Inflammatory breast cancer is a form of breast cancer that causes breast swelling and skin changes.

Inflammatory breast cancer happens when a growth of cells forms in the breast tissue. The cells break away from where they start to grow and travel to the lymphatic vessels in the skin. The cells can block the vessels and cause the skin on the breast to look swollen. This skin on the breast might look pink, red, purple or bruised, depending on your skin color.

Inflammatory breast cancer is considered a locally advanced cancer. When a cancer is locally advanced, that means it has spread from where it started to nearby tissue and possibly to nearby lymph nodes.

Inflammatory breast cancer can easily be confused with a breast infection, which is a much more common cause of breast swelling and skin changes. Seek medical attention right away if you notice skin changes on your breast.

Inflammatory breast cancer is different from more common types of breast cancer because it usually develops rapidly, often does not form a distinct lump, and is already locally advanced when it is diagnosed. The swelling and skin changes happen when cancer cells block lymph vessels in the skin of the breast.

Inflammatory breast cancer doesn't commonly form a lump, as occurs with other forms of breast cancer. Instead, signs and symptoms of inflammatory breast cancer include:

• Fast change in the appearance of one breast, over the course of several weeks.
• Thickness, heaviness or swelling of one breast.
• Changes in skin color. Depending on your skin color, this can give the breast a pink, red, purple or bruised appearance.
• Unusual warmth of the affected breast.
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel.
• Tenderness, pain or aching.
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone.
• Flattened nipple or nipple that turns inward on the affected breast.

For inflammatory breast cancer to be diagnosed, these symptoms must have been present for less than six months.

What inflammatory breast cancer may look and feel like

The skin changes of inflammatory breast cancer may look pink, red, purple or bruised, depending on your skin color. The affected area may be swollen, warm, thickened or dimpled, and it may look and feel like an orange peel. The breast also may have a heavy, tender, painful or burning feeling. These changes usually develop quickly over several weeks to months and often involve at least one-third of the breast.

Inflammatory breast cancer usually affects one breast. One breast may become larger, warmer or heavier than the other. A lump is not common, though some people may have an underlying mass.

Inflammatory breast cancer in men

Men can get inflammatory breast cancer because men have breast tissue. In men, inflammatory breast cancer may cause rapid breast swelling, a change in skin color, warmth and tenderness. It does not cause a lump. Inflammatory breast cancer is very rare in men. Learn more about male breast cancer.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Other, more common conditions have symptoms similar to those of inflammatory breast cancer. A breast injury or breast infection, called mastitis, may cause skin color changes, swelling and pain.

Inflammatory breast cancer can easily be confused with a breast infection, which is much more common. It's reasonable and common to first be treated with antibiotics for a suspected breast infection. If the condition does not improve, your healthcare professional may consider more-serious causes of your symptoms, such as inflammatory breast cancer.

If you've been treated for a breast infection but your symptoms continue, contact your healthcare professional. You may have a mammogram or other test to evaluate your symptoms. The only way a healthcare professional can know whether your symptoms are caused by inflammatory breast cancer is to remove a sample of tissue for testing.

Conditions that can look like inflammatory breast cancer

Mastitis and other breast infections can cause a change in skin color, warmth, swelling, tenderness and itching that resemble inflammatory breast cancer. Mastitis is especially common during breastfeeding. A breast injury also can cause swelling, pain and skin color changes. If treatment for a suspected infection does not improve symptoms, or if the affected area gets larger or symptoms worsen, contact your healthcare professional for more testing.

Paget's disease of the breast can cause scaly, crusted, itchy or irritated skin that usually begins on the nipple and may spread to the darker skin around it. Eczema and contact dermatitis can cause similar nipple or skin changes. These conditions are different from inflammatory breast cancer, but persistent breast or nipple changes need medical evaluation.

Inflammatory breast cancer happens when cells in the breast develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many irregular cells to build up.

Most often, the DNA changes happen in a cell in one of the tubes, called ducts, that can carry breast milk to the nipple. But the cancer also can begin with a cell in the glandular tissue, called lobules, where breast milk can be produced.

In inflammatory breast cancer, the cancer cells break away from where they started. They travel to the lymphatic vessels in the breast skin. The cells collect in and clog the vessels. The blockage in the lymphatic vessels causes skin color changes, swelling and dimpled skin, giving the appearance of an orange peel. This skin change is a classic sign of inflammatory breast cancer.

