Breast: inflammatory carcinoma: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Breast: inflammatory carcinoma

Sample item

A 35-year-old woman has a red, swollen, warm breast with peau d'orange covering more than a third of the skin for 3 weeks, with no response to two weeks of antibiotics. There is no discrete mass. A skin punch biopsy shows tumour emboli in dermal lymphatics. What is the correct management sequence?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Neoadjuvant chemotherapy, then modified radical mastectomy and radiotherapy

Inflammatory carcinoma is clinical stage T4d, caused by dermal lymphatic emboli, and it behaves aggressively with early dissemination. The standard is multimodality therapy, starting with systemic neoadjuvant treatment, then modified radical mastectomy with axillary dissection and chest wall radiotherapy. Primary surgery and conservation have poor outcomes.

Option by option

  • A. Breast-conserving surgery followed by radiotherapy

    Conservation is unsafe in T4d disease because of the diffuse skin and lymphatic involvement.

  • B. Endocrine therapy alone

    Endocrine therapy alone is inadequate for such an aggressive, often receptor-negative cancer.

  • C. Primary modified radical mastectomy followed by chemotherapy

    Upfront surgery has high local failure and offers no early control of micrometastases.

  • D. Neoadjuvant chemotherapy, then modified radical mastectomy and radiotherapy (correct)

    Correct. Systemic therapy first, then mastectomy and radiotherapy, is the accepted sequence.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Neoadjuvant chemotherapy, then modified radical mastectomy and radiotherapy. Inflammatory carcinoma is clinical stage T4d, caused by dermal lymphatic emboli, and it behaves aggressively with early dissemination.

Why is "Breast-conserving surgery followed by radiotherapy" not the answer?

Conservation is unsafe in T4d disease because of the diffuse skin and lymphatic involvement.

Why is "Endocrine therapy alone" not the answer?

Endocrine therapy alone is inadequate for such an aggressive, often receptor-negative cancer.

Why is "Primary modified radical mastectomy followed by chemotherapy" not the answer?

Upfront surgery has high local failure and offers no early control of micrometastases.

What concept does this question test?

It tests Breast: inflammatory carcinoma in General Surgery. The standard is multimodality therapy, starting with systemic neoadjuvant treatment, then modified radical mastectomy with axillary dissection and chest wall radiotherapy. Primary surgery and conservation have poor outcomes.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Breast: inflammatory carcinoma?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.