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Looking after ulcerating tumours

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This page is about looking after an ulcerating tumour. You can find information on

 

Who can help you

If you have an ulcerating tumour, you will need specialist help in looking after it. Some nurses specialise in wound care. They can recommend the dressings best suited to the size and position of your wound. Feel free to ask your nurse any questions. They are there to help and will be very sensitive to your feelings and the difficulties you are facing. They can often help with things you don't feel comfortable discussing with your doctor. Or they might just be an ear to listen, especially if you do not feel like talking through such personal issues with your friends and family.

 

Types of dressings

There are many different types of dressing that are suited to different types of wounds and problems. The type of dressing you need may change as your wound changes. The ideal dressing keeps a wound clean and moist, but not wet. It should absorb any oozing from the wound but not stick to it. Dressings that leave fibres or particles in the wound are not good because that can irritate and may cause infection. It is safe to leave modern dressings in place for more than one day. But the length of time a dressing can be left in place depends on the type of wound and the amount of ooze (exudate). Some people do prefer to have a fresh daily dressing.

Foam dressings, soft silicone dressings and super absorbent dressings can be best for wounds that ooze a lot. There are also dressings made from seaweed, called alginate dressings. These absorb moisture and turn into a soft gel. Some contain clotting agents to help stop bleeding. Charcoal backed dressings can help to stop any smell coming through the dressings, when they are fitted well enough to seal off the wound. Silver dressings help to fight the bacteria which can cause smells. You really need the advice and guidance of a specialist nurse, who will know all the products on the market and be able to pick the right ones for you.

 

Having a dressing changed

If you are at home, you may need to go to your GP's surgery so that the practice nurse can change your dressing. Or a district nurse can visit you at home to change the dressing. If you are in hospital, the nurses there will do your dressings. You may find having your dressing done very stressful, and the sight of the wound may upset you. You may want to distract yourself by watching television. Or you may prefer to practice relaxation techniques such as visualisation or hypnotherapy. How often you need to have your dressing changed will depend on your own circumstances. 

There are some products available that help to make the sticky part of the dressing easier to remove. So this should help to make dressing removal less sore. 

If you are worried about having your dressing changed, let your nurses know. They will do all they can to make it as easy as possible for you.

 

Controlling oozing

Liquid can ooze or weep from ulcerating tumours. This is called exudate. It can be very distressing and unpleasant, especially if it leaks through dressings and onto your clothes.

Stick on foam dressings or stick on soft silicone dressings can be best if your wound oozes a lot. Frequently cleaning the wound and changing the dressings may be necessary. But this may damage the fragile skin around the wound. Your nurse may recommend soft silicone dressings which cause very little damage to the skin. And barrier products that you spray or paint on to help protect surrounding healthy skin. 

Your skin will be particularly delicate if you've had radiotherapy to the area, or have any swelling caused by the growth of the tumour. In this case it may be better to have other sorts of dressings that can be kept in place with a bandage. A close fitting T shirt or specialist leg or arm stocking can help keep dressings in place. Your nurse can advise you on this.

Your wound should not stop you doing the things you enjoy, like going out in public. Controlling the discharge will increase your confidence and quality of life. So it is important that your dressing is absorbent and held firmly in place.

 

Pain

Not all ulcerating tumours are painful. But if yours is, it is very important that your doctor or nurse assesses your pain so you get the right painkillers (analgesia). The type of pain you have will depend on where the wound is. If the tumour is pressing on nerves, you may feel pain in other parts of your body as well as at the area of the wound. This is called referred pain.

You may need to have very strong painkillers, such as morphine. You can have morphine as a tablet, an injection into a vein or muscle or under the skin (subcutaneously). It also comes as a gel that can be spread directly onto your wound, although this may not be suitable for very wet wounds. If dressing changes are very painful, your doctor may suggest you have an extra dose of painkillers beforehand. Or while in hospital you could breathe in a gas called nitrous oxide (Entonox) during the dressing change. This is not harmful – many women use it during childbirth.

Non stick dressings are less painful to change. During and in between changes your nurse may spray the dressing with warm salty water (saline). This keeps it moist and makes the dressing easier to remove.

Some people find using complementary therapies such as visualisation and hypnosis help to reduce pain.

 

Controlling smell from the wound

If you have an ulcerating tumour, its smell may be the most distressing symptom. It can also be upsetting for your family and friends. The smell may be strong enough to make you and other people feel sick. This is a lot to deal with but a number of things can help.

The smell is caused by germs (bacteria) inside the wound. Sometimes antibiotics can help kill them off. The antibiotic usually used for this is metronidazole (Flagyl). You can take this as a tablet, have an injection into a vein in your arm, or apply it directly on the wound.

