Treatment

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. For inflammatory breast cancer, treatment often includes surgery, radiation therapy, chemotherapy, and hormone therapy. Each treatment option is described below. Inflammatory breast cancer is typically considered a late-stage breast cancer and, therefore, treated aggressively.

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, read 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. 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 woman’s survival time.

Chemotherapy may be given orally (by mouth) or intravenously (injected into a vein) and is usually given in cycles. Chemotherapy generally does not require a hospital stay; it is given in an outpatient setting. Chemotherapy may be neoadjuvant therapy (given before surgery to shrink a large tumor) or adjuvant therapy (given after surgery to reduce the risk that the cancer returns). Chemotherapy may also be given at the time of a breast cancer recurrence. Patients in clinical trials may be offered new drugs or new combinations of existing drugs.

Chemotherapy may be the first treatment given for inflammatory breast cancer, especially because cancer cells may have already spread to other parts of the body. Chemotherapy can reduce the size of the tumor and the swelling in the breast, increasing the likelihood of successful surgery.

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. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources , which provides links to multiple drug databases.

Surgery

The type of surgery for inflammatory breast cancer depends on the stage of the cancer. Because inflammatory breast cancer grows quickly, a mastectomy (removal of the entire breast), is often done. In some cases, lumpectomy (removal of the tumor and a disease-free area [margin] of tissue around it), is possible.

For more information about considerations after breast cancer surgery, read after a mastectomy and preventing lymphedema after breast cancer treatment, breast reconstruction, and choosing a breast prosthesis.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Adjuvant radiation therapy is given regularly for a number of weeks after a lumpectomy or partial mastectomy to eliminate any remaining cancer cells near the tumor site or elsewhere within the breast. Adjuvant radiation therapy is also recommended for some women after a mastectomy depending upon the size of their tumor, number of cancerous lymph nodes under the arm, and width of the tissue margin around the tumor removed by the surgeon. Adjuvant radiation therapy is effective in reducing the chance of breast cancer returning in both the breast and 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, and skin changes. A small amount of the lung can be affected by the radiation, although the risk of pneumonitis, or a radiation-related pneumonia, is rare. 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. Although exposure to radiation is thought to be a risk factor for cancer after many years, less than one in 500 survivors will develop a different kind of cancer, other than a breast cancer, within the area that was treated. Clinical trials comparing lumpectomy and adjuvant radiation therapy with mastectomy have not shown a difference in the number of patients developing or dying of other cancers within a 20-year time span.

The most common type of radiation treatment is called external beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. In this treatment, small radioactive pellets are placed in or near the site of the breast tumor within plastic catheters placed temporarily in the breast. A balloon catheter placed near the breast that delivers radiation therapy (called Mammosite) is another type of radiation therapy.

For more information on radiation therapy, read the Cancer.Net Feature: Understanding Radiation Therapy, the Cancer.Net Feature: Radiation Therapy—Your Personal Experience, and the Cancer.Net Feature: Side Effects of Radiation Therapy.

Hormone therapy

Hormone therapy is useful to manage a tumor that tests positive for either estrogen or progesterone receptors for both early-stage and metastatic cancer. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually limits the growth of the tumor.

If it is determined that the tumor is hormone receptor-positive (uses estrogen or progesterone to grow [see Diagnosis]), then adjuvant hormone treatment may be used alone or after chemotherapy. Examples of hormone therapy used as adjuvant therapy are tamoxifen (Nolvadex), anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).

Tamoxifen is the drug that researchers have studied the longest for use as a hormone therapy. It blocks estrogen from binding to breast cancer cells. It has been shown to be effective for reducing the risk of recurrence in the treated breast, the risk of developing cancer in the other breast, and the risk of developing cancer in women with no history of the disease but who are at higher than average risk for breast cancer. Current research shows that there is no benefit of taking tamoxifen longer than five years.

The side effects of tamoxifen include hot flashes, a small increased risk of uterine (endometrial) cancer and uterine sarcoma, and an increase in the risk of blood clots. Tamoxifen can be effective for both premenopausal and postmenopausal women.

In postmenopausal women who have an increased risk of developing breast cancer, raloxifene has shown to be another hormone therapy that is as effective as tamoxifen in preventing invasive breast cancer, but not as effective in preventing noninvasive cancer, such as ductal carcinoma in situ (DCIS). The side effects of raloxifene include a small risk of blood clots, leg and joint pain, hot flashes, pain during sexual intercourse, and vaginal dryness. Raloxifene has not been studied in premenopausal women, and it is not considered a substitute for tamoxifen for adjuvant therapy for women with hormone receptor-positive breast cancer.

An aromatase inhibitor (AI) decreases the amount of estrogen in postmenopausal women by blocking the aromatase enzyme, which is needed to make estrogen. These drugs include anastrozole, letrozole, and exemestane. The side effects of AIs may include joint pain and an increased risk of fractures (broken bones). Clinical trials are evaluating whether women benefit from an AI after tamoxifen, or by taking an AI for more than five years. For more information about AIs, read the ASCO Technology Assessment for Patients: Aromatase Inhibitors for Early Breast Cancer.

Recurrent and metastatic breast cancer

Breast cancer is called recurrent if the cancer has come back after it was first diagnosed and treated. It may come back in the breast (a local recurrence); in the chest wall; or in another part of the body, including distant organs (such as the lungs, liver, and bones). Some patients live years after a recurrence of breast cancer.

Breast cancer may also spread to other organs such as the brain, the opposite breast, adrenal glands, spleen, and ovaries and is called metastatic breast cancer. This type of cancer is treatable, but not curable. The goal of treatment for advanced disease is to achieve remission (temporary or permanent absence of disease) or slow the growth of the tumor.

Generally, a recurrence is detected when a person has symptoms. Even though there are tests that may detect a metastatic recurrence before the onset of symptoms, research shows that having such tests does not improve the response to treatments used for advanced disease, nor do they prolong life.

Signs and symptoms depend on the site of the recurrence and may include:

• A lump under the arm or along the chest wall
  
  
• Bone pain or fractures, which may signal bone metastases
  
  
• Headaches or seizures, which may signal brain metastases
  
  
• Chronic coughing or trouble breathing, which may signal lung metastases

Other symptoms may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue. A biopsy of the recurrent site is often recommended to be certain of the diagnosis and to check for ER, PR, and HER2 status, because this may have changed from the time of the original diagnosis.

The treatment of metastatic or recurrent breast cancer depends on the previous treatment(s) and the characteristics of the tumor (such as ER, PR, and HER2 status). Once metastatic disease is detected, the treatment may involve surgery to remove the metastasis and/or chemotherapy, hormone therapy, targeted therapy, and radiation therapy (if it hasn’t been already given) to control it. In some circumstances, radiation therapy may also be given to relieve symptoms.

Treatment guides from ASCO for breast cancer include Aromatase Inhibitors for Early Breast Cancer,Bisphosphonates for Breast Cancer, Follow-Up Care for Breast Cancer, HER2 Testing for Breast Cancer, Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer, and Tumor Markers for Breast Cancer.