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Breast Cancer - Inflammatory - Introduction

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Lineagotica’s Guide to Inflammatory Breast Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the breast

The breast is made up of different tissue, ranging from very fatty tissue to very dense tissue. Within this tissue is a network of lobes. The lobes are made up of tiny, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, and lobes. These ducts carry the milk from the lobes to the nipple, located in the middle of the areola. The areola is the darker area that surrounds the nipple. Blood and lymph vessels also run throughout the breast. Blood nourishes the cells, and the lymph system drains bodily waste products. The lymph vessels connect to lymph nodes, the tiny, bean-shaped organs that help fight infection.

About inflammatory breast cancer

Cancer begins when healthy cells in the breast change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Breast cancer spreads when the cancer grows into other parts of the body or when breast cancer cells move to other parts of the body through the blood vessels and/or lymph vessels. This is called metastasis.

Inflammatory breast cancer is a less common form of breast cancer. The cancer gets its name because the symptoms, which can include redness, tenderness, swelling, and pain in the breast, are similar to the symptoms of a breast infection. However, unlike an infection, inflammatory breast cancer does not improve with antibiotic treatment.

In inflammatory breast cancer, the cancer cells enter and block the lymph vessels within the breast. This blockage can cause a fluid backup and swelling of the breast and overlying skin. It can also cause the breast to look red and inflamed. Because of the pattern and speed of growth of inflammatory breast cancer, as well as a higher risk of spreading than other types of breast cancer, treatment requires a team approach. Treatment often includes a combination of chemotherapy, surgery, radiation therapy, and possibly hormonal or endocrine therapy. These treatments are explained in the Treatment Options section.

Breast cancer subtypes

Breast cancer is not a single disease, even among the same type of breast cancer. When you are diagnosed with breast cancer, your doctor will recommend doing lab tests on the cancerous tissue. These tests will help your doctor learn more about your cancer and choose the most effective treatment.

Tests can determine if the cancer is:

  • Hormone receptor positive or negative. Breast cancers expressing estrogen receptors (ER) and progesterone receptors (PR) are called “hormone receptor positive.” These cancers may depend on the hormones estrogen and/or progesterone to grow. A breast cancer that does not have estrogen and progesterone receptors is called “hormone receptor negative.”

  • HER2 positive or negative. About 20% to 25% of breast cancers depend on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers are called “HER2 positive” and have too many HER2 receptors and/or extra copies of the HER2 gene. The HER2 gene makes a protein that is found on the cancer cell and is important for tumor cell growth. A breast cancer that does not have excessive numbers of HER2 receptors or copies of the HER2 gene is called “HER2 negative.”

  • Triple negative. If a breast tumor does not express ER, PR, and/or HER2, it is called “triple negative.” This type of breast cancer may grow more quickly than hormone receptor-positive disease and may be more sensitive to chemotherapy. Inflammatory breast cancer is often triple negative. 

Looking for More of an Introduction?

If you would like more of an introduction to breast cancer, explore these related items. Please note that these links will take you to other sections on Lineagotica:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to breast cancer. This fact sheet is available as a PDF, so it is easy to print out.

  • ASCO Answers Guide: Get this free 52-page booklet that helps you better understand breast cancer and treatment options. The booklet is available as a PDF, so it is easy to print out.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert in breast cancer that provides basic information and areas of research.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Statistics

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find information about the number of women who are diagnosed with inflammatory breast cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on many factors. Use the menu to see other pages.

Inflammatory breast cancer makes up an estimated 1% to 5% of all breast cancers. Nearly all cases are diagnosed in women. The average age of diagnosis for inflammatory breast cancer is 52, compared to age 57 for less rare breast cancers. Black women seem to have a higher risk of inflammatory breast cancer than white women.

Because inflammatory breast cancer can grow and spread quickly, this cancer often spreads to the lymph nodes around the breast. This means it is often at a locally advanced stage when it is diagnosed. For approximately 1 out of 3 women with inflammatory breast cancer, the cancer has already spread to distant parts of the body when first diagnosed.

For inflammatory breast cancer, survival rates vary depending on the stage, tumor grade, certain features of the cancer, and the treatment a woman receives. For stage III of the disease, the median survival rate is 57 months. For stage IV, it is 21 months. The median is the midpoint, which means that half of women live longer and half live for a shorter time.

It is important to note that new treatments are ahead of published statistics. Women diagnosed with inflammatory breast cancer today may have higher survival rates than in the past because doctors now have a better understanding of how to treat inflammatory breast cancer.

It is also important to remember that statistics on the survival rates for women with inflammatory cancer are an estimate. The estimate comes from annual data based on women with this cancer in the United States. Women should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Sources: American Cancer Society and the National Cancer Institute.

