Inflammatory Breast Cancer (cont.)

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What are the stages of inflammatory breast cancer?

Staging of a cancer refers to the determination of how far the tumor has spread at the time of diagnosis. Staging is determined by a variety of methods including results from surgical procedures, lymph node biopsy, and imaging tests. Staging is important because it aids in developing a treatment plan.

Cancer in situ (DCIS) is referred to as stage 0, because the tumor cells have not invaded. Invasive breast cancers are staged along a scale of I to IV, with stage I being the earliest stage and stage IV representing tumors that have metastasized to distant organs like the bones, lungs, or brain. Because inflammatory breast cancers have already spread into the lymphatic vessels and cause symptoms related to this presence in the lymphatic system, inflammatory breast cancers are stage III or stage IV at diagnosis.

What is the treatment for inflammatory breast cancer?

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Treatment for inflammatory breast cancer typically involves chemotherapy, surgery, and radiation. In some cases, additional targeted therapies are given. The term neoadjuvant refers to therapies that are given prior to surgery, while adjuvant refers to treatments given after surgery.

Neoadjuvant chemotherapy refers to chemotherapy medications that are given prior to surgery to shrink the tumor. In patients with inflammatory breast cancer, this is often done so that the tumor is smaller and easier to remove at surgery. A typical course of neoadjuvant chemotherapy would involve at least six cycles of chemotherapy over four to six months. The chemotherapy regiment usually involves taxane and anthracycline drugs.

If the tumor cells express the HER2 protein (see above), targeted therapies such as trastuzumab (Herceptin) can also be given as a neoadjuvant (prior to surgery) therapy and continued after surgery (adjuvant therapy). Inflammatory breast cancers are often positive for the HER2 protein, so the tumors can be responsive to treatments that target this protein. In addition to trastuzumab, other drugs that target HER2 activity are available.

It is less common for inflammatory breast cancers to express hormone (ER or PR) receptors, but if the tumor is hormone receptor-positive, hormone therapies that target estrogen can be effective. Tamoxifen is a drug that interferes with the activity of estrogen in the body and is a common hormone therapy drug. It can be given to both premenopausal and postmenopausal women. In postmenopausal women, drugs known as aromatase inhibitors are also used as of hormone therapy. Examples of aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).

Surgery for inflammatory breast cancer usually involves a modified radical mastectomy with removal of lymph nodes, since the tumor has spread into the lymphatic system. Following surgery, radiation therapy is typically administered to the chest wall. This treatment uses radiation to destroy remaining cancer cells. The most common type of radiation therapy is given in a clinic, usually five days a week for several weeks.

Adjuvant therapy after surgery can include hormone therapy, chemotherapy, targeted therapy, or a combination of these methods described above.

Clinical trials, in which new drugs, new therapies, or combination of drugs and therapies are tested, may be available for some patients with inflammatory breast cancer and offer an additional treatment option. Anyone interested in taking part in a clinical trial should discuss this possibility doctor. Information about clinical trials is available from the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER and at

Medically Reviewed by a Doctor on 2/6/2015

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