Looking after fungating tumours

How often your dressing needs changing depends on your circumstances.

You might need to go to your GP's surgery so that the practice nurse can change your dressing if you are at home. Or a district nurse can visit you at home to change the dressing.

The nurses will change your dressings if you are in hospital.

Having your dressing changed can be very stressful and the sight of the wound might upset you. You can try to distract yourself by watching television. Or you can practice relaxation techniques such as visualisation or hypnotherapy.

Some products 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 try to make it as easy as possible for you.

Read about visualisation or hypnotherapy

Liquid can ooze or weep from fungating tumours. This is called exudate. It can be very distressing and unpleasant. It can be especially hard if it leaks through dressings and onto your clothes. Stick on foam dressings or stick on soft silicone dressings are best if your wound oozes a lot.

Your nurse might also apply a non sterile pad as a second layer dressing. This goes on top of the first dressing. It can help to further absorb any liquid.

It might be necessary to clean the wound and change the dressings frequently. This could damage the fragile skin around the wound. So, your nurse might recommend soft silicone dressings. These cause little damage to the skin. There are also barrier products that you spray or paint on surrounding healthy skin. It protects the 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 a dressing that you can keep in place with a bandage. You can try a close-fitting T shirt to keep it in place. A fitted garment, such as leggings, arm or leg tubes, might also work.

Your wound shouldn’t stop you from doing the things you enjoy, like going out in public. Controlling the oozing will increase your confidence and quality of life. So, it’s important that your dressing is absorbent and held in place.

Not all ulcerating tumours are painful. But if yours is painful, your doctor or nurse must assess your pain. They can prescribe you 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 your nurse can apply to your wound. But this may not be suitable for very wet wounds.

Your doctor might suggest extra painkillers before you have your dressing changed. This can be helpful if changing your dressing is very painful. In hospital, you could breathe in 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. Your nurse may spray the dressing with warm salty water (saline). They will do so during and between changes. This keeps it moist and makes the dressing easier to remove.

Some people use complementary therapies to help reduce pain. These can be:

• transcutaneous electrical nerve stimulation (TENS)

• relaxation

• distraction

• visualisation

Read more about pain control

The smell might be the most distressing symptom of a fungating 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 some things can help.

Antibiotics

Germs (bacteria) cause the smell 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, or apply it on the wound, or have it as an injection into a vein in your arm.

Wound debridement

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. There are also dressings called monofilament dressings which aim to remove dead tissue.

Your nurse might also spray (irrigate) your wound with warm saline. This helps to remove any extra liquid (exudate) and dead tissue (debris).

Other methods of debridement can be surgery or maggots to remove dead tissue. This may not be suitable for everyone. 

Odour reducing dressings

Some dressings can reduce the wound’s odour. These are:

• charcoal dressings absorb the bad smell and trap it inside the dressing

• silver dressings (silver can kill most bacteria)

• honey dressings (high sugar content stops bacteria from growing)

Many of these dressings don't work if they get wet. This can be a problem, as fungating (ulcerating) tumours often leak fluid.

Your nurse might use alginate dressings containing honey. These will be for wounds which are not oozing too much. Honey dressings are not suitable for painful wounds. They can cause a slight burning sensation.

During a dressing change, you might worry that the smell of the wound will upset people around you. It’s important to try to relax. Remember that your nurses will have done this many times before.

Other 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 smell of deodorant, 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 that cat litter granules help to reduce the smell. You can have a container with the granules under your bed. The granules absorb smells.

Bleeding is common with fungating wounds. This is because the blood vessels in the area become very fragile.

The bleeding may be difficult to control. It might be worse if you have a low platelet count because of your cancer treatment. Platelets help the blood to clot and control bleeding.

Non stick dressings help to prevent bleeding during a dressing change.

If you are changing the dressing yourself, 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. Your nurse can talk you through what to do.

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, on the wound to help control the bleeding

• silver nitrate treatment can also stop the bleeding. It can seal (cauterise) small areas of bleeding

• you might have radiotherapy to the area or electrochemotherapy

Very heavy bleeding

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 much heavier. Your doctor or nurses will talk to you about this possibility. They will put measures in place that will support you and your family should it happen. This is very rare, so don’t get too worried that it’s going to happen to you. But it is important that you tell them how you would like to be cared for should it happen.

If this rare complication does happen and you are at home, it can be very frightening. 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.

What you can do

If you have a fungating (ulcerating) tumour that begins to bleed and doesn’t stop within 10 to 15 minutes:

• apply an absorbent pad or dark coloured towel to soak up the blood

• phone for an ambulance

• if you're alone, phone someone nearby who can keep you company

• prepare an overnight bag in case you need to stay in hospital

• try to stay calm

• sit or lie down if this makes you more comfortable while you wait for help to come

Itching is a common problem with wounds and can be difficult to cope with. Research shows that medicines normally used for itching (antihistamines) don't work for wounds. Your nurse might try one or more of the following:

Moisturising cream

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

Mild steroid cream

In some situations, your doctor might suggest the use of a mild steroid cream around the wound. This can help to relieve itching.

Dressings

They keep the area well hydrated and can help to reduce itching. You might hear them called hydrogel sheets.

Clothing

Pure cotton (100 percent) can feel softer. Silk undergarments that 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. The electrical charge stimulates the nerves that run up the spine to the brain. By doing so it blocks nerves carrying the itching messages.