Inflammatory breast cancer: symptoms, diagnosis and treatment

Cancer Research UK lists the symptoms as swelling of the breast, redness or a change in normal skin colour, pain, swollen lymph nodes, a firm or hard breast that is hot to the touch, skin that looks like orange peel (peau d’orange), nipple changes such as flattening or inversion, and sometimes a lump. Symptoms can appear quite suddenly.

The NHS gives general symptoms of breast cancer that include a lump or swelling in the breast, chest or armpit, a change in the skin such as dimpling that may look like orange peel, a colour change (darker on black or brown skin, red on white skin), a change in size or shape of one or both breasts, nipple discharge and a change in the nipple. Breast pain by itself is not usually a symptom of breast cancer.

• A breast that is swollen, red or darker than usual

• Skin with a dimpled, orange-peel texture

• A firm or hard breast that feels warm

• Swollen glands in the armpit

• A nipple that becomes flattened or turns inwards

In inflammatory breast cancer, cancer cells often block the small lymph vessels in the breast. These vessels are part of the lymphatic system, which collects waste products and drains them into the veins. When they are blocked the skin becomes inflamed, which gives the condition its name and its appearance.

Cancer Research UK describes it as rare, accounting for less than 5% of breast cancers. It tends to develop more quickly than other types and may spread to other parts of the body. Because the skin changes dominate, many people do not feel a discrete lump at first.

Cancer Research UK explains that inflammatory breast cancer is often confused with an infection of the breast, mastitis, which is common in women who are pregnant or breastfeeding. A GP might give a course of antibiotics if they think symptoms could be due to mastitis, but should refer you to a specialist if they think you are unlikely to have mastitis or if symptoms do not clear up after antibiotics.

The practical message is to go back promptly if a red, swollen breast does not respond as expected. The NHS advises seeing a GP if you have any changes in your breasts that are not normal for you and says that finding cancer early may make it easier to treat.

The two conditions can look similar, which is why a GP may try antibiotics first. The table below uses the descriptions from Cancer Research UK and the NHS. You cannot reliably tell them apart by appearance, so a breast that is red, swollen and warm needs to be assessed.

Cancer Research UK says your GP should arrange for you to go to a breast clinic if you have symptoms that could be due to inflammatory breast cancer. This is usually a one-stop clinic where you have several tests in one visit. Tests can include a breast examination, mammogram, breast ultrasound, a biopsy of skin or a lump, an MRI scan, and other scans such as CT or PET-CT. Photographs of the breast may be taken to help monitor response to treatment.

The NHS adds that a referral to a breast clinic does not definitely mean you have cancer, and that the GP will ask about your symptoms and family history and may examine your breasts.

Treatment depends on whether the cancer cells have receptors for particular drugs, your general health and any other medical conditions. Cancer Research UK says you usually have chemotherapy first to shrink the cancer, with targeted drugs such as trastuzumab if the cells have HER2 receptors. Surgery usually follows, most likely a mastectomy, and the surgeon may also remove lymph nodes under the armpit. Radiotherapy after surgery helps to stop the cancer coming back, and hormone therapy tablets for some years are given if the cancer has hormone receptors.

The outlook is generally worse than for other types because it can develop quickly and spread, but Cancer Research UK says doctors think it is improving as treatment improves. You have regular check-ups after treatment, and breast reconstruction may be possible after mastectomy, sometimes as a separate operation.

There are fewer clinical trials specifically for inflammatory breast cancer because it is difficult to run trials for rare cancers, so it is worth asking your cancer specialist or breast care nurse about any that are open.

On the NHS, a GP will ask about your symptoms and family history, may examine your breasts, and refer you to a breast clinic if they think the symptoms could be cancer. The NHS says a referral does not definitely mean you have cancer. Cancer Research UK says a breast clinic is usually a one-stop clinic where you have several tests in one visit.

Private breast clinics offer similar assessment, often with quicker appointments. The tests and treatments described by Cancer Research UK are the same, and a red, swollen breast that does not settle should not be left waiting for a routine appointment.