A fungating tumor is a cancer that has broken through the skin and become an open wound, rather than a wound that a cancer happens to sit under. Because the cancer keeps growing in the wound, it usually does not heal the way a cut or ulcer would. Still, a lot can be done to make it smell less, leak less and bleed less, and for many people treatment can shrink it. Much of the daily care often falls on family at home, so knowing what helps matters as much as understanding the cause.
Why Cancer Breaks Through the Skin
The wound forms when a tumor pushes out through the skin. At the same time, the cancer grows new blood vessels, has patches of dying tissue, and stays inflamed.1Journal of Pain and Symptom Management. When a Wound is More Than a Wound That mix explains the main problems people notice. The new vessels are fragile and bleed easily, the dead tissue smells, and the inflammation makes fluid and pain.
Early on, it may look like a firm lump or a hard patch of skin that reddens and then breaks open. Once open, it can grow outward like a cauliflower or inward like a crater. It may weep fluid or bleed slightly before anyone realizes what it is. Telling the cancer team early gives more treatment options.
It is most likely with melanoma and other skin cancers, breast cancer, and head and neck cancer, because these tumors grow close to the skin.2Cancer Research UK. What are fungating tumours (ulcerating cancers) It can happen with many other cancer types, especially when the cancer is advanced.3The Ohio State University Comprehensive Cancer Center. Management of Fungating Wounds It can also appear where a cancer has spread to the skin from somewhere else.
Poor hygiene does not cause it. The wound comes from the cancer, not from anything the patient or a carer did. Good care controls symptoms but cannot by itself stop the wound forming.
A pressure sore or leg ulcer starts as a problem with skin and circulation, and it can heal once the cause is fixed. A fungating wound starts from the cancer underneath, so cleaning and dressings alone cannot make it close. A wound on a known cancer site that does not improve with ordinary care should be shown to the cancer team.
Can It Heal, and What Treatments Shrink It
Radiotherapy aimed at the wound met its goal, usually easing ulceration, in about 84% of treated patients at one cancer center.4PubMed Central. Radiotherapy in the treatment of malignant fungating wounds: clinical practice, response rates, and outcome from a tertiary cancer center It helps many people but not everyone.
Radiotherapy to a wound is usually given as a short course of outpatient visits, each lasting only minutes on the treatment table. The aim is to shrink the tumor, which can reduce bleeding, fluid and smell. The benefit builds over days to weeks, so the wound may look no better early on. The treated skin can become sore or red for a while, and the radiotherapy team can advise on caring for it.
Other treatments are being tested too. A medicated solution applied to the skin slowed growth of shallow breast-cancer skin lesions, with treatment lasting a median 56 days versus 21 days on a dummy treatment.5PubMed Central. Topical agents and dressings for fungating wounds Chemotherapy, hormone treatment or surgery may also shrink the tumor if the cancer responds, which the oncology team decides. For most people, though, the realistic aim is a cleaner, less painful, less smelly wound rather than full healing.
Comfort-focused wound care is not giving up. It can run alongside cancer treatment, and controlling smell and leaking can let someone go out and see people again.
Useful questions for the cancer team: Is radiotherapy to the wound an option, and how many sessions would it take? Might the current cancer treatment shrink it? Who should you call for dressing advice between appointments? Can a palliative care or specialist wound nurse be involved?