Factors that raise the risk of inflammatory breast cancer include:

Being female

Women are much more likely than men to get breast cancer, including inflammatory breast cancer. Everyone is born with some breast tissue, so anyone can get breast cancer.

Being younger

Inflammatory breast cancer is more frequently diagnosed in people in their 40s and 50s.

Being Black

Black people have a higher risk of inflammatory breast cancer than do white people.

Having obesity

People who have obesity have a greater risk of inflammatory breast cancer.

Making changes in your daily life may help lower your risk of breast cancer. Try to:

• Ask about breast cancer screening. Talk with your doctor or other healthcare professional about when to begin breast cancer risk assessment. Ask about the benefits and risks of screening. Together, you can decide what breast cancer screening tests are right for you.

• Become familiar with your breasts through breast self-exam for breast awareness. You may choose to become familiar with your breasts by occasionally inspecting them during a breast self-exam for breast awareness. If you find a change, lumps or other unusual signs in your breasts, tell a healthcare professional right away.

  Breast awareness can't prevent breast cancer. But it may help you to better understand the look and feel of your breasts. This might make it more likely that you'll notice if something changes.

• Drink alcohol in moderation, if at all. For breast cancer prevention, it is best not to drink alcohol. If you choose to drink alcohol, limit how often you drink and keep the amount small.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your healthcare professional whether exercising is OK and start slowly.
• Limit hormone therapy during menopause. Combination hormone therapy may raise the risk of breast cancer. Talk with a healthcare professional about the benefits and risks of hormone therapy. Some people have symptoms during menopause that cause discomfort. They may decide that the risks of hormone therapy are acceptable to get relief. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
• Keep a healthy weight. If your weight is healthy, work to keep that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. Eat fewer calories and slowly increase the amount you exercise.

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, called a breast biopsy.

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. Other imaging tests, such as a breast MRI, may be recommended in some 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 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 results of the cancer staging tests to help create your treatment plan.

Imaging tests may include an MRI, a CT scan, a bone scan and a positron emission tomography (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. Inflammatory breast cancer is different: It is always diagnosed as stage 3 or stage 4 because it involves the skin of the breast. Stage 3 means the cancer has not spread to distant parts of the body. Stage 4 means it has spread to distant areas, such as the lungs, liver, bones or brain.

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 for breast cancer is used before surgery for inflammatory breast cancer. This presurgical 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 treatment after you've completed other treatments. This may include chemotherapy, biological therapy for cancer, targeted treatment for breast cancer or hormone therapy for breast cancer, depending on the cancer's biomarkers and response to treatment. Biomarkers are features of cancer cells that can help guide treatment choices.

Surgery

After chemotherapy, you may have surgery 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.

You may have different options for reconstruction, including breast reconstruction with flap surgery, transverse rectus abdominis muscle (TRAM) flap surgery and breast reconstruction with implants. Your healthcare team can tell you what options may be best for your situation.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy for breast cancer, you lie on a table while a machine moves around you. The machine directs radiation to precise points in 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 (HER2). The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, targeted therapy 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, called metastatic breast cancer, targeted therapy medicines are available that focus on other changes within cancer cells. 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 (ER) positive breast cancer and progesterone receptor (PR) positive breast cancer.

Hormone therapy for breast cancer 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, also called biological therapy 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. In triple-negative breast cancer (TNBC), 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.

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.

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

A little preparation can help you make the most of your appointment.

• Be aware of any restrictions before your appointment. 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 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 would recommend 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 ongoing, or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Cancer staging describes the extent of cancer in the body. It helps the healthcare team plan treatment, estimate the prognosis and determine whether clinical trials may be appropriate. Inflammatory breast cancer grows and spreads quickly. Symptoms often develop over several weeks, and the defining breast changes must have begun within the past six months to be considered inflammatory breast cancer.. Unlike many other breast cancers, inflammatory breast cancer is always stage 3 or stage 4 when diagnosed.

Staging terms

Breast cancer staging uses information about the tumor, nearby lymph nodes and whether the cancer has spread to distant parts of the body. This is called the TNM system: T describes the primary tumor, N describes nearby lymph nodes, and M describes distant metastasis.

