A fungating (malignant) wound is when cancer that is growing under the skin breaks through the skin to create a wound. As the cancer grows, it blocks and damages tiny blood vessels, which can starve the area of oxygen. This causes the skin and underlying tissue to die (necrosis). There may also be infection and areas of the wound may become ulcerated.
Fungating wounds are rare, and most people who have cancer will never develop a fungating wound. They can develop in the area where the cancer started (the primary), or when the cancer has spread to another part of the body (the secondary or metastasis). If a fungating wound does develop, it’s most likely to happen with breast cancer, head and neck cancer and melanoma.
Cancer is always the underlying cause of a fungating wound. Treatments which reduce the tumour may also decrease the size of the wound and improve symptoms. The treatments that may be used will depend on the type of cancer, which part of the body is affected and how advanced the tumour is. Commonly-used treatments include radiotherapy, chemotherapy, hormonal therapy and surgery.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. It can help by shrinking the tumour and drying up excessive discharge from the wound. Sometimes people find their symptoms become worse straight after radiotherapy. The skin around the area may also become dry and red. These side effects are usually temporary, and should begin to improve after a couple of weeks.
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It’s used to shrink the tumour that is causing the wound and so relieve any symptoms.
Some cancers, such as breast cancer, can be stimulated to grow by certain hormones. Hormonal therapy acts by altering the production of these hormones, or blocking their action, and can help to slow the growth of the cancer. This can help to improve symptoms.
Depending on the size and position of the tumour, it may be possible to remove it, either partly or fully, with surgery. There can be a risk of bleeding as fungating wounds often cause damage to blood vessels, so an operation isn’t always possible. Your doctor can discuss with you whether surgery is possible in your situation.
Although cancer treatments may help reduce the size of the wound, they are unlikely to heal it completely. Managing the wound is therefore very important in improving a person’s comfort and their quality of life. Your nurses will do all they can to make sure that everything is being done to minimise the effects of the wound on you and your everyday activities. In order to do this, your nurse may ask the advice of a specialist nurse in wound care, often called a tissue viability nurse.
Leakage or discharge is probably the most common symptom of a fungating wound and often happens because of infection. Dressings that are very absorbent can be used with additional padding to help with this problem. Some wound dressings can be left in place for a number of days but this depends on the amount of fluid leaking from the wound and where the wound is situated. Changing the dressings regularly can help stop the discharge from building up. Sometimes only the top layer of the dressing needs to be changed.
The discharge or leakage from a wound can make the healthy skin around it sore and red. It’s often helpful to apply a barrier film or cream, such as Cavilon™, to the skin around the wound to protect it.
The presence of an unpleasant smell is common. It can be caused by infection, and many people find this symptom the most distressing. A variety of different dressings may be used on the wound, which can help to control an unpleasant smell. Some dressings contain silver, which can reduce the number of bacteria in the wound, and these can be effective in controlling the odour. These dressings can often be left in place for a number of days, which can also be helpful.
Specially prepared sugar paste and honey has also been used to prevent bacteria growing in fungating wounds. However, it is important to use these as directed by your doctor or nurse, as untreated honey can introduce infection. Charcoal dressings can help to filter any smell.
Antibiotics can help to control any infection that may be present in the wound, which can help to reduce the smell. Applying antibiotic gels directly onto the wound can also help.
People often feel self-conscious about an unpleasant smell, particularly when in company. Air fresheners, environmental air filters and aromatherapy oils can help disguise unpleasant smells and help people feel more comfortable with friends and family. Aromatherapy oils can be applied to the outer layer of the dressing. Make sure the oil doesn’t come into contact with your skin.
Pain can be caused by the tumour damaging nerves, or by dressings sticking to the skin. There are many different types of painkillers (analgesics) that can be used to help relieve pain. Taking painkillers regularly can often be more helpful, as it helps to keep the pain away. Your nurse or doctor can give you advice about the best painkiller to use. If your pain isn’t being controlled, let your doctor or nurse know so that they can adjust the dose or try a different painkiller. If the pain is worse when the dressings are changed, let your nurse know as they may be able to choose a different dressing that suits your wound better. It may also be helpful to take a short-acting painkiller just before the dressing is changed.
Other things that may help are:
- using non-stick dressings
- soaking the dressing off slowly
- using a local anaesthetic gel
- using gas and air (entonox), which is a painkiller that’s breathed in
- using painkillers applied directly onto the wound in a gel (topical opioids).
Bleeding can be caused if the tumour damages (ruptures) small blood vessels. Many people can feel alarmed by the sight of blood. However, it’s common for fungating wounds to ooze blood. It is important to tell your doctor or nurse if you notice bleeding, or a change in the amount of bleeding. This will allow them to take action to reduce or stop it.
Dressings that don’t stick, or using a non-stick inner dressing with a removable outer dressing, can help to reduce bleeding.
Other things that may help include:
- applying pastes onto the wound, such as sucralfate
- using dressings such as aquacel, which are easy to remove (wetting this dressing can also help to remove it). For wounds that are bleeding heavily, you can use surgical dressings which help stop bleeding (haemostatic dressings).
Also, applying a drug, such as adrenaline or tranexamic acid, to the area for short periods may help stop bleeding.
Itching can be an ongoing problem. It’s caused when the skin is stretched and nerve endings are irritated. Unfortunately, this type of irritation doesn’t tend to respond well to tablets that normally help to relieve itching, like antihistamines.
However, things that may help to relieve the itching are:
- TENS machines (transcutaneous electrical nerve stimulation), which stimulate the nerves reaching the brain and makes the body release its own painkillers (endorphins)
- dressings which keep the skin well hydrated, called hydrogel sheets creams, such as menthol in aqueous cream. If you are allergic to any dressings or adhesives, it’s important to let your nurse or doctor know as this may be a cause of itching.