatory breast cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Hormonal therapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen consists of a specific treatment schedule of drugs given at repeating intervals for a set number of times. Chemotherapy for inflammatory breast cancer is usually given before surgery, called preoperative or neoadjuvant chemotherapy. Sometimes additional chemotherapy is also given after chemotherapy, called adjuvant chemotherapy.

Chemotherapy for inflammatory breast cancer that has not spread outside of the breast and regional lymph nodes usually includes a combination of drugs.

Common drugs for non-metastatic inflammatory breast cancer may include:

• Capecitabine (Xeloda)

• Carboplatin (available as a generic drug)

• Cyclophosphamide (available as a generic drug)

• Docetaxel (Taxotere)

• Doxorubicin (available as a generic drug)

• Epirubicin (Ellence)

• Fluorouracil (5-FU)

• Methotrexate (Rheumatrex, Trexall)

• Paclitaxel (Taxol)

• Protein-bound paclitaxel (Abraxane)

Common chemotherapy combinations for inflammatory breast cancer may include:

• AC or EC (doxorubicin and cyclophosphamide or epirubicin and cyclophosphamide) followed by T (paclitaxel or docetaxel)

• TAC (docetaxel, doxorubicin, and cyclophosphamide)

Other chemotherapy combinations that may be used for inflammatory breast cancer include:

• AC (doxorubicin and cyclophosphamide)

• CAF (cyclophosphamide, doxorubicin, and 5-FU)

• CEF (cyclophosphamide, epirubicin, and 5-FU)

• CMF (cyclophosphamide, methotrexate, and 5-FU)

• EC (epirubicin and cyclophosphamide)

• TC (docetaxel and cyclophosphamide)

Treatments that target the HER2 receptor may be given with chemotherapy for HER2-positive breast cancer (see "Targeted therapy," below).

Immunotherapy may be given with chemotherapy for triple negative breast cancer (see "Immunotherapy," below).

The side effects of chemotherapy depend on the individual and the drug and dose used, but they can include fatigue, risk of infection, nausea and vomiting, numbness and tingling in the fingers and toes, hair loss, loss of appetite, and diarrhea or constipation. These side effects usually go away after treatment is finished. Long-term side effects may occur, such as nerve damage or fatigue, and, rarely, heart damage or secondary cancers.

Learn more about the basics of chemotherapy .

You can learn more about drugs used to treat metastatic inflammatory breast cancer in the Guide to Metastatic Breast Cancer .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These treatments are very focused, and they work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all cancers have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in the cancer. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

HER2 is a specialized protein found on breast cancer cells that controls cancer growth and spread. If an inflammatory breast cancer tests positive for HER2, targeted therapy will likely be an option for treatment along with standard chemotherapy.

HER2-positive inflammatory breast cancer is usually treated with medications that target HER2. The choice of which HER2-targeted drug to use depends on the cancer’s stage.

Commonly used HER2-targeting medications for breast cancer include:

• Trastuzumab (Herceptin, Herzuma, Ogivri, Ontruzant, Hylecta)

• Pertuzumab (Perjeta)

• Ado-trastuzumab emtansine (Kadcyla)

• Neratinib (Nerlynx)

HER2-targeted therapy is usually given in combination with chemotherapy, and then after chemotherapy ends. Common combination regimens for HER2-positive inflammatory breast cancer include:

• AC-THP (doxorubicin, cyclophosphamide, paclitaxel, trastuzumab, pertuzumab)

• TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab)

Other combination regimens that may be used for HER2-positive inflammatory breast cancer include:

• AC-TH (doxorubicin, cyclophosphamide, paclitaxel, trastuzumab)

• TCH (docetaxel, carboplatin, trastuzumab)

If a patient has no cancer still remaining in the breast at the time of surgery, they will generally be recommended to continue to receive trastuzumab with or without pertuzumab every 3 weeks until completion of 1 year of therapy (11 to 14 doses). However, if a patient is found to have cancer still remaining in the breast at the time of surgery, they will generally be recommended to receive ado-trastuzumab emtansine every 3 weeks for 14 doses.

Patients receiving HER2-targeted therapy have a small risk of developing heart problems . This risk is increased if they also have other risk factors for heart disease. Heart problems do not always go away, but they are usually treatable with medication. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Bone modifying drugs

Bone modifying drugs block bone destruction and help strengthen the bone. They may be used to prevent cancer from recurring in the bone or to treat cancer that has spread to the bone . Bone modifying drugs are not a substitute for standard anti-cancer treatments. Certain types of bone modifying drugs are also used in low doses to prevent and treat osteoporosis, which is the thinning of the bones.