Controlling the Smell
Bacteria that thrive without oxygen in dead tissue release fatty acids with sour, cheesy, vomit-like and foot-like smells.6PubMed Central. The Microbiome, Malignant Fungating Wounds, and Palliative Care A sulfur compound adds to the odor and is not tied to one particular germ.7PubMed Central. The Microbiome, Malignant Fungating Wounds, and Palliative Care The smell becomes pungent when these mix with the same breakdown products behind the smell of decay.8PubMed Central. The Microbiome, Malignant Fungating Wounds, and Palliative Care
Metronidazole gel, an antibiotic applied directly to the wound, has the strongest evidence for controlling smell.9PubMed. Malignant Fungating Wounds in Advanced Cancer: Pathophysiology, Odor Control, and Dignity-Centered Management Salt-impregnated dressings, activated charcoal dressings and curcumin ointment have some supporting evidence.10PubMed. A systematic review of topical treatments to control the odor of malignant fungating wounds Foam dressings containing silver reduced smell in more people than plain foam dressings.11PubMed Central. Topical agents and dressings for fungating wounds Cadexomer iodine and Manuka honey are newer options that may break up bacterial films.12PubMed. Malignant Fungating Wounds in Advanced Cancer: Pathophysiology, Odor Control, and Dignity-Centered Management Soaking or rinsing with a mild antiseptic cleanser containing PHMB can also cut odor by disrupting bacteria.13NHS Forth Valley. Guidelines for the Management of Malignant Wounds M:EMPHIS PATHWAY
Metronidazole gel is usually tried first because it targets the bacteria that cause the odor. Charcoal, silver or honey dressings are often added or substituted if the smell persists. The best choice depends on how much fluid the wound makes and where it sits, since the dressing must stay in place. It often takes some trial and error, so tell the nurse what has and has not worked.
At home, change dressings on a schedule rather than waiting for odor to break through. Seal used dressings in a bag and take them outside promptly. An air purifier or an open window helps more than strong perfumes, which can mix unpleasantly with the smell.
A new or much stronger smell can signal infection. Report it rather than just adding more dressings, because the wound may need a different treatment.
Managing Fluid and Dressings
Wound fluid can be heavy. Controlling it depends mainly on how well the dressing fits and how much it absorbs.14PubMed. Exudate management in fungating wounds Superabsorbent silicone dressings kept fluid inside the dressing in about 92% of checks, with the rest leaking and none damaging the skin.15Wounds International. Management of Malignant Cutaneous Wounds Using Silicone Superabsorbent Dressings: A Quality Improvement Project Case Series If dressings keep leaking, a different size or type is usually needed rather than more layers.
A dressing should extend well beyond the wound edges so fluid cannot reach the skin before the dressing is full. Very wet wounds need highly absorbent dressings, while drier ones need something that keeps the surface moist. Wounds on awkward areas such as the breast fold, neck or face may need shaped dressings or special tapes. The nurse can adjust the choice as the amount of fluid changes.
Fluid on healthy skin can make it sore and broken. Barrier creams or films from the nurse help, and silicone dressings come off more gently, with less bleeding and pain.
For a dressing change, gather everything first, and give pain relief beforehand if advised. If the old dressing is stuck, soak it off rather than pulling. Rinse gently, pat the skin dry around the wound, and apply the new dressing. Note any changes in size, smell or bleeding so you can report them.
Cleaning the Wound Without Making It Bleed
Gentle rinsing with salt water or tap water is preferred over scrubbing, which can cause bleeding.16Wound Practice and Research. Managing a malignant wound in palliative care Cutting away dead tissue is not advised because of the high risk of bleeding.17NHS Forth Valley. Guidelines for the Management of Malignant Wounds M:EMPHIS PATHWAY Instead, letting dead tissue soften and loosen under a moist dressing is the preferred approach.18NHS Forth Valley. Guidelines for the Management of Malignant Wounds M:EMPHIS PATHWAY This can increase wound fluid, so it is balanced against how much the wound already leaks.19Wound Practice and Research. Managing a malignant wound in palliative care Common mistakes include using cotton wool, which leaves fibers in the wound, scrubbing to remove dead patches, and using strong antiseptics without a nurse’s advice.
What to Do When It Bleeds
Bleeding often happens because tumor cells wear into blood vessels, and some people also have clotting problems.20Dragonfly Health. Managing Bleeding Fungating Wounds/Tumors Blood-thinning medicines may be reviewed and stopped where possible.21Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline Gentle firm pressure is the first step for any oozing.
Use a clean, non-stick dressing or cloth and press firmly and steadily over the bleeding point, firm but not so hard that it causes pain. Keep pressing without lifting to look, since checking often breaks up the clot that is forming. If blood soaks through, add more layers on top rather than removing the first one.