Sometimes it helps to remove some of the dead tissue and bacteria in and around the wound. This is called wound debridement. There are a number of different ways to do this. The best way, if possible, is to keep the wound covered with a dressing that keeps it moist. This allows chemicals from your body called enzymes to break down the dead tissue. Other methods of debridement may involve using surgery or maggots to remove dead tissue. There are also dressings called monofilament dressings which aim to remove dead tissue. 

A number of dressings can be put on the wound to reduce the odour. Some of these contain charcoal, which absorbs the bad smell and traps it inside the dressing. Other dressings and topical agents act to remove the source of the smell, such as bacteria. Often, silver dressings are used because silver can kill most bacteria. In the past, nurses used honey dressings and these have recently come back into use. The high sugar content stops bacteria from growing. 

Many of these dressings don't work if they get wet. This can be a problem, as ulcerating tumours often leak fluid. Alginate dressings containing honey are now available and can be used on wounds which are not oozing too much. Honey dressings are not suitable for painful wounds as they can cause a slight burning sensation.

When you are having your dressing changed, you may be worried about the smell of the wound upsetting people around you. It is important to try to relax and remember that your nurses will have done this many times before. They may have a deodorising spray they can use around your bed before doing the dressing. Some of these do help. If you don't like the deodorant smell, you may prefer essential oils or an air filter. Or you may be able to have your dressing changed in a room away from other patients or your family. It may also help to make sure the room is well ventilated. Some people find having a cat litter tray under their bed helps reduce the smell because cat litter can absorb smells.

Having a wound like this can make you feel very depressed and anxious about going out or being with other people.

You may also feel that you can’t continue with your sexual relationship because you don’t want your partner to be put off by your appearance or the smell of your wound. There is more information about how to deal with the emotional distress of these wounds in the living with an ulcerating tumour section.

 

Controlling bleeding

Bleeding is common with these wounds as the blood vessels in the area become very fragile. The bleeding may be difficult to control. If you have a low platelet count because of your cancer treatment, bleeding may be worse. Platelets help to clot blood and control bleeding.

Non stick dressings are very important in helping to prevent bleeding during a dressing change. It is best to clean the wound with a gentle flow of warm saline or water. And it is good not to rub, dab or squirt water from a syringe with any force onto the wound because this could dislodge fragile tissue and cause bleeding.

If your wound bleeds constantly, your doctor may prescribe a drug to help your blood to clot. Or your nurse can put a cream, such as sucralfate paste, directly on the wound to help control the bleeding. Silver nitrate treatment can also stop the bleeding by sealing (cauterising) bleeding areas.

If the bleeding is excessive, your doctor may refer you to a vascular surgeon. These doctors specialise in surgery to blood vessels and may be able to tie off (ligate) or seal (cauterise) the bleeding vessels.

There is a small risk that the wound could invade a larger blood vessel and make the bleeding become much heavier. Your doctor or nurses will talk to you about this possibility. This is very rare, so don’t get too worried that it’s going to happen to you. If this rare complication does happen and you are at home, it can be very frightening and it is important to get help as soon as possible. Your nurse will give you emergency phone numbers that you can ring if you are worried or need advice.

If you have an ulcerating tumour that begins to bleed and doesn’t stop within 10 to 15 minutes

  • Apply an absorbent pad or towel to soak up the blood
  • Phone for an ambulance
  • If you are alone, phone a nearby friend, relative or neighbour who can keep you company and prepare an overnight bag for you in case you need to stay in hospital
  • Try to stay calm – sit quietly, or lie down if this makes you more comfortable, while you wait for help to come
 

Itching

Itching is a common problem and can be difficult to cope with. We know from research that medicines that normally help to control itching (antihistamines) don't work with an itching wound. There are other treatments that can help including

Moisturising cream around the wound can help to reduce itching and make it more comfortable 

TENS – stands for Transcutaneous Electrical Nerve Stimulation. Small pads are stuck onto the skin and they release a small electrical charge. This causes a tingling feeling in the skin. By stimulating the nerves that run up the spine to the brain, TENS blocks nerves carrying the itching messages. 

Dressings that keep the area well hydrated called hydrogel sheets can help to reduce itching

Anti depressant tablets such as paroxetine may help to reduce itching but they can cause side effects so your specialist may try other treatments first

Clothing – the clothing you wear next to your skin can make a difference to itching. Pure cotton (100 percent) can feel softer. Silk under garments designed to help control body heat and moisture may also help with itching

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Updated: 15 July 2013