The drugs used to block bone destruction and present breast cancer recurrence in the bone are:

• Bisphosphonates. These block the cells that destroy bone, called osteoclasts.

All people with breast cancer who have been through menopause, including people with inflammatory breast cancer, should have a discussion with their doctor whether bisphosphonates are right for them. Several factors affect this decision, including your risk of recurrence, the side effects of treatment, the cost of treatment, your preferences, and your overall health.

If treatment with bisphosphonates is recommended, ASCO recommends starting within 3 months after surgery or within 2 months after adjuvant chemotherapy. This may include treatment with clodronate (multiple brand names), ibandronate (Boniva), or zoledronic acid (Reclast, Zometa). Clodronate is not available in the United States.

This information is based on the ASCO and Ontario Health (Cancer Care Ontario) guideline, “ Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer .” Please note that this link takes you to another ASCO website.

Other types of targeted therapy for breast cancer

You may have other targeted therapy options for breast cancer treatment, depending on several factors. The following drugs are used for the treatment of non-metastatic breast cancer in people with an inherited BRCA1 or BRCA2 gene mutation and a high risk of breast cancer recurrence.

• Olaparib (Lynparza). This is a type of oral drug called a PARP inhibitor, which destroys cancer cells by preventing them from fixing damage to the cells. ASCO recommends using olaparib to treat early-stage, HER2-negative breast cancer in people with an inherited BRCA1 or BRCA2 gene mutation and a high risk of breast cancer recurrence. Adjuvant olaparib should be given for 1 year following the completion of chemotherapy, surgery, and radiation therapy (if needed).

• Abemaciclib (Verzenio). This oral drug, called a CDK4/6 inhibitor, targets a protein in breast cancer cells called CDK4/6, which may stimulate cancer cell growth. It is approved as treatment in combination with hormonal therapy (tamoxifen or an aromatase inhibitor; see "Hormonal therapy" below) to treat people with hormone receptor-positive, HER2-negative, early breast cancer that has spread to the lymph nodes and has a high risk of recurrence. ASCO recommends consideration of 2 years of treatment with abemaciclib combined with 5 or more years of hormonal therapy for patients meeting these criteria, including for people whose cancer has a Ki-67 score higher than 20% (see Diagnosis ). Treatment should be given following the completion of chemotherapy, surgery, and radiation therapy.

You can learn more about drugs used to treat metastatic inflammatory breast cancer in the Guide to Metastatic Breast Cancer .

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. The following drug can be used in combination with neoadjuvant chemotherapy for treatment of inflammatory breast cancer that is triple negative.

• Pembrolizumab (Keytruda). This is a type of immunotherapy that is approved by the FDA to treat high-risk, early-stage, triple-negative breast cancer in combination with chemotherapy before surgery. It then is given alone following surgery.

Different types of immunotherapy can cause different side effects. Common side effects include skin rashes, flu-like symptoms, diarrhea, and weight changes. Other severe but less common side effects can also occur. Talk with your doctor about possible side effects of the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Hormonal therapy

Hormonal therapy, also called endocrine therapy, is an effective treatment for breast cancer that tests positive for either estrogen or progesterone receptors (called ER positive or PR positive; see Introduction ) in all stages of breast cancer. This type of breast cancer uses hormones to fuel its growth. Blocking the hormones may slow the growth of the cancer and destroy the cancer cells. Hormone therapy is typically recommended for hormone receptor-positive cancer after chemotherapy and radiation therapy or as treatment for metastatic breast cancer.

Hormonal therapy is usually taken for at least 5 years. It may be taken for up to 10 years, especially when there is a higher risk of the cancer returning. How long to continue hormonal therapy depends on the stage of cancer, the risk of it returning, and any side effects you are experiencing.

Hormonal therapy for inflammatory breast cancer is typically started either during or after adjuvant radiation therapy (see below). Hormonal therapy options include:

• Tamoxifen (available as a generic) blocks estrogen from binding to breast cancer cells. It is a hormonal therapy that can be used before or after menopause.

• Aromatase inhibitors (AIs, all available as generics) decrease the amount of estrogen made by the body. These drugs include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). AIs are effective in treating breast cancer in postmenopausal people or premenopausal people who are also receiving ovarian suppression.