Breast cancer staging uses information about the tumor, nearby lymph nodes and whether the cancer has spread to distant parts of the body. This is called the TNM system: T describes the primary tumor, N describes nearby lymph nodes and M describes whether the cancer has spread to a distant part of the body. Biomarker tests look for features of the cancer cells, including estrogen receptor, progesterone receptor and HER2 status. These results help guide treatment. Inflammatory breast cancer is classified as T4d because it involves the breast skin. It cannot be stage 1 or stage 2. Stage 3 means the cancer has not spread to a distant part of the body. Stage 4 means the cancer has spread to a distant part of the body.

Staging tests

Staging tests help your healthcare team confirm the diagnosis, find out how far the cancer has spread and plan treatment.

• Staging begins with a physical exam and a breast biopsy to confirm invasive breast cancer, meaning cancer that has grown into the surrounding breast tissue.
• Biomarker tests check hormone receptor and HER2 status.
• Imaging tests may include a CT scan, a breast MRI, a bone scan or a positron emission tomography (PET) scan to look for cancer in nearby lymph nodes and distant parts of the body.

The healthcare team combines the exam, biopsy, biomarker and imaging results to assign stage 3 or stage 4.

Stage 3 inflammatory breast cancer

Stage 3 inflammatory breast cancer has spread into the skin of the breast and may involve nearby lymph nodes or nearby structures. The cancer has not spread to distant parts of the body. It is considered locally advanced cancer.

Because inflammatory breast cancer can progress rapidly, treatment usually begins soon after diagnosis. The typical approach is chemotherapy for breast cancer or other systemic treatment before surgery. This is followed by a modified radical mastectomy, which removes the affected breast and nearby lymph nodes, and radiation therapy for breast cancer. Targeted therapy, hormone therapy for breast cancer or biological therapy for cancer may be added based on the cancer's biomarkers.

Stage 4 inflammatory breast cancer

Stage 4 inflammatory breast cancer, also called metastatic inflammatory breast cancer, has spread beyond the breast and nearby lymph nodes to a distant part of the body. This includes areas such as the bones, lungs, liver or brain. The speed and pattern of spread vary from person to person. Inflammatory breast cancer is more likely than many other breast cancers to have already spread when it is diagnosed.

Treatment usually focuses on medicines that work throughout the body, such as chemotherapy, breast cancer hormone therapy, targeted therapy or immunotherapy. Radiation therapy or surgery may be used in selected situations to relieve symptoms or control cancer in a specific area. Treatment choices depend on biomarkers, previous treatment, symptoms and the parts of the body affected.

Five-year relative survival rates for women with inflammatory breast cancer are 53% when the cancer has spread to nearby lymph nodes or tissues and 22% when it has spread to distant parts of the body. These categories are called regional disease and distant disease in survival statistics. Regional disease generally corresponds to stage 3 inflammatory breast cancer. Distant disease corresponds to stage 4. Survival statistics do not include a localized category for inflammatory breast cancer because the cancer already involves the breast skin when it is diagnosed.

Survival statistics

A five-year relative survival rate compares people with the same type and extent of cancer with people in the overall population. For example, a 53% five-year relative survival rate means that people with regional inflammatory breast cancer are about 53% as likely as people without that cancer to be alive five years after diagnosis.

It's important to remember that survival rates describe groups of people treated in the past. They cannot predict exactly what will happen for one person in the future. Your healthcare team can explain what these survival statistics may mean for you.

The available five-year relative survival rates are:

• 53% for regional inflammatory breast cancer, meaning cancer that has spread beyond the breast to nearby lymph nodes or structures.
• 22% for distant inflammatory breast cancer, meaning cancer that has spread to a distant part of the body.
• 40% for all stages combined.

Inflammatory breast cancer is serious because it grows and spreads quickly and is often diagnosed at an advanced stage. Stage 3 inflammatory breast cancer may be treated with the goal of removing all the cancer and preventing it from returning. Stage 4 inflammatory breast cancer generally is not considered curable, but treatment may slow its growth and help people live longer. Treatment focuses on managing the cancer, easing symptoms and maintaining quality of life.

What you can do

Factors that can affect prognosis include the cancer's stage, hormone receptor and HER2 status, overall health, how well treatment works, and whether the cancer returns after treatment. Following the treatment plan and keeping follow-up appointments help the care team assess the cancer's response, manage side effects and watch for recurrence. Ask your healthcare team what the statistics may mean in your situation and whether a clinical trial may be an option.

Treatment can affect daily life and quality of life. Supportive and palliative care can help manage symptoms and treatment effects. Ongoing research and newer treatments may improve outcomes beyond those reflected in older survival data.