Fungating Breast Cancer: Wound Care, Relief, and Coping

A fungating, or ulcerating, breast cancer is one in which the cancerous tissue breaks through the skin of the breast. This skin can start bleeding or weeping fluid, and the tumor can cause the skin to die (turn necrotic) and get infected, resulting in a foul smell and an open wound.

Fungating tumors are rare but can occur in breast and skin cancers. They may also develop due to specific radiation treatments.

Large fungating tumors usually develop in people with advanced cancers that have spread (are metastatic) and in people not getting treatment for the tumor. But it’s not always a sign of advanced cancer. If you have an ulcerating wound, talk with a healthcare provider to get a clear diagnosis. 

Fungating tumors are relatively rare. Out of the 1 million global cases of breast cancer yearly, 10% to 30% are locally advanced. Only 2% to 5% of locally advanced breast cancers develop a fungating wound. Locally advanced cancers have spread to surrounding tissues and potentially to regional lymph nodes.

This article will describe fungating breast cancers, how to manage and care for the wound, and how life expectancy differs in this type of breast cancer from other types of breast cancer.

Appearance and Location

Despite its name, a fungating wound is not caused by nor is it a fungus. It’s a patch of skin that is dying because it no longer gets the nutrients it needs. Often, a tumor has blocked the blood vessels supplying oxygen to the area.

The ulcer looks like an open wound. It may bleed, weep, or crust over. It may develop a growth shaped like a fungus, mushroom, or cauliflower.

The common symptoms of a fungating tumor include:

• Pain and itching of the skin
• Bleeding or other discharge from the wound
• Dead or dying tissue on the surface of the skin
• A foul smell or other signs of infection

The most common location for these fungating tumors is the skin of the:

• Breast
• Groin and genitals
• Face, head, and neck
• Chest
• Arms and legs

Fungating Tumor Care

If the fungating tumor can't be removed surgically, it can be very hard to heal completely. Generally, treatment for fungating tumors involves:

• Cleaning dead skin and other tissues out of the wound (debridement)
• Applying solutions to keep the wound clean
• Applying advanced dressings
• Applying or taking antibiotics and antimicrobials to keep bacteria from growing in the wound
• Surgery to remove dead tissue
• Cancer treatment to help shrink the tumor

These days, wound dressings are not limited to big adhesive bandages. Dressings that are good for wounds with a lot of fluid include:

• Hydrofiber foam as a generic absorbent dressing
• Dressings made with alginate, a chemical in seaweed that absorbs 20 times its weight in moisture
• Mesalt dressings with sodium chloride promote wound healing and stimulate cleansing

Wounds that have become odorous might benefit from dressings with:

• An activated-charcoal backing to stop odor
• Honey to improve healing and reduce odor
• Silver to fight bacteria

Other specialized dressings include:

• Monofilament dressings to remove dead tissue
• Soft silicone dressings, which are gentle on the skin
• Clot-inducing material to help stop bleeding and weeping

A wound-care specialist (potentially a physician, plastic surgeon, or nurse) can help keep the wound clean and advise you on how to care for it. Your care team can tell you which dressings to use based on the size and location of your wound. 

They may have you come back in for dressing changes or have you change the dressings at home. A home-care nurse may also be able to help with dressing changes. Specialized dressings can be expensive, especially if dressing changes are needed often. 

During a dressing change, you or your healthcare provider should:

• Rinse the wound with tap water or sterile water.
• Cleanse the area with liquid medicinal soap with a pH between 4 and 6.
• Lightly spray the wound with warm saline (salt water) or plain water to wash away fluids, blood, or dead tissue.
• Apply topical treatments like antibacterial ointments or pain relief.
• Apply any dressings treated with an agent (like charcoal or hydrogel).
• Apply absorbent dressings over the other dressings.
• Secure the dressings with a wrap or adhesive.

If there is bleeding, ensure it stops within 15 minutes before applying the new dressing. Strategies for stopping bleeding include:

• Direct pressure, with or without epinephrine 
• Silver nitrate sticks
• Calcium alginate 
• Absorbable gelatin and collagen dressings 
• Carafate (sucralfate paste)

If the bleeding doesn’t stop, see your healthcare provider.

