This information is about a rare type of breast cancer called inflammatory breast cancer. Ideally it should be read with our general information about breast cancer.

In inflammatory breast cancer the cancer cells may not grow as a lump that can be felt in the breast, but grow along, and block, the tiny channels (lymph vessels) in the skin of the breast. With some people, their body reacts to the cancer cells in the lymph vessels and, as a result, the breast looks inflamed and swollen (which is how the condition gets its name). The lymph vessels are part of the lymphatic system, which is responsible for removing fluid from tissues and collecting and filtering out bacteria and any waste materials that the body’s cells do not want.

The symptoms often develop quite suddenly. The breast looks red and inflamed, and feels warm and swollen. Ridges or raised marks may appear on the skin of the breast, or the skin may have a pitted appearance, like the peel of an orange (known as peau d’orange).

Other symptoms may include a lump or thickening in the breast, pain in the breast or nipple, or a fluid (discharge) leaking from the nipple.

The appearance of the breast during examination may suggest the diagnosis to your doctor. Certain tests will be needed to help make the diagnosis definite, and to find out whether the cancer has spread.

Biopsy This is the most important test to find out if cancer is present. A small sample of tissue is taken from the breast and then examined under a microscope to check for signs of cancer. A local anaesthetic is sometimes used to numb the area before the biopsy is carried out. A biopsy may also be taken from the lymph nodes under the arm to see if any cancer cells are present.

Mammogram (breast x-ray) Mammograms may be used to look for changes in the affected breast, and to check the other breast.

Ultrasound scan In this test sound waves are used to make up a picture of the breast tissue. It is done in the hospital’s scanning department. A special gel is spread onto the breast and then a small device like a microphone, which emits sound waves, is rubbed over the area. The sound waves are converted into a picture using a computer. The test is completely painless and takes 5–10 minutes.

Inflammatory breast cancer can spread more quickly than other types of breast cancer, so treatment will often be started straight away. You are likely to be offered a combination of different treatments that treat both the body as a whole (systemic treatment) and the breast area individually (local treatment).

Treatment often includes a combination of chemotherapy, radiotherapy, hormonal therapy and surgery. For most types of breast cancer, surgery is usually the first treatment. With inflammatory breast cancer, however, chemotherapy is usually given first. Giving chemotherapy before surgery is known as neo-adjuvant treatment.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy helps to treat and control the disease in the breast itself, and reduce any swelling. As the chemotherapy travels all over the body, it will treat any cancer that may have spread beyond the breast to other parts of the body.

Surgery

 Following chemotherapy, most women will have surgery. It is more common with inflammatory breast cancer to have the whole breast removed (a mastectomy). However, sometimes it is possible to have just the part of the breast that is affected removed (a wide local excision). This will depend upon how well the cancer has responded to the chemotherapy, and the size and position of the tumour.

After surgery, you may have radiotherapy and hormonal therapy, to help reduce the risk of the cancer coming back.

Hormonal therapy

Some breast cancer cells have oestrogen receptors on their surface. This is known as oestrogen receptor positive (ER+) breast cancer. This means that the cells rely on the hormone oestrogen to grow. Oestrogen is a female hormone that is naturally produced in the body and it can stimulate some breast cancer cells to divide and grow.

If you have ER+ breast cancer, you may be prescribed a hormonal therapy that is designed to counteract the effects of oestrogen. Hormonal therapies can slow or stop the growth of breast cancer cells, either by altering the levels of particular female hormones that are naturally produced in the body, or by preventing the hormones from being taken up by the cancer cells.

There are different types of hormonal therapy, and they work in slightly different ways. Your doctor or breast care nurse will give you more information about the hormonal therapy you will be taking, and any possible side effects it may have.

Radiotherapy

Radiotherapy uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It may be given to the breast area to help reduce the risk of the cancer coming back after chemotherapy and surgery.

Trastuzumab (Herceptin®)

Herceptin is one of a new group of drugs called monoclonal antibodies.

Some breast cells divide and grow when a protein, human epidermal growth factor, attaches itself to another protein called HER2. Herceptin blocks this process by attaching itself to the HER2 protein so that the epidermal growth factor cannot reach the breast cancer cells.

Some breast cancer cells have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive.Herceptin® only works in people who have high levels of the HER2 protein (HER2 positive), which you can be tested for. Over half  (about 60%) of people diagnosed with inflammatory breast cancer are HER2 positive.

Herceptin® can be used to treat early breast cancer or breast cancer which has spread (secondary breast cancer).

Research into treatments for inflammatory breast cancer is ongoing, and advances are constantly being made. Cancer doctors use clinical trials to assess new treatments. Before any trial is allowed to take place, an ethics committee must have approved it and agreed that the trial is in the interest of patients.

You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what involves. You may decide not to take part, or withdraw from a trial at any stage. You will then receive the best standard treatment available.

You may experience many different emotions, including anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their condition. You may find it helpful to talk things over with your doctor or nurse, or with one of our cancer support service nurses. Close friends and family members can also offer support.

This section has been compiled using information from a number of reliable sources, including:

• Breast Cancer (2nd Edition). Daniel F. Roses. Churchill Livingston, 2005.
• Cancer of the Breast (5th edition). Eds Donegan and Spratt, Saunders, 2002
• Improving Outcomes in Breast Cancer – The Research Evidence. National Institute of Clinical Excellence, 2002.
• Up To Date  Pathology and molecular pathogenesis of inflammatory breast cancer. www.uptodate.com
• Trastuzumab For the Adjuvant Treatment of Early-Stage HER2-Positive Breast Cancer. National Institute for Health and Clinical Excellence (NICE), August 2006.
• Guidance on the Use of Trastuzumab for the Treatment of Advanced Breast Cancer. National Institute for Health and Clinical Excellence (NICE), March 2002.

For further references, please see the general bibliography.