Breast Cancer - Inflammatory: Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2010

ON THIS PAGE: You will learn about the different ways doctors use to treat people/children with this type of cancer. To see other pages, use the menu on the side of your screen.

The treatment of inflammatory breast cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. Inflammatory breast cancer is typically considered a later-stage breast cancer and, therefore, treated aggressively with surgery, radiation therapy, and systemic therapy (chemotherapy, hormone therapy, and/or HER2 targeted therapy).

Chemotherapy is usually the first form of treatment for inflammatory breast cancer. Chemotherapy given before surgery is known as preoperative or neoadjuvant chemotherapy. The purpose of chemotherapy is to control or kill cancer cells, including those in the breast as well as those that may have spread to other parts of the body. After chemotherapy, patients with inflammatory breast cancer usually undergo surgery and radiation therapy to the breast or chest wall. Both radiation and surgery are local treatments that affect only cells in the breast and the immediately surrounding area. The purpose of surgery is to remove the tumor from the body, while the purpose of radiation therapy is to destroy remaining cancer cells. Each treatment option is described below.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials section.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Most people with breast cancer receive chemotherapy in their doctor's office or outpatient clinic. An adjuvant (post-surgery) chemotherapy regimen consists of a specific treatment schedule of drugs given at repeating intervals for a specific number of times.

Chemotherapy may be given intravenously (injected into a vein) or occasionally orally (by mouth), and is usually given in cycles. Chemotherapy for inflammatory breast cancer is usually given before surgery. Chemotherapy is also commonly given at the time of a breast cancer recurrence. Patients in clinical trials may be offered new drugs or new combinations of existing drugs.

The side effects of chemotherapy depend on the individual and the drug and the dose used, but can include fatigue, hair loss, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once 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 do not shorten a patient's survival time.

Different drugs are useful for different types of cancer, and research has shown that combinations of certain drugs are sometimes more effective than individual ones. The following drugs or combinations of drugs may be used to treat inflammatory breast cancer:

  • Cyclophosphamide (Cytoxan)
  • Methotrexate (multiple brand names)
  • Fluorouracil (5-FU, Adrucil)
  • Doxorubicin (Adriamycin)
  • Epirubicin (Ellence)
  • Paclitaxel (Taxol)
  • Docetaxel (Taxotere)
  • CMF (cyclophosphamide, methotrexate, and 5-FU)
  • CAF (cyclophosphamide, doxorubicin, and 5-FU)
  • CEF (cyclophosphamide, epirubicin, and 5-FU)
  • EC (epirubicin and cyclophosphamide)
  • AC (doxorubicin and cyclophosphamide)
  • TAC (docetaxel, doxorubicin, and cyclophosphamide)
  • AC followed by T (doxorubicin and cyclophosphamide, followed by paclitaxel)
  • TC (docetaxel and cyclophosphamide)
  • Vinorelbine (Navelbine)
  • Capecitabine (Xeloda)
  • Protein bound paclitaxel (Abraxane)
  • Pegylated liposomal doxorubicin (DOXIL, Dox-SL, Evacet, LipoDox)
  • Gemcitabine (Gemzar)
  • Carboplatin (Paraplat, Paraplatin)
  • Cisplatin (Platinol)
  • Ixabepilone (Ixempra)

Learn more about 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.

Surgery

Surgery is performed to remove the tumor in the breast and to evaluate the surrounding axillary (underarm) lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Because inflammatory breast cancer is usually located extensively throughout the breast and involves the lymphatic vessels in the skin, it is difficult to remove the entire tumor with negative margins (no cancer left at the edges of the tissue removed during surgery) if surgery is the first step in treatment. Any cancer left behind at the time of surgery increases the chances of recurrence in the breast and affects wound healing. So, chemotherapy is given first in inflammatory breast cancer to shrink and kill the cancer in the breast, improving the chance that surgery will be successful.

The usual surgical treatment for inflammatory breast cancer is a mastectomy (removal of the entire breast). In some cases, lumpectomy (removal of the tumor and a small, clear (cancer-free) margin of tissue around it) is possible. A lumpectomy may also be called breast-conserving surgery, a partial mastectomy, or a segmental mastectomy.

Lymph node removal and analysis

Lymph nodes can trap cancer cells traveling away from the original tumor site. It is important to find out whether any of the lymph nodes near the breast contain evidence of cancer.

In an axillary lymph node dissection, the surgeon removes many of the lymph nodes from under the arm, which are then examined by a pathologist for cancer cells. The actual number of nodes removed varies. The removal of lymph nodes increases the risk of lymphedema. Learn about preventing lymphedema after breast cancer treatment.

Reconstructive (plastic) surgery

Women who undergo a mastectomy may wish to consider breast reconstruction, which is surgery to rebuild the breast. Reconstruction may be done with tissue from another part of the body, or with synthetic (artificial) implants. In inflammatory breast cancer, the reconstruction is usually not done at the same time as mastectomy (immediate reconstruction), due to the need for radiation therapy. However, many women may consider future (delayed) reconstruction. Talk with your doctor for more information. Read more about breast reconstruction after a mastectomy and choosing a breast prosthesis.

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill 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. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a specific time. Standard radiation therapy after a mastectomy is given to the chest wall for five days (Monday through Friday) for five to six weeks. Standard radiation therapy after a lumpectomy is external-beam radiation therapy given daily for five days per week (Monday through Friday) for six to seven weeks. This usually includes radiation therapy to the whole breast first for four-and-a-half to five weeks, followed by a more focused treatment to the site of the tumor bed 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 six to seven weeks to periods of three to four weeks. However, these regimens have not been studied in patients with inflammatory breast cancer. As always, patients should talk with their doctors about available options for radiation therapy, as well as the advantages, and disadvantages of these options.

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 patients with inflammatory breast cancer after mastectomy, because of the high risk of cancer cells being left behind on the chest wall. Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove, although this approach is rare.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, and skin changes. Other side effects may include upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. A small amount of the lung can be affected by the radiation, although the risk of pneumonitis, or a radiation-related inflammation of the lung tissue, is low. In the past, with older equipment and techniques of radiation therapy, women treated for left-sided breast cancers had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from radiation damage.

Learn more about radiation therapy.

Targeted therapy

Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. One of the targeted therapies used for treating HER2-positive inflammatory breast cancer is a drug called trastuzumab (Herceptin). HER2 is a specialized protein found on breast cancer cells that controls cancer growth and spread. Patients receiving trastuzumab have a small (2% to 5%) risk of heart problems, and this risk is increased if a patient has other risk factors for heart disease. These heart problems do not always go away, but they are usually treatable with medication. Other targeted treatments are being tested in clinical trials; see the Current Research section for more information. Learn more about targeted treatments.

Hormone therapy

Hormone therapy helps manage a tumor that tests positive for either estrogen or progesterone receptors in all stages of breast cancer. Because most inflammatory breast cancers do not have these receptors, this treatment is not used. Find additional information about hormone therapy in the breast cancer treatment section.

Find out more about common terms used during cancer treatment.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.