The next section in this guide is Medical IllustrationsIt offers drawings of body parts often affected by inflammatory breast cancer. Use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Medical Illustrations

Approved by the Lineagotica Editorial Board, 12/2017

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

The image is a drawing of a person’s breasts. The breast is made up of different types of tissue, which sit on top of the pectoralis major muscle over the ribcage. Within the fatty tissue of the breast is a network of lobes, made up of tiny, tube-like structures called lobules that contain milk glands. Lactiferous ducts connects the lobes, glands, and lobules to carry milk to the nipple, located in the middle of the areola, the darker area that surrounds the nipple. Lymph vessels also run through the breast, and connect to axillary lymph nodes, tiny, bean-shaped organs that are found in groupings in various parts of the body, including the armpits. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Risk Factors

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the risk of developing cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The risk factors for inflammatory breast cancer are the same as those for other forms of breast cancer. It is not known what specific factors can raise a woman’s risk of inflammatory breast cancer. A family history of breast cancer in general may increase the risk of developing inflammatory breast cancer, but no specific genetic mutations or changes have been found for this type of breast cancer. However, women with genetic mutations that increase the risk of breast cancer may have a higher risk of developing inflammatory breast cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer. The methods used for preventing inflammatory breast cancer are similar to those used for other types of breast cancer. Learn more about breast cancer prevention.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. You may use the menu to choose a different section to read in this guide.  

Breast Cancer - Inflammatory - Screening

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find out more about screening for this type of 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 the basics of cancer screening and recommendations for breast cancer screening.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Symptoms and Signs

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Symptoms of inflammatory breast cancer may appear quickly and within a short time of each other.

  • A red, swollen, or warm breast. This symptom is caused when the cancer cells block the lymph vessels in the skin of the breast. Because inflammatory breast cancer cells are located within the lymphatic system of the breast, the cells have the potential to spread to other locations in the body.

  • Skin or nipple changes, including ridges, puckering, or roughness on the skin. The pores of the skin may be more noticeable. These skin changes have been compared with the skin of an orange and may be called “peau d’orange.”

  • A lump in the breast, although often there is not a distinct lump

  • Pain in the breast or nipple

  • Nipple discharge

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis

If cancer is diagnosed, relieving symptoms is an important part of cancer care and treatment. This may also be called symptom management, supportive care, or palliative care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Diagnosis

Approved by the Lineagotica Editorial Board, 12/2017

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 this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. However, imaging tests may not be as helpful as a biopsy (see below) for evaluating breast cancer. 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 whether 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.

This list describes options for diagnosing this type of cancer. Not all tests listed below 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 medical condition

  • 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.

Breast imaging tests

  • 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 women who have no symptoms. A diagnostic mammography is often used when a woman 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. A breast MRI may be used after a woman has been diagnosed with 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 some women 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 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 biopsy technique for finding out whether an abnormality on a physical examination or an imaging test is 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. 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 skin biopsy is often used to help diagnose inflammatory breast cancer. 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, which is the removal of part of the lump or excisional, which 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 Treatment Options section.

Analyzing the biopsy sample

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

  • Tumor features. Examination of the tumor under the microscope is used to determine if it is invasive or in situ, ductal or lobular, and whether the cancer has spread to the lymph nodes. Inflammatory breast cancer is always invasive.

  • ER and 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, some inflammatory breast cancers do have these receptors. Learn about ER and PR testing recommendations from ASCO and the College of American Pathologists (CAP).

  • 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. Read ASCO’s and CAP's recommendations for HER2 testing for breast cancer.

  • Grade. The tumor grade is also determined from the biopsy. 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 contains different cell groupings, it is called 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

The 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 chemistries. These tests are often done to look at minerals in your blood, such as potassium and sodium. They help to 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. Learn more about tumor markers for breast cancer.   

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. Read the Stages section for more information. 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 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 dark, compared to healthy bone, which appears gray. 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 appear dark.

  • 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 creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows abnormalities, including most tumors. A CT scan can be used to measure the tumor’s size and 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) scan. A PET scan may also be used to find out whether the cancer has spread to organs outside of the breast. A PET scan is usually combined with a CT scan (see above). However, you may hear your doctor refer to this procedure just as a PET scan. 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. 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 any abnormalities in the bone, similar to the bone scan.

After diagnostic tests are completed, your doctor will review all of 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 area 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. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Stages

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, how much the cancer has grown, and if or where it has spread. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

The most commonly used tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

There are 2 types of TNM staging for breast cancer. First, the clinical stage is based on the results of tests done before surgery, which may include a physical examination, mammogram, ultrasound, and MRI scans. Then, the pathologic stage is assigned based on the pathology results from the breast tissue and any lymph nodes removed during surgery. It is usually determined several days after surgery. In general, more importance is placed on the pathologic stage than the clinical stage.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. Read about specific T, N, and M classifications in the Guide to Breast Cancer. They also use other factors, such as tumor grade and the results of ER/PR and HER2 testing to determine the stage and your prognosis (see Diagnosis).