• Ovarian suppression refers to the use of drugs or surgery to stop the ovaries from producing estrogen. It may be used in addition to another type of hormonal therapy for people who have not been through menopause. There are 2 methods used for ovarian suppression:

  • Drugs called gonadotropin or luteinizing releasing hormone (GnRH or LHRH) analogs that stop the ovaries from making estrogen. Goserelin (Zoladex) and leuprolide (Eligard, Lupron) are GnRH and LHRH agonists that stop the ovaries from making estrogen for 1 to 3 months.

  • Surgery to remove the ovaries, which permanently stops estrogen production.

Side effects of hormonal therapy can include hot flashes, decreased sexual desire or ability, body aches and stiffness, and mood swings. Find additional information about hormone therapy in the breast cancer treatment section . Learn more about the basics of hormone therapy .

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Surgery

Surgery for breast cancer involves the removal of the tumor in an operation. Surgery is also used to examine the surrounding axillary or underarm lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Because inflammatory breast cancer is usually located throughout the breast and the lymphatic vessels in the skin, starting with surgery first may not be successful to remove all of the cancer with negative margins. A negative margin means that there is no cancer left at the edges of the tissue removed during surgery. Any cancer left behind during surgery increases the chances of recurrence in the breast and affects healing. Because of this, chemotherapy is typically given first for inflammatory breast cancer to shrink and destroy the cancer in the breast, improving the chance that surgery will be successful.

The usual surgical treatment for inflammatory breast cancer is the removal of the entire breast, a procedure called a mastectomy. Reconstructive surgery of the breast after mastectomy is discussed below.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery .

Lymph node removal and analysis

It is important to find out whether any of the lymph nodes near the breast contain cancer. This information is used to determine treatment and prognosis.

• Sentinel lymph node biopsy . In a sentinel lymph node biopsy, the surgeon finds and removes a small number of lymph nodes from under the arm that receive lymph drainage from the breast. The pathologist then examines these lymph nodes for cancer cells. In general, a sentinel lymph node biopsy is not appropriate for inflammatory breast cancer, and an axillary lymph node dissection is preferred (see below).

• Axillary lymph node dissection . In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. Then, a pathologist examines these lymph nodes for cancer cells. The actual number of lymph nodes removed varies from person to person. An axillary lymph node dissection is the preferred way to evaluate the axillary lymph nodes of a person with inflammatory breast cancer.

Reconstructive or plastic surgery

After a mastectomy, a patient may wish to consider breast reconstruction, which is surgery to rebuild the breast. Breast reconstruction is performed by a reconstructive plastic surgeon.

There are many methods to reconstruct the breast. It may be done with tissue from another part of the body or with synthetic or artificial implants. Certain options may be preferred for inflammatory breast cancer because radiation therapy (see below) is almost always needed. Talk with your doctor for more information and learn more about reconstruction options .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Adjuvant radiation therapy is radiation treatment after surgery. It is effective in reducing the chance of breast cancer returning in both the breast and the chest wall. Adjuvant radiation therapy is nearly always recommended for people with inflammatory breast cancer after mastectomy because of the high risk of cancer cells remaining in the chest wall.

Standard radiation therapy after a mastectomy is given to the chest wall for 5 days (Monday through Friday) for 5 to 6 weeks.

Standard radiation therapy after a lumpectomy is external-beam radiation therapy given daily. This usually includes radiation therapy to the whole breast for several weeks, depending on whether the cancer had spread to the lymph nodes. It is then followed by a more focused treatment to the area where the tumor was located in the breast for the remaining treatments. This focused part of the treatment, called a boost, is standard for people with invasive breast cancer to reduce the risk of a recurrence in the breast.

If there is evidence of cancer in the underarm lymph nodes, radiation therapy may also be given to the lymph node areas in the neck or underarm near the breast or chest wall. There has been growing interest in newer radiation regimens to shorten the length of treatment from 6 to 7 weeks to 3 to 4 weeks. However, these regimens have not been studied in people with inflammatory breast cancer. As always, talk with your doctor about your options for radiation therapy, as well as the risks and benefits of these options.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, and skin changes. Skin changes may include redness, discoloration, and pain or burning, sometimes with blistering or peeling. Very rarely, a small amount of the lung can be affected by the radiation, causing pneumonitis, a radiation-related inflammation of the lung tissue. This risk depends on the size of the area that received radiation therapy. However, this tends to heal with time. In the past, with older equipment and radiation therapy techniques, people who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from the effects of radiation therapy.