Nurses and doctors have several options. Alginate dressings that help blood clot are a first-line choice.22Right Decisions. Fungating tumours in palliative care in adults Gauze soaked in tranexamic acid, a medicine that helps clots hold, can be pressed on for 5 to 10 minutes.23Dragonfly Health. Managing Bleeding Fungating Wounds/Tumors Gauze soaked in adrenaline for about 10 minutes helps minor bleeding by tightening vessels.24Right Decisions. Fungating tumours in palliative care in adults Gelatin sponges with thrombin can stop mild to moderate bleeding within about 10 minutes.25Dragonfly Health. Managing Bleeding Fungating Wounds/Tumors If these fail, sucralfate paste is tried.26Right Decisions. Fungating tumours in palliative care in adults
When bleeding is heavy or other treatments fail, a radiologist can thread a catheter into the vessel and block it, which has stopped life-threatening bleeds from breast tumors.27PubMed Central. A Case of Life-Threatening Bleeding Due to a Locally Advanced Breast Carcinoma Successfully Treated with Transcatheter Arterial Embolization Radiotherapy is another option for ongoing bleeding.28Right Decisions. Fungating tumours in palliative care in adults
Call for help if bleeding soaks through dressings despite pressure, if it returns every day, or if the person seems dizzy or pale. It helps to agree in advance with the team who to call out of hours.
Preparing for a Major Bleed Near the End of Life
Catastrophic bleeds are rare, but wounds in the neck near the carotid arteries or in the groin near the femoral arteries are most likely to cause them.29Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline A possible fatal bleed should be discussed openly with the patient and recorded in their care plan.30Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline The chance is low for most wounds, and knowing the plan reduces panic.
The team may prescribe a calming medicine called midazolam, 10mg given inside the cheek, that family can give and repeat after 10 minutes if needed.31Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline Dark towels soak up and hide blood, which lessens the shock for everyone.32Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline During a bleed, stay with the person, reassure them, apply pressure and keep them on their side to protect breathing.33BMJ Supportive & Palliative Care. Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care Afterward, cleaning services and bereavement support can help the family.34Great Western Hospitals NHS Foundation Trust. Management of Bleeding Malignant Fungating Wounds in Palliative Care Patients in the Hospital and Community Guideline
Sometimes a smaller bleed comes before a larger one, which gives a chance to act. Any unexpected bleed from a wound near the neck or groin should be reported promptly, and the team may use it to revisit the plan and the supplies at home.
Telling Infection Apart From Normal Wound Changes
Bacteria being present is not the same as infection; infection means the body is reacting.35Wound Essentials. Understanding wound infection and colonisation Increasing pain and the wound breaking down are two of the most reliable signs.36Wound Essentials. Understanding wound infection and colonisation Redness spreading more than about 2 cm, pus, a deeper or softening wound base, and fever point to more serious infection.37Podiatry Today. How To Differentiate Between Infected Wounds And Colonized Wounds In people on chemotherapy or steroids, signs can be muted.38Wound Essentials. Understanding wound infection and colonisation
Some fluid, a little odor and mild surface redness are common in fungating wounds even without infection. A change from the person’s baseline is more useful than a single observation, and a wound that has looked the same for weeks is less worrying than one that changes quickly.
Take photos to compare day to day. Report fever or spreading redness the same day. Antibiotics by mouth may be needed beyond wound gels.
Coping and Getting Support
A smelly wound can bring depression, shame, embarrassment and a changed body image, sometimes leading to isolation.39PubMed. Psychological and physical care of malodorous fungating wounds People also report a lack of information and advice on managing the wound.40PubMed. Malignant fungating wounds: the meaning of living in an unbounded body
In one group of carers, all managed the wound without professional help and felt isolated and heavily burdened.41Support Care Cancer. Caring for a loved one with a malignant fungating wound Families should ask for a palliative or wound specialist nurse rather than waiting to be offered one. Ask for home nursing visits for dressing changes, written instructions and a supply plan. Let the patient choose who sees the wound. Counseling or support groups can help both patient and carer.
Partners often hold back from discussing the wound to avoid causing embarrassment. Naming the problem plainly, and asking what would help, often brings relief. Touch, closeness and normal routines can continue, and the nurse can advise on what is safe.
Be careful with unproven remedies. One case report described healing with aromatherapy oils, but a single case proves little. Check any home remedy with the nurse first, since some oils irritate fragile tissue.