Inflammatory breast cancer is generally considered stage IIIB breast cancer when it is first diagnosed. It may be diagnosed as stage IV if it has spread outside the breast and lymph nodes.

Stage 0: Stage zero (0) describes disease that is only in the ducts and lobules of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called noninvasive cancer (Tis, N0, M0).

Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).

Stage IB: Cancer has spread only to the lymph nodes and is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller (T0 or T1, N1mi, M0).

Stage IIA: Any 1 of these conditions:

  • There is no evidence of a tumor in the breast, but the cancer has spread to the lymph nodes under the arm called the axillary lymph nodes. It has not spread to distant parts of the body. (T0, N1, M0).

  • The tumor is 20 mm or smaller and has spread to the axillary lymph nodes (T1, N1, M0).

  • The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0).

Stage IIB: Either of these conditions:

  • The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes (T2, N1, M0).

  • The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0).

Stage IIIA: The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes, which are located under the sternum or breastbone. It has not spread to other parts of the body (T0, T1, T2 or T3, N2, M0). Stage IIIA may also be a tumor larger than 50 mm that has small areas of cancer in the lymph nodes (T3, N1, M0).

Stage IIIB: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to the axillary or internal mammary lymph nodes. It has not spread to other parts of the body (T4; N0, N1 or N2; M0).

Stage IIIC: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body (any T, N3, M0).

Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Metastatic cancer spread found when the cancer is first diagnosed occurs about 5% to 6% of the time. This may be called de novo metastatic breast cancer. Most commonly, metastatic breast cancer is found after a previous diagnosis of early breast cancer. Learn more about metastatic breast cancer.

Recurrent: Recurrent cancer is cancer that has come back after treatment. A breast cancer recurrence can be either local or distant or both. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Treatment Options

Approved by the Lineagotica Editorial Board, 12/2017

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

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the 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. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

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, oncology nurses, social workers, pharmacists, 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, HER2 targeted therapy, and/or hormone therapy as appropriate. Treatment for inflammatory breast cancer usually starts with chemotherapy. Chemotherapy before surgery is called neoadjuvant or preoperative therapy. After chemotherapy, people with inflammatory breast cancer usually have surgery followed by radiation therapy to the breast or chest wall. 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.

Descriptions of common treatment options for inflammatory breast cancer are listed below. 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. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. 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. Learn more about making treatment decisions.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen, or schedule, 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.

A patient may receive 1 drug at a time or combinations of different drugs given at the same time. 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 breast cancer may include:

  • Capecitabine (Xeloda)

  • Carboplatin (Carboplatin Hexal)

  • Cisplatin (available as a generic drug)

  • Cyclophosphamide (multiple names)

  • Docetaxel (Docefrez, Taxotere)

  • Doxorubicin (multiple names)

  • Pegylated liposomal doxorubicin (Doxil)

  • Epirubicin (Ellence)

  • Eribulin (Halaven)

  • Fluorouracil (5-FU)

  • Gemcitabine (Gemzar)

  • Ixabepilone (Ixempra)

  • Methotrexate (multiple brand names)

  • Paclitaxel (Taxol)

  • Protein bound paclitaxel (Abraxane)

  • Vinorelbine (Navelbine)

Common chemotherapy combinations for breast cancer may include:

  • AC (doxorubicin and cyclophosphamide)

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

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

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

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

  • EC (epirubicin, cyclophosphamide)

  • TAC (docetaxel, doxorubicin, 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).

The side effects of chemotherapy depend on the individual and the drug and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers, but studies have shown that these side effects typically do not shorten a patient’s life.

Learn more about the basics of chemotherapy and preparing for treatment. 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. Learn more about your prescriptions by using searchable drug databases.

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 while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. In addition, many research studies are taking place now 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, the addition of targeted therapy to standard chemotherapy may be an option for treatment.

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

Commonly used HER2-targeting medications include:

  • Trastuzumab (Herceptin, Ogivri)

  • Pertuzumab (Perjeta)

  • Lapatinib (Tykerb)

  • Ado-trastuzumab emtansine (Kadcyla)

  • Neratinib (Nerlynx)

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

  • ACTH (doxorubicin, cyclophosphamide, paclitaxel, trastuzumab)

  • TCH (docetaxel, carboplatin, trastuzumab)

  • THP (paclitaxel or docetaxel, trastuzumab, pertuzumab)

  • TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab)

Patients receiving HER2-targeted therapies have a very small risk of developing heart problems. This risk is increased if a patient has 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. Other targeted treatments are being tested in clinical trials; see the Latest Research section for more information.

