This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Breast, Subject name: Surgery
In inflammatory carcinoma breast with metastasis to axilla, treatment of choice: 
Select and explain. 
A. NACT + MRM + Radiotherapy, B. Radical mastectomy plus chemotherapy, C. Radical mastectomy plus radiotherapy, D. Chemotherapy followed by hormone therapy
A: NACT + MRM + Radiotherapy
Answer: A: NACT + MRM + Radiotherapy 
Explanation: Hallmark of inflammatory breast Ca is diffuse tumour involvement of dermal lymphatic channel breast & overlying skin, often without an underlying tumour mass. Presents with inflammatory changes like erythema, edema (peau de orange) warmth as a result of lymphatic obstruction. At least 33% skin over breast involved. History of rapid onset & progression. Inflammatory breast Ca is a clinical diagnosis & can occur with tumour of ductal or lobular histology Inflammatory breast Ca = stage T4d, corresponds to stage IIIB i.e. locally advanced breast Ca. Rx: NACT + MRM + .