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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Inflammatory breast cancer does not usually form a lump. The breast becomes red, swollen, warm and heavy over weeks, with skin thickened like orange peel, because cancer cells have blocked the lymph channels in the skin. It is often mistaken for infection, is always at least stage III, and needs chemotherapy first, then mastectomy and radiotherapy, with HER2 or immune drugs added by subtype.
Inflammatory breast cancer is a clinical diagnosis, staged T4d: rapid onset over six months or less of erythema and oedema covering at least a third of the breast, often with warmth, heaviness and peau d'orange, with or without a palpable mass. Tumour emboli in the dermal lymphatics on a skin punch biopsy support the diagnosis but are not required, and their absence does not exclude it. Because the picture mimics mastitis, women are often given antibiotics first; any presumed infection that does not settle within a week or two in a woman who is not breastfeeding needs imaging and biopsy. Staging includes PET-CT or CT and bone scan, because roughly a third of patients in registry series have distant metastases at diagnosis. Compared with other breast cancers a higher share are HER2-positive or triple-negative and fewer are hormone receptor-positive, and no mutation unique to the inflammatory phenotype has been found.
Treatment is trimodality and the order is fixed. Systemic therapy comes first: an anthracycline and taxane, with trastuzumab and pertuzumab throughout for HER2-positive disease and a pembrolizumab-based regimen for triple-negative disease by extrapolation from KEYNOTE-522, since inflammatory cases were few in the landmark trials. Response on examination and imaging then permits a modified radical mastectomy with axillary dissection; breast conservation, sentinel node biopsy alone, skin-sparing incisions and immediate reconstruction are avoided because the disease is in the skin lymphatics. Post-mastectomy radiotherapy to the chest wall and regional nodes follows in every patient, with bolus to bring the dose to the skin and a higher dose for poor responders. Endocrine therapy, completion of a year of HER2 therapy with trastuzumab emtansine or trastuzumab deruxtecan if disease remained, and olaparib or capecitabine for residual triple-negative disease follow the rules of non-inflammatory cancer.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis and staging | Skin punch biopsy and core biopsy with receptor testing, clinical photography, bilateral mammography and ultrasound, and PET-CT or CT with bone scan because distant spread is common at presentation. | not mapped |
| Systemic therapy first | Anthracycline and taxane chemotherapy; trastuzumab and pertuzumab throughout for HER2-positive disease; pembrolizumab-based chemotherapy for triple-negative disease by extrapolation from KEYNOTE-522. | not mapped |
| Surgery | Modified radical mastectomy with axillary dissection after response to chemotherapy; breast conservation, sentinel node biopsy alone and skin-sparing approaches are avoided, and reconstruction is deferred until after radiotherapy. | not mapped |
| Radiotherapy | Post-mastectomy radiotherapy to the chest wall and regional nodes in every patient, with bolus and often a higher dose for poor responders. | not mapped |
| After trimodality treatment | Endocrine therapy for hormone receptor-positive disease; trastuzumab emtansine or trastuzumab deruxtecan for residual HER2-positive disease (KATHERINE, DESTINY-Breast05); olaparib or capecitabine for residual triple-negative disease as in non-inflammatory cancer. | not mapped |