Hormonal therapy

Hormonal therapy, also called endocrine therapy, is an effective treatment for tumors that test positive for either estrogen or progesterone receptors (called ER-positive or PR-positive; see Introduction) in all stages of breast cancer. This type of tumor uses hormones to fuel its growth. Blocking the hormones may slow the growth of the tumor 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. Research shows that taking hormonal therapy for up to 10 years may be better than 5 years, especially for higher-risk tumors. 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 (Nolvadex, Soltamox) blocks estrogen from binding to breast cancer cells. It is a hormonal therapy that can be used by women who have been through menopause and women who have not.

  • Aromatase inhibitors decrease the amount of estrogen made by the body. This type of treatment is effective in treating breast cancer in postmenopausal women.

  • 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 women 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), leuprolide (Lupron), and triptorelin (Trelstar) are GnRH and LHRH agonists that stop the ovaries from making estrogen for 1 to 3 months.

    • Surgery to remove the ovaries, which also stops estrogen production. However, this is permanent.

  • Fulvestrant (Faslodex) is a drug that is given by injection once a month. It is used to treat metastatic breast cancer. It stops estrogen from helping a cancer grow in a way that is different from tamoxifen.

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

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 the entire tumor 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. So, 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

Cancer cells may be found in the axillary lymph nodes in some cancers. 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, sentinel lymph node biopsy is not appropriate for inflammatory breast cancer, and an axillary lymph node dissection, see below, is preferred.

  • 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

Women who need a mastectomy 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.

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. Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor. This can make the tumor easier to remove. However, neoadjuvant radiation therapy is rarely offered as part of breast cancer treatment.

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 for 5 days per week (Monday through Friday) for 6 to 7 weeks. This usually includes radiation therapy to the whole breast first for 4 to 5 weeks, 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 women 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 periods of 3 to 4 weeks. However, these regimens have not been studied in people with inflammatory breast cancer. As always, patients should talk with their doctors about available 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.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

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. Also, clinical trials might 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. 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 patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Finishing treatment and the chance of recurrence

For patients with stage I, stage II, or stage III 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’s 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 does return 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 this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments 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 this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

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

If treatment doesn’t work

Recovery from breast cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

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

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called 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.

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. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - About Clinical Trials

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Researchers are always looking for better ways to care for patients with different types of breast cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating breast cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with breast cancer.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent, which is led by a doctor and the research team. During informed consent, the doctor should:

  • Describe all of the patient's options, so that the person understands the standard treatment, and how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each patient to participate in the clinical trial, including the number of provider visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. Although many clinical trials allow both men and women to enroll, some clinical trials have eligibility criteria restricting a study to women only. It is important to discuss with your doctor if a potential study allows both men and women.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for inflammatory breast cancer, learn more in the Latest Research section.

Lineagotica offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Latest Research

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ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of 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.

  • Drug combinations/new drugs. There is interest in treating inflammatory breast cancer with specific drug combinations that might improve the chances of effective surgery. For advanced disease, targeted treatments aimed at how a cancer grows are being studied.

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

Looking for More About the Latest Research?

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

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

Breast Cancer - Inflammatory - Coping With Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for inflammatory breast cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care and Monitoring section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with inflammatory breast cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care and Monitoring. It explains the importance of checkups after cancer treatment is finished. You may use the menu to choose a different section to read in this guide.

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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 doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, 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. ASCO offers its full recommendations for follow-up care for breast cancer survivors in a separate article.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. 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 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’s important to share how you are feeling at those visits, and ask any questions you may have about your health or follow-up plan.

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

Managing long-term and late side effects

Most people expect to experience 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 afterwards. Long-term and late effects can include both physical and emotional changes.

  • Long-term effects of surgery. After a mastectomy, a woman’s 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 during treatment, a condition called lymphedema that causes swelling of the hand and/or arm may occur, and this is a life-long 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.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, 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 create a treatment summary to 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 decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family 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 forms with him or her 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. You may use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

Women recovering from inflammatory breast cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care and Monitoring) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical 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 and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Lineagotica:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Lineagotica offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Questions to Ask the Health Care Team

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find some questions to ask your doctor or other members of your 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 your 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 Lineagotica’s free mobile app for a digital list and other interactive tools to manage your care.

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 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?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask about chemotherapy or targeted therapy

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

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

  • What can be done to 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?

  • 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 I need them?

  • 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 some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.

Breast Cancer - Inflammatory - Additional Resources

Approved by the Lineagotica Editorial Board, 12/2017

ON THIS PAGE: You will find some helpful links to other areas of Lineagotica that provide information about cancer care and treatment. This is the final page of Lineagotica’s Guide to Inflammatory Breast Cancer. Use the menu to go back and see other pages.

Lineagotica includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Lineagotica:

This is the end of Lineagotica’s Guide to Inflammatory Breast Cancer. You may use the menu to choose a different section to read in this guide.