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 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, depending on the volume of leakage. Dressings containing medical grade honey (Activon®) can also help to prevent bacteria growing in fungating wounds. Charcoal dressings can help filter any smell.
Antibiotics can help control any infection that may be present in the wound, which can help to reduce the smell. Applying antibiotic gels directly on to the wound can also help.
People often feel self-conscious about an unpleasant smell, particularly when in company. Air fresheners, odour neutralisers, environmental air filters and aromatherapy oils can help disguise unpleasant smells and help people feel more comfortable with friends and family. A few drops of an odour neutraliser such as Nildor® can also be applied to the outer layer of the dressing when it is changed. However, make sure the odour neutraliser 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 keep the pain away. Your doctor or nurse 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 on to 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 non-stick inner dressings with removable outer dressings, can help reduce bleeding. Other things that may help include:
- applying pastes on to the wound, such as sucralfate
- using fibrous dressings such as Aquacel®. It’s best to wet these dressings before removing them, especially where the dressing is in contact with the wound edges. This makes the dressing easier to remove and helps to prevent bleeding around the wound edges.
For wounds that are bleeding heavily, you can use surgical dressings that 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 relieve itching, such as antihistamines. However, things that may help relieve the itching are:
- TENS (transcutaneous electrical nerve stimulation) machines, which stimulate nerves that carry non-painful messages to the brain (overriding and stopping the pain messages). TENS machines can also make the body release its own painkillers (endorphins)
- dressings that 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.