Physical Coping Strategies

Even with the best wound care, ulcerating wounds can be very uncomfortable. They may be painful, have a foul odor, or weep a lot of fluid. They may grow many times larger than normal, causing asymmetry. There are several options to manage many of these issues.

Special surgical dressings, like those made with charcoal, can help reduce the odor of an infected wound and also make it more comfortable to wear clothing or move around. Antibiotics can also help.

If the tumor leaking fluid is seeping through your clothes, consider adding a layer of non-sterile, absorbent dressings over your wound.

If changing the dressings is painful, ask your healthcare provider about painkiller options.

Mental Health 

A fungating wound is a visible and sometimes painful reminder of cancer. A large wound that doesn’t heal, smells foul, or leaks can be distressing. Fungating or ulcerating tumors can be tougher on your mental health than advanced cancer on its own. Being unable to fix or heal the wound can be traumatic—as if you have lost control of your body.

People with fungating wounds may feel embarrassment, shame, anger, anxiety, or guilt. Clinical depression is common in these people.

It can be even worse if the wound is visible to others. They may notice the smell, swelling, or leaking fluid, making you feel your illness is on display. You may start to avoid social situations or become withdrawn. 

Talk to your treatment team about discussing your feelings with a mental health professional. Your healthcare providers can help you process these changes in your body.

Help With Dressing Changes 

If you’re helping a loved one change their dressing on a fungating wound, keep them distracted and suggest they avoid looking at the wound. Engage your loved one in conversation or turn on the TV. Be mindful that seeing or smelling the wound may be distressing to them.

Changing your dressings frequently can damage the healthy skin around the tumor. You may find that barrier products help protect the skin. These can be sprayed or painted on surrounding healthy skin to keep the bandages from damaging it.

You may also ask your healthcare provider about adding an ostomy barrier, which can be applied to the skin around the wound that acts as a second skin barrier. These must be changed weekly but can protect the skin without further damaging it.

If changing the dressings is painful, nonstick bandages can make changes more manageable, as well as spraying the used dressing with warm, salt water to unstick it during removal. You can decrease the number of changes needed by using a bandage that can absorb liquid.

You can ask your healthcare provider for pain relief options to help with the dressing change; they may suggest using a local painkiller gel or cream.

Primary and Secondary Formation 

Fungating tumors can be either primary or secondary. Primary ulcerating wounds develop from the first tumor that becomes cancer. These are most commonly seen in skin cancers but can also develop in other cancers.

Secondary fungating breast cancer spreads to the breast once the tumor becomes malignant. Cancer can start in the breast or another body part, but the tumor that leads to an ulcerating or fungating wound is not the first tumor that developed.

Effect on Prognosis 

Fungating breast cancer is usually associated with advanced disease, as an ulcerating wound can signify a very large breast tumor. Although it's been reported in medical literature that the life expectancy of a person with breast cancer with a fungating mass is limited to six to 12 months, many people with smaller tumors often live longer.

In a 2017 study, people with breast cancer who had skin ulceration at diagnosis were matched with people with breast cancer without ulcers. The two groups showed minimal differences in survival rates, as follows:

• Five-year disease-free survival for people with skin ulcerations was 53%, while the similar cases without ulcers were 58%.
• The overall survival of the group with ulcers was 75%, while 84% of the group without ulcers were alive five years later. 

The study shows that skin ulceration doesn't seem to make much difference in survival rate if the cancer is treatable. But, the study excluded people with more advanced cancers, including those larger than 5-centimeter, inoperable tumors that extended into the chest wall.

It's possible that these more advanced cancers may lead to extended fungating tumors because they can't be removed.

Summary

Fungating breast cancer is when a tumor breaks through the skin. This skin can start bleeding or weeping fluid, and cancer can cause the skin to die and get infected, resulting in a foul smell and an open wound.

Healthcare providers and wound-care nurses treat fungating breast cancers in many ways. But the most essential treatment is