Learn more about the basics of radiation therapy .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic inflammatory breast cancer

If cancer has spread to another part in the body from where it started, it is called metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of the treatments discussed above, or additional treatment options that are only used to treat metastatic breast cancer . However, surgery and radiation therapy may be used more often to manage symptoms in other parts of the body than to treat the cancer. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Finishing treatment and the chance of recurrence

For patients with stage III inflammatory breast cancer, when treatment ends, a period many call "post-treatment survivorship " begins. After treatment, people can feel uncertain and worry that the cancer may come back. While many patients never have the disease return, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (locoregional recurrence), or in another place (distant recurrence or metastatic disease).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatment types described above, such as chemotherapy, surgery, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent inflammatory breast cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from breast cancer is not always possible. If the cancer cannot be cured or controlled, the goals of care may switch to focusing on helping a person live as well as possible with the cancer.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about inflammatory breast cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about inflammatory breast cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• New drugs and treatment combinations. There is interest in treating inflammatory breast cancer with specific drug combinations or combinations of drugs and radiation therapy that might help keep the cancer from returning. For advanced disease, treatments that include new targeted therapies or drugs that affect the immune system called immunotherapy are being studied.

• Palliative care/supportive care . Clinical trials are underway to find better ways of reducing symptoms and side effects of current inflammatory breast cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in inflammatory breast cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to review news, research, and other information about breast cancer.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. In some instances, people may be able to visit a survivorship clinic that specializes in the post-treatment needs of people diagnosed with breast cancer. The American Society of Clinical Oncology (ASCO) offers its full recommendations for follow-up care for breast cancer survivors in a separate article.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Breast cancer can come back in the breast or other areas of the body. Generally, a recurrence is found when a person has new symptoms or an abnormal finding on physical examination. The symptoms depend on where the cancer has recurred and may include:

• A new lump in the breast, under the arm, or along the chest wall

• Bone pain or fractures

• Headaches or seizures

• Chronic coughing or trouble breathing

• Extreme fatigue

• Feeling ill

Your doctor will ask specific questions about your health at follow-up visits. It is important to share how you are feeling at those visits and ask any questions you may have about your health or follow-up care plan.

The anticipation before having a follow-up visit or waiting for test results may add stress to you or a family member. This is sometimes called "scanxiety." Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

• Long-term effects of surgery. After a mastectomy, the chest may be scarred and have a different shape or size than before surgery. If lymph nodes were removed as part of the surgery or affected by treatment, a condition called lymphedema may develop. Lymphedema causes swelling of the hand, arm, breast, and/or chest wall, and it is a lifelong risk for patients.

• Long-term effects of radiation therapy. Some patients experience breathlessness, a dry cough, and/or chest pain 2 to 3 months after finishing radiation therapy because the treatment can cause swelling and a hardening or thickening of the lungs called fibrosis. These symptoms may seem similar to the symptoms of pneumonia but do not go away with antibiotics. The symptoms can be treated with medications called steroids. Most patients fully recover with treatment. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.

• Long-term effects of trastuzumab and/or chemotherapy. Patients who received trastuzumab or certain types of chemotherapy called anthracyclines may be at risk of heart problems . Talk with your doctor about the best ways to check for heart problems. Patients treated with chemotherapy also have a risk of other long-term side effects, such as menopausal symptoms, fatigue, chemobrain, permanent numbness and tingling of the fingers and toes, and weight gain.

• Long-term effects of hormonal therapy. Patients who take hormonal therapy for many years can have menopausal symptoms such as hot flashes and vaginal dryness. Tell your doctor or nurse if you notice any abnormal vaginal bleeding or other new symptoms, as you may need additional tests to learn more about the cause. People who are taking an aromatase inhibitor (AI), such as anastrozole, exemestane, or letrozole, should have a bone density test periodically during treatment since these drugs may cause some bone weakness or bone loss, which increases the risk of breaking a bone. In addition, AIs can sometimes cause aches, pains, and stiffness during treatment. Talk with your doctor about what you can do to manage these symptoms if you experience them.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask the health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of breast cancer do I have?

• What stage is the cancer? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What are the chances that the cancer will be successfully treated?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of this treatment, both in the short term and the long term?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• How can I keep myself as healthy as possible during treatment?

• How can I learn more about this specific type of breast cancer?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about chemotherapy, hormone therapy, or targeted therapy

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

Questions to ask about breast reconstruction

• Is breast reconstruction an option for me?

• What types of breast reconstruction options do I have?

• What are the advantages and disadvantages of each type?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

For additional questions, see the Guide to Breast Cancer .

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.