There are many ways of looking after an ulcerating tumour, including different types of dressing and ways to control the symptoms of the wound.
You will need specialist help to look after an ulcerating tumour.
Some nurses specialise in wound care. They can recommend the most suitable dressings for 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’re facing. They can often help with things you don't feel comfortable discussing with your doctor.
Or they might just be a listening ear, especially if you don’t feel like talking through such personal issues with your friends and family.
Looking after your tumour
Different types of dressing are suited to different types of wounds and problems. The type of dressing you need could 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’s safe to leave modern dressings in place for more than one day. But how long 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 and honey 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. They will know all the products on the market and be able to pick to right ones for you.
How often you need to have your dressing changed will depend on your own circumstances.
If you’re living at home, you might 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’re in hospital, the nurses there will do your dressings.
You could find having your dressing done very stressful and the sight of the wound might upset you. So you might want to distract yourself by watching television. Or you might prefer to practice relaxation techniques such as visualisation or hypnotherapy.
There are products that help to make the sticky part of the dressing easier to remove, so it's less sore.
Tell your nurses if you’re worried about having your dressing changed. They will do all they can to make it as easy as possible for you.
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.
It might be necessary to clean the wound and change the dressings frequently. But this could damage the fragile skin around the wound.
So your nurse might recommend soft silicone dressings which cause very little damage to the skin. There are also barrier products that you spray or paint on to help protect surrounding healthy skin.
Your skin will be particularly delicate if you have had radiotherapy to the area, or if you have any swelling caused by the tumour's growth.
In this case it might 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 shouldn’t 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’s important that your dressing is absorbent and held firmly in place.
Not all ulcerating tumours are painful. But if yours is painful, it’s very important that your doctor or nurse assesses your pain. Then you can get the right painkillers (analgesia).
The type of pain you have will depend on where the wound is. With a tumour that's pressing on nerves, you might feel pain in other parts of your body as well. This is called referred pain.
Ways of controlling pain
You might 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. But this may not be suitable for very wet wounds.
Your doctor might suggest an extra dose of painkillers beforehand if changing your dressing is very painful. Or in hospital, you could breathe in a gas called nitrous oxide (Entonox) during the dressing change. This gas isn’t 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 to reduce pain.
The smell might be the most distressing symptom of an ulcerating tumour. It can also be upsetting for your family and friends.
The smell could 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 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 might 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 reduce the wound’s odour:
- Some dressings 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.
- Honey dressings 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 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’re having your dressing changed, you might be worried about the smell of the wound upsetting people around you. It’s important to try to relax. Remember that your nurses will have done this many times before.
Things that can help
The nurses might have a deodorising spray they can use around your bed before doing the dressing. Some of these do help. Or if you don't like the deodorant smell, you might prefer essential oils or an air filter.
You might be able to have your dressing changed in a room away from other patients or your family.
It can 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.
Bleeding is common with these wounds as the blood vessels in the area become very fragile.
The bleeding may be difficult to control. It might be worse if you have a a low platelet count because of your cancer treatment. Platelets help to clot blood and control bleeding.
Non stick dressings are very important in helping to prevent bleeding during a dressing change.
It’s best to clean the wound with a gentle flow of warm saline or water. Don't rub, dab or squirt water from a syringe with any force onto the wound. 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
- 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
With excessive bleeding, your doctor might refer you to a vascular surgeon. These doctors specialise in surgery to blood vessels. They might 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 to ring if you're 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're 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 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.
These other treatments can also help:
- Moisturising cream around the wound can help to reduce itching and make it more comfortable.
- Dressings that keep the area well hydrated, called hydrogel sheets, can help to reduce itching.
- Anti depressant tablets such as paroxetine could help to reduce itching. But they can cause side effects, so your specialist might try other treatments first.
- Clothing you wear next to your skin can make a difference to itching. Pure cotton (100 percent) can feel softer. Silk undergarments designed to help control body heat and moisture can also help with itching.
- TENS (Transcutaneous Electrical Nerve Stimulation). Small pads are stuck onto the skin and they release a small electrical charge. By stimulating the nerves that run up the spine to the brain, TENS blocks nerves carrying the itching messages.
Having a wound like this can make you feel very depresed and anxious about going out or being with other people.
You might 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.
You can find information about how to deal with the emotional distress of these wounds in our section on living with an ulcerating tumour.