Editing Inflammatory breast cancer (section)

== Treatment ==

* Stage III
** Systemic (CTX +/- HER2)
*** Most patients will have at least a partial response
** Consider RTX if no response to CTX
*** If no response to CTX and RTX, consider palliation - will be hard to offer surgery if skin is still no good
** Modified radical mastectomy + ALND
*** Generally 3-5 weeks after completion of CTX, when neutropaenia has resolved and patient is recovered
*** Lumpectomy is not considered - very high rates of local recurrence
*** All patients require clearance of level I and II, with removal of any palpable nodes in level III. No role for SLNB.
*** No immediate breast reconstruction - might delay RTX
** Radiotherapy
*** 4-6 weeks after surgery, when able to raise arm above head
*** Ipsilateral chest wall, axillary and supraclavicular nodes, and internal mammary chain
** Prolonged endocrine therapy/HER2 therapy if applicable
*** ER therapy during/immediately after RTX
* Stage IV
** Systemic therapy
** Surgery or RTX if indicated for palliation
*** Does not improve overall survival
*** For example, if primary tumour is enlarging but distant mets are well-controlled, or with triple negative cancers who have a good response to initial chemotherapy to prevent rapid growth of primary tumour during planned breaks in CTX