An ulcerating cancer wound is when a cancer that is growing under the skin breaks through the skin and creates a wound. Doctors sometimes call them fungating cancer wounds. It can be a distressing problem to cope with, but there are different treatments and ways to manage the symptoms.

When the cancer grows, it blocks and damages tiny blood vessels. This can reduce the supply of oxygen to the area. This causes the skin and the tissue underneath to die and the wound may become infected and ulcerated.

Ulcerating wounds are rare and most people with cancer will never develop one. It is more likely to happen in breast cancer, head and neck cancer and melanoma. This is because these cancers develop close to or on the skin.

An ulcerating wound can develop in the area where the cancer started (primary site) or a part of the body the cancer has spread to (secondary site).

The most common symptoms are:

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

An ulcerating wound is caused by cancer. So treatments that shrink the cancer may also reduce the wound and improve the symptoms.

Treatments will depend on the type of cancer, the part of the body affected and how advanced the cancer is. Commonly used treatments include radiotherapy, chemotherapy, hormonal therapy and surgery or a combination of these. Your doctor will talk to you about which treatment is best for your situation.

Radiotherapy

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells while doing as little harm as possible to normal cells. It can help shrink the tumour and may reduce the amount of leakage, discharge or bleeding from the wound. You may find your symptoms become worse straight after radiotherapy. Your skin in the surrounding area may also become dry and red. These side effects are usually temporary, and should begin to improve after a couple of weeks.

Chemotherapy

Chemotherapy uses anti-cancer drugs to destroy cancer cells. It's used to help shrink the tumour and reduce any symptoms.

Electrochemotherapy

This helps to control the growth of the cancer and the ulcerating wound. Chemotherapy is injected either directly into the tumour area or into the bloodstream. An electric pulse is then used to help the chemotherapy get inside the cancer cells. Once inside the cancer cells, the chemotherapy destroys them.

Electrochemotherapy may also help control bleeding, pain and discharge from ulcerating wounds. The treatment can be repeated if needed.

Your doctor or specialist nurse will be able to give you more information about this treatment if it’s suitable for you.

Hormonal therapy

Some cancers, such as breast cancer, can be encouraged to grow by certain hormones. Hormonal therapies reduce the level of hormones in the body or block their action. This can help slow the growth of the cancer and help improve symptoms.

Surgery

Depending on the size and position of the tumour, it may be possible to remove part or all of it with an operation. Because ulcerating wounds often cause damage to blood vessels, there can be a risk of bleeding and 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 and help improve symptoms, it is unlikely to heal completely.

Your specialist cancer nurse, district nurses and specialist nurses in wound care (often called tissue viability nurses) may be involved in supporting you. They will advise you how to care for the wound and explain how the symptoms can be controlled. Your nursing team will help you to manage the wound so that it doesn’t prevent you from getting on with your day-to-day life.

Leakage

Leakage or discharge is probably the most common symptom of an ulcerating wound. It often happens because of infection. Your nurse will usually suggest an absorbent dressing with additional padding to help with this problem.

Some wound dressings can be left in place for a number of days, depending on the amount of leakage and where the wound is. Sometimes only the top layer of the dressing needs to be changed.

Your nurse will explain the type of dressing you need and how often it should be changed. Your district nurse or practice nurse may change the dressing for you.

You may find it useful to have extra supplies of dressings, especially for holidays, or have pads that help protect your bed at night.

The discharge or leakage from the wound may make the healthy skin around it sore and red. It's usually helpful to apply a barrier film or cream, such as Cavilon™, around the wound to protect the skin. Your nurse can advise you on this.

Your nurse may suggest showering with warm water to help you clean the wound. This can also reduce the smell. It can help you to feel better as well. It is important to ask your specialist nurse if showering is advised in your situation as it’s not suitable for everyone.

Unpleasant smell

An unpleasant smell is a common symptom. It can be distressing and difficult to cope with. But there are ways that it can be improved and managed. Sometimes the smell is caused by an infection in the wound.

Your nurses can use different dressings to help control the smell. Some dressings contain silver, which reduces the number of bacteria in the wound. These dressings can often be left in place for a number of days. Dressings containing a medical form of honey can also help to prevent bacteria growing in the wound.

Your nurse may suggest charcoal dressings to help filter any smell. For these to work well, it’s important that there is a good seal around the edge of the dressing.

If there is an infection in the wound, anti-biotics can help control it and reduce the smell. Applying anti-biotic gels directly on to the wound can also help.

You may feel self-conscious about an unpleasant smell, particularly when you are with other people. Air fresheners, odour neutralisers, environmental air filters and aromatherapy oils can help disguise smells so you feel more comfortable with friends and family.

Pain

Pain can be caused by the tumour damaging nerves or by dressings sticking to your skin. There are different things that can be done depending on the cause.

Different painkillers can be used. Taking them regularly is more helpful, as this helps keep the pain away. Your doctor or nurse can give you advice about the best painkiller to use. If the pain isn’t controlled, let them know. They can adjust the dose or try a different painkiller.

If the pain is worse when dressings are changed, let your nurse know. They can use a different dressing that is more suitable for you. They may suggest you 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 or painkiller gel
• using gas and air (entonox), which is a painkiller you breathe in.

Bleeding

The wound may bleed if the tumour damages the small blood vessels. You may feel alarmed by the sight of blood but this is a common symptom. It is important to tell your doctor or nurse if you notice any bleeding, or a change in the amount of bleeding. They may suggest using dressings or drugs to reduce or stop the bleeding.

Dressings that don’t stick or non-stick inner dressings, such as soft silicone, 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.
• Using non-fibrous dressings, such as Biatain^® Alginate dressing.

If the wound is bleeding heavily, your nurse may suggest dressings that help stop bleeding (haemostatic dressings). They may also suggest applying a drug such as adrenaline or tranexamic acid to the area for short periods, which may help stop bleeding.

Itching

Itching is caused when the skin is stretched or the nerve endings are irritated. This type of itching doesn't usually respond well to tablets that are normally used, such as anti-histamines. Other things that may help relieve itching include:

• dressings that keep the skin well hydrated, called hydrogel sheets
• moisturising creams, such as E45
• menthol in an oil-based product
• cotton bedding and clothing.

If the itching continues, your doctor or nurse may suggest using a TENS (transcutaneous electrical nerve stimulation) machine. TENS machines stimulate nerves that carry non-painful messages to the brain (overriding and stopping the pain messages). They can also make the body release its own painkillers (endorphins).

If you are allergic to any dressings or adhesives, it's important to tell your nurse or doctor as this may be a cause of itching.

Keeping dressings in place

Sometimes the wound may be in an awkward position – for example, in the armpit. This can make it difficult to find the right size and shape of dressing, and the best way of securing it. You may find the following ways of holding the dressing in place helpful:

• Using clothing bandages – for example Tubifast™, Comfifast™ and Skinnies WEB™. Your nurse can give you more information about these.
• Wearing Lycra^® clothing, such as crop tops, t-shirt vests or cycling shorts, to help keep a dressing in the right position under clothing.

You may feel anxious, embarrassed or depressed because of the wound. Some people feel isolated and worry about leaving the house. It’s important to remember that you will be much more aware of the wound than other people.

How you think and feel about your body (body image) may change. You may also worry about the effects on your close relationships. We have a booklet called Body image and cancer that explains different types of support and has suggestions about what you can do.

Talk to your family and close friends about how you feel. They can listen and give you support. You may also find it helpful to talk to your doctor or nurse for support or more specialised help if you need it.

Support groups, counselling and complementary therapies, such as relaxation and aromatherapy, can also be helpful. Our cancer support specialists can give you details of support organisations and counselling services in your area.