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. The wounds will often look like a fungus or cauliflower. Other 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 is most likely to happen with breast cancer, head and neck cancer and melanoma. 

People often find that they have several symptoms at the same time. The most common symptoms of a fungating wound include:

• discharge
• an unpleasant smell
• pain
• bleeding
• itching.

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 which 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

Radiotherapy treats cancer by using high-energy rays which destroy the cancer 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 of the radiotherapy are usually temporary, and should begin to improve after a couple of weeks.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It is used to shrink the tumour that is causing the wound and so relieve any symptoms.

Hormonal therapy

Some cancers, such as breast cancer and prostate 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.

Surgery

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 is not always possible.

Although cancer treatments may help reduce the size of the wound, they are unlikely to heal it completely. This makes managing the wound, to improve a person’s comfort and their quality of life, very important. 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

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.

The leakage (exudate) from a wound can make the healthy skin around it sore and red. It is often helpful to apply a barrier cream (like zinc oxide) or film, to the skin around the wound to protect it.

Unpleasant smell

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.

Often people 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.

Pain

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 is not being controlled let your doctor or nurse know so that they can 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 which may help are:

• using non stick dressings
• soaking the dressing off slowly
• using a local anaesthetic gel
• using gas and air (entonox)
• using painkillers applied directly onto the wound in a gel (topical opioids).

Bleeding

Bleeding can be caused if the tumour damages (ruptures) small blood vessels. Many people can feel alarmed by the sight of blood. However, it is common for fungating wounds to ooze blood. It is important to tell your doctor or nurse if you notice bleeding, or an increase/decrease 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 nonstick 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 called alginates.

For wounds that are bleeding heavily, surgical dressings which help stop bleeding (haemostatic dressings) can be used. Applying a drug called adrenaline to the area for short periods, can help to stop bleeding. If bleeding is non-stop, it may be possible to surgically stop the bleeding, but this is rarely done.

Itching

Itching can be an ongoing problem. It is caused when the skin is stretched and nerve endings are irritated. Unfortunately, this type of irritation does not tend to respond well to tablets that normally help to relieve itching, like antihistamines. However, things which 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 then it is important to let the nurse or doctor know as this may be a cause of itching.

Sometimes one of the most difficult things to deal with is where the wound is situated. Wounds can appear in awkward positions (for example in the armpit) and so make it difficult to find the right size and shape of dressing, and the best way of securing it. In these situations trying different ways of holding the wound dressing in place can be helpful.

Close fitting garments like crop tops, running vests, tight T-shirts or cycling shorts can be helpful as they hold the dressing in the right position yet are comfortable and easily washed and dried (those made with lycra are good for this).

You may also find it useful to have extra supplies of dressings, especially at holiday times, or have pads that protect your bed at night.

Fungating cancer wounds can cause many feelings, including anxiety, embarrassment and depression. Many people feel isolated and worry about leaving the house. They may be worried or embarrassed if they have a wound that affects their outward appearance, or if the wound has an unpleasant smell. It can also be demanding on relationships as people can feel very aware of the wound on their body.

You will probably be much more aware of the wound than other people, so speak to your nurse about the most acceptable way to dress it comfortably. Some people find complementary therapies such as, relaxation, or aromatherapy helpful. Others find it helpful to talk things over with their doctor or nurse. Close friends and family members can also offer support. Our cancer support service nurses can give you details of support organisations and counselling services in your area.

This section is based upon our Fungating cancer wounds factsheet which has been compiled using information from a number of reliable sources, including:

• Oxford Textbook of Palliative Care (3rd edition) Eds. Doyle et al. Oxford University Press, 2004.
• Handbook of Palliative Care (2nd edition) Faull et al. Blackwell Publishing, 2005.
• Handbook of Wound Management in Cancer Care Eds. Naylor et al. Science, 2001.

For further references, please see the general bibliography.