Ulcerating cancer wounds

Ulcerating cancer wounds develop when cancer that is growing under the skin breaks through the skin. Doctors sometimes call them fungating cancer wounds. They are rare. Most people who have cancer will never have one.

Symptoms of ulcerating cancer wounds include:

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

Treatments may include:

  • radiotherapy
  • chemotherapy
  • electrochemotherapy
  • hormonal therapy
  • surgery.

These treatments may reduce the size of the wound and improve the symptoms. It is unlikely that the wound will completely heal. Your nurse or a specialist nurse in wound care will help you manage the wound. They may use special dressings or apply creams or gels to control the symptoms.

The symptoms can be distressing to cope with, but there are different ways to manage them. It is important to remember that you will be more aware of the wound than other people. It may help to talk about your feelings to your family, friends, doctor or nurse.

What are 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. 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. 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).


Signs and symptoms of an ulcerating cancer wound

The most common symptoms are:

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


Treatment for ulcerating cancer wounds

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 the body affected
  • how advanced the cancer is.

Commonly used treatments include radiotherapy, chemotherapy, hormonal therapy and surgery, or a combination of these. Your doctor will talk with 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. 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 begin to improve after a couple of weeks.

Chemotherapy

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

Electrochemotherapy

This is a combination of chemotherapy and a small electrical current. It can help to control the growth of the cancer and 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 will be able to give you more information about this treatment if it is 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 is not always possible. Your doctor can discuss with you whether surgery is possible in your situation.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Controlling symptoms of ulcerating cancer wounds

Although cancer treatments may help reduce the size of the wound and help improve symptoms, it is unlikely to heal completely.

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 advise you 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. It is best not to use your own dressings or creams on the wound without checking them with the nurses.

The nurses will be able to answer any questions you have about the wound. They can also help you cope with the symptoms.

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 and the community.

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 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 pads to help protect your bed 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 they may advise you which is the best cream to buy.

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. 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.

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 several 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 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 an unpleasant 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.

These should not be put onto the wound or dressings.

Pain

Pain can be caused by the tumour damaging nerves. It may also be caused by dressings sticking to your skin. There are different things that can help, 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. Tell them if the pain is not controlled. They can adjust 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.

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.

Non-stick dressings or dressings that have a non-stick inner, with removable outer dressing, can help reduce bleeding.

Other things that may help reduce bleeding include:

  • applying pastes to the wound, such as sucralfate.
  • using fibrous dressings such as Aquacel®.
  • using non-fibrous dressings, such as Biatain® Alginate dressing.

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

Itching

Itching is caused when the skin is stretched or the nerve endings are irritated. This type of itching does not usually respond well to tablets that are normally used for itching, 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 machine (transcutaneous electrical nerve stimulation machine). TENS machines stimulate nerves that carry non-painful messages to the brain. This overrides and stops the pain messages. 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 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.


Your feelings

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 (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 (0808 808 00 00) can give you details of support organisations and counselling services in your area.

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