Ulcerating cancer wounds
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.
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. Most people with cancer 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 (the primary site)
- a part of the body where the cancer has spread to (a secondary site).
An ulcerating wound is caused by cancer. Treatments that shrink the cancer may also reduce the wound and improve the symptoms.
The treatment you have will depend on:
- the type of cancer
- the part of your body that is affected
- the type and size of the cancer and whether it has spread (the stage of cancer)
Your doctor will talk with you about which treatment is best for your situation.
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. Straight after the radiotherapy, you may find your symptoms become worse. Your skin in the surrounding area may also become dry and red. These side effects are usually temporary and should start to improve after a couple of weeks.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It is used to help shrink the tumour and reduce any symptoms. It may take some time before any effects of chemotherapy are seen on the wound.
Electrochemotherapy is a combination of chemotherapy and a small electrical current. It can help to control the growth of the cancer. It may reduce bleeding, pain and discharge from an ulcerating wound. A low dose of chemotherapy is injected into the tumour or into a vein (intravenously). An electrical pulse is then given directly to the cancer cells using an electrode. The electrical pulse helps the chemotherapy get into the cancer cells. Once inside the cancer cells, the chemotherapy destroys them. The treatment can be repeated if needed. Electrochemotherapy is not widely available. Your doctor or specialist nurse can give you more information about this treatment if it is suitable for you.
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 slow the growth of the cancer and help improve symptoms. It may take some time before any improvement is seen with the wound.
Depending on the size and position of the tumour, it may be possible to remove part or all of it with an operation. You may need a skin graft. This is when skin is taken from another part of the body to cover the area where the tumour was removed. Because ulcerating wounds often cause damage to blood vessels, there can be a risk of bleeding and an operation is not always possible. Your doctor can discuss with you whether surgery is an option.
Ulcerating cancer wounds are very difficult to heal completely. Cancer treatments may help reduce the size of the wound, but the main aim of treatments is to improve symptoms.
Who can help?
If you have an ulcerating cancer wound, you will usually be supported by a team of nurses. This will include:
- your specialist cancer nurse
- district nurses
- specialist nurses in wound care (often called tissue viability nurses).
They will give you advice about how to care for the wound and explain how the symptoms can be controlled. The nursing team will help you to manage the wound so that you can get on with your day-to-day life.
The nurses will be able to answer any questions you have about the wound. They can also help you cope with the symptoms. They may give you a supply of dressings or creams to keep at home. You should only use dressings or creams that are given to you or recommended by the nurses. Always check with the nurses before using anything else.
You may be referred to a specialist palliative care team for advice. The team is made up of people who are experts in managing symptoms. There are palliative care teams based in hospitals, hospices and the community.
Leakage or discharge is probably the most common symptom of an ulcerating wound. It often happens because of an infection in the wound.
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 several 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. You may also find it useful to use special pads on your bed if the wound leaks at night.
The discharge or leakage from the wound may make the healthy skin around it sore and red. A barrier cream can be used to help protect the skin. The nurses may give you a cream to use, or advise you about the best one to buy.
Your nurse may suggest showering with warm water to help you clean the wound. This can also reduce any smell. It can help you to feel better as well. Showering is not suitable for everyone. It is important to ask the nurses if you can shower your wound. They can give you advice about shower gels and soaps.
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. Reducing bacteria in the wound may help improve the smell. These dressings can often be left in place for several days. Dressings containing a medical form of honey can also help prevent bacteria growing in the wound
Your nurse may suggest charcoal dressings to help filter any smell. For these to work well, it is important that there is a good seal around the edge of the dressing.
If there is an infection in the wound, antibiotics can help control it and reduce the smell. Applying antibiotic gels directly onto the wound can also help.
You may feel self-conscious about a smell, especially when you are with other people. There are ways to disguise smells, so you feel more comfortable with friends and family. These include:
- air fresheners
- odour neutralisers
- environmental air filters
- aromatherapy oils.
Do not put them on the wound, dressings or clothing. You should follow the instructions on the packaging. Or your nurse can give you more advice about the best way to use these products.
The tumour may damage nerves and cause pain. Or it may be painful if the dressings stick to your skin. There are different things that can help.
You can use different painkillers. It is more helpful if you take the painkillers regularly, as this helps control the pain. Your doctor or nurse can give you advice about the best painkiller to use. If you feel the painkiller is not helping, let them know. They can change the dose or try a different painkiller.
If the pain is worse when dressings are changed, tell your nurse. They may be able to 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 while the dressing is being changed.
If the pain becomes worse, talk to your doctor or nurse. You may have an infection in the wound. They can look at the wound and prescribe antibiotics if needed.
The wound may bleed if the tumour damages the small blood vessels. You may feel alarmed if you see 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.
Bleeding is sometimes caused by dressing changes. Non-stick dressings or dressings that have a non-stick inner with a removable outer dressing, can help reduce bleeding caused by this.
Your nurses may also suggest using dressings to reduce or stop the bleeding. These include:
- applying a paste called sucralfate to the wound – sucralfate can reduce bleeding from ulcers and wounds
- using dressings which form a gel once in contact with the wound – the gel can help to prevent bleeding and absorb blood.
They may also suggest applying a drug such as adrenaline or tranexamic acid to the area for short periods
You may have itching around the wound. This can happen if the skin is stretched, or the nerve endings are irritated. Tablets such as antihistamines, which are normally used for itching, do not work very well for this. But the itching may be relieved by:
- 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 itching does not improve, your doctor or nurse may suggest using a TENS (transcutaneous electrical nerve stimulation) machine. A TENS machine stimulates nerves that carry non-painful messages to your brain. It is thought that TENS may work by blocking messages from being carried along the nerves to the brain. They can also make the body release its own painkillers (endorphins).
If you are allergic to any dressings or adhesives, it is important to tell your nurse or doctor as this may cause itching.
Keeping dressings in place
The wound may be in an awkward position, for example in your armpit. This can make it difficult to find the right size and shape of dressing, and the best way of securing it. You could try the following ways of holding the dressing in place:
- 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. This helps to 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 is important to remember that you will be much more aware of the wound than other people.
How you think and feel about your body (your body image) may change. You may also worry about the effects on your close relationships. We have more information about body image and cancer that explains the types of support you can get 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 (0808 808 00 00) can give you details of support organisations and counselling services in your area.
Below is a sample of the sources used in our ulcerating wounds information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
National Institute of Clinical Excellence (NICE). Malignant skin ulcer. Clinical Knowledge Summaries. Last revised March 2021. Accessed January 2020. Available here: cks.nice.org.uk/topics/palliative-care-malignant-skin-ulcer
National Institute of Clinical Excellence (NICE). Electrochemotherapy for metastases in the skin from tumours of non-skin origin and melanoma. Interventional procedures guidance (IPG446). Published March 2013. Accessed January 2020. www.nice.org.uk/guidance/ipg446
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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