Inflammatory Breast Cancer (IBC) is the most aggressive form of breast cancer. Those with IBC present with redness, swelling, or peau d' orange (thickness/redness/swelling) of the skin. In IBC, dermal lymphatic invasion has occurred, meaning that cancer cells have plugged up the lymphatic vessels of the skin. By definition, IBC is at least stage IIIb, and 30% of patients who present with IBC have distant metastasis. Because of this, those with IBC will most likely need to participate in a metastatic workup, usually including a bone scan and/or CT scan of the chest, abdomen, and pelvis, to determine if their cancer has metastasized to their bones or other organs. 

Treatment Options for Stage 3 Inflammatory Breast Cancer 
If you have stage III inflammatory breast cancer, (meaning the cancer has not metastasized yet), there is a common, step by step treatment plan that you will most likely undergo. 

Step 1) Neoadjuvant Chemotherapy 
Neoadjuvant chemotherapy is when chemotherapy is given before surgery. The two main types of chemo drugs are anthracyclines, such as doxorubicin and epirubicin, and taxanes, such as paclitaxel and docetaxel. To learn more about chemotherapy, click here.

Step 2) Modified Radical Mastectomy 
A modified radical mastectomy is a surgery in which the entire breast is removed, along with the axillary lymph nodes, which are the lymph nodes under the arm (this is called an axillary lymph node dissection, or ALND). This surgery will most likely happen 3 to 8 weeks after neoadjuvant chemo, to ensure that your blood counts are stable without giving the cancer time to spread. (This surgery will only happen if IBC responds to chemotherapy; if it does not, other chemo drugs and/or radiation therapy will be given, as the cancer must shrink before surgery can be performed).

Step 3) Post-Mastectomy/Adjuvant Radiation Therapy 
Adjuvant Radiation therapy, or radiation therapy after breast surgery, will most likely be the next step in your IBC treatment plan. Because IBC is very aggressive, it has a high chance of recurrence after surgery, especially in the chest wall. Radiation therapy reduces the chance that the cancer will come back. To learn more about radiation therapy, click here. 

Step 4) Begin a Systemic Therapy 
After surgery and radiation treatment, you will most likely begin hormone therapy (If your cancer is hormone receptor positive), targeted therapy (HER2+), and/or chemotherapy. These treatments will also reduce the risk of your IBC coming back. 
Click on the underlined treatments to learn more about them. 

Step 5) Consider Reconstruction 
Since a modified radical mastectomy involves removing the entire breast, some may be interested in breast reconstruction. However, reconstruction must happen after radiation therapy and skin recovery, which can take six months to one year. To learn more about breast reconstruction click here. 

Treatment for Stage IV Inflammatory Breast Cancer
For any stage IV, breast cancer, including inflammatory breast cancer, Systemic Therapy (chemotherapy, hormone therapy, targeted therapy, and/or immunotherapy) will be the main form of treatment. 
Systemic therapies are therapies meant to inhibit cancer growth and spread throughout the body, rather than solely in the breast. The type of systemic therapy you will receive will most likely be based on the molecular subtype of your cancer, or, in other words, which biomarkers your cancer cells possess (ER, PR, and/or HER2):

1)Hormone Therapy 
Hormone therapy is a treatment option for those who have Hormone Receptor positive (HR+) breast cancer, meaning your cancer is ER (Estrogen Receptor) and or PR (progesterone receptor) positive. There are two main types of hormone therapy: Selective Estrogen Receptor Antagonists (SERMS)  such as tamoxifen and raloxifene, and Aromatase Inhibitors such as exemestane and letrozole. To learn more about hormone therapy, click here.

2) Targeted Therapy
The most common type of targeted therapy is HER2 targeted therapy,  for those who have HER2+ cancers. These therapies block HER2, a receptor that sets off a downstream path that allows cancer cells to divide quickly. Common HER2 directed therapies include tratuzumab and pertuzamab. There are other types of targeted therapies, however, including targeted therapies for hormone receptor positive cancers (such as CDK4/6 inhibitors and P13K inhibitors), targeted therapies for those with the BCRA mutations (PARP inhibitors), and targeted therapies for those with Triple Negative Breast Cancers (antibody drug conjugates). 
To learn more about targeted therapies, click here. 

3) Chemotherapy 
If your cancer is ER, PR, or HER2 positive, chemotherapy may be coupled with hormone or targeted therapy, depending on the stage, grade, and recurrence risk or your cancer.  However, if your cancer is Triple Negative (TNBC/basal like) your doctor will almost always prescribe chemotherapy as a line of treatment. The most common chemotherapies are anthracyclines (also known as adriamycins) such as doxorubicin and epirubicin and taxanes such as paclitaxel and doxetaxal. To learn more about chemotherapy, click here. 

4) Immunotherapy
Immunotherapy is an innovative treatment option that is showing promising outcomes, especially in later stage TNBC. Immunotherapy works through inhibiting checkpoint proteins that hide cancer cells from t-cells (your bodies immune system cells), therefore allowing your immune system to find and attack cancer cells. To learn more about immunotherapy, click here.