Diagnosis
Inflammatory breast cancer is a clinical diagnosis that often starts with a discussion of your health history and an exam of the breast. Other tests include imaging tests and removing some cells for testing.
Tests and procedures used to diagnose inflammatory breast cancer include:
- A physical exam. Your healthcare professional examines your breast to look for changes in skin color, swelling and other signs of inflammatory breast cancer.
- Imaging tests. Imaging tests make pictures of the body. Your healthcare professional may recommend a breast X-ray, called a mammogram, or a breast ultrasound to look for signs of cancer in your breast. Additional imaging tests, such as an MRI, may be recommended in certain situations.
- Removing a sample of tissue for testing. A biopsy is a procedure to remove a sample of tissue for testing in a lab. The tissue might be removed using a needle that is put through the skin and into the suspected cancer cells. A skin biopsy also may be helpful. This type of biopsy removes a sample of skin cells. The sample is tested in a lab to see if it is cancer.
Tests to determine the extent of the cancer
If you're diagnosed with inflammatory breast cancer, you may have other tests to see if the cancer has spread. These tests help your healthcare team find out the extent of your cancer, also called the stage. Cancer staging tests often involve imaging tests. The tests might look for signs of cancer in your lymph nodes or in other parts of your body. Your healthcare team uses the cancer staging test results to help create your treatment plan.
Imaging tests may include MRI, CT, bone scans and a positron emission tomography scan, which also is called a PET scan. Not every test is right for every person. Talk with your healthcare professional about which tests are best for you.
The stages of breast cancer range from 0 to 4. The lower numbers mean the cancer is small and hasn't spread from where it started. As the cancer grows, its stage gets higher. Because inflammatory breast cancer is aggressive and grows quickly, the stages usually range from 3 to 4. By stage 4, the cancer has spread to other areas of the body, such as the organs and bones.
Treatment
Inflammatory breast cancer treatment begins with chemotherapy. If the cancer hasn't spread to other areas of the body, treatment continues with surgery and radiation therapy. If the cancer has spread to other areas of the body, your healthcare team may recommend other medicines in addition to chemotherapy. These treatments can slow the growth of the cancer.
Chemotherapy
Chemotherapy treats cancer with strong medicines. You may receive chemotherapy medicines through a vein, in pill form or both.
Chemotherapy is used before surgery for inflammatory breast cancer. This pre-surgical treatment, called neoadjuvant therapy, aims to shrink the cancer before surgery. Neoadjuvant chemotherapy increases the chance that surgery will be successful.
If your cancer has a high risk of returning or spreading to another part of your body, your healthcare professional may recommend additional chemotherapy after you've completed other treatments. Additional chemotherapy decreases the chance that the cancer will recur.
Surgery
After chemotherapy, you may have a procedure to remove the affected breast and some of the nearby lymph nodes. The operation usually includes:
- Surgery to remove the breast, called mastectomy. A total mastectomy removes all of the breast tissue. This includes the lobules, ducts, fatty tissue and some skin, including the nipple and areola.
- Surgery to remove the nearby lymph nodes, called axillary dissection. The surgeon removes the lymph nodes under the arm and near the affected breast.
Talk with your healthcare team about your options for breast reconstruction. Surgery to reconstruct the breast is often delayed until after you complete all of your breast cancer treatments.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
For inflammatory breast cancer, radiation therapy is used after surgery to kill any cancer cells that might remain. The radiation is aimed at your chest, armpit and shoulder.
Targeted therapy
Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
For example, several targeted therapy medicines focus on a protein that some breast cancer cells make too much of. This protein is called human epidermal growth factor receptor 2, also called HER2. The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the medicines can damage cancer cells while sparing healthy cells.
If your inflammatory breast cancer cells test positive for HER2, your healthcare team might recommend combining targeted therapy with your initial chemotherapy treatment. After surgery, targeted therapy can be combined with hormone therapy.
For cancer that spreads to other parts of the body, targeted therapy medicines that focus on other changes within cancer cells are available. Your cancer cells may be tested to see which targeted therapies might be helpful for you.
Hormone therapy
Hormone therapy is used to treat breast cancers that use the body's hormones to grow. Healthcare professionals refer to these cancers as estrogen receptor positive, also called ER positive, and progesterone receptor positive, also called PR positive.
Hormone therapy can be used after surgery or other treatments to decrease the chance of the cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
- Medicines that block hormones from attaching to cancer cells, called selective estrogen receptor modulators.
- Medicines that stop the body from making estrogen after menopause, called aromatase inhibitors.
- Surgery or medicines that stop the ovaries from making hormones.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy might be an option if your cancer has spread to other areas of the body and is triple negative. Triple negative means that the cancer cells don't have receptors for HER2 or the hormones estrogen or progesterone. Your healthcare professional may test your cancer cells to see if they're likely to respond to immunotherapy.
Palliative care
Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.
Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with other treatments, people with cancer may feel better and live longer.
Coping and support
Inflammatory breast cancer progresses rapidly. Sometimes this means you need to start treatment before you've had time to think everything through. With time, you'll find what helps you cope with the uncertainty and distress of a cancer diagnosis. Until then, you may find that it helps to:
Learn enough about inflammatory breast cancer to make decisions about your care
Ask your healthcare team about your cancer, including your test results, treatment options and, if you like, your prognosis. As you learn more about inflammatory breast cancer, you may become more confident in making treatment decisions.
Keep friends and family close
Keeping your close relationships strong can help you deal with inflammatory breast cancer. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.
Find someone to talk with
Find someone who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute and the American Cancer Society.
Preparing for your appointment
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If you're diagnosed with inflammatory breast cancer, you'll be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins or supplements you're taking and the doses.
- Take a family member or friend along. Sometimes it can be very hard to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For inflammatory breast cancer, some basic questions to ask include:
- Do I have inflammatory breast cancer?
- Has my inflammatory breast cancer spread beyond my breast?
- Do I need more tests?
- Can I have a copy of my pathology report?
- What are my treatment options?
- What are the potential risks of each treatment option?
- Can any treatments cure my inflammatory breast cancer?
- Is there one treatment you believe is best for me?
- If you had a friend or family member in my situation, what would you recommend?
- How much time can I take to choose a treatment?
- How will cancer treatment affect my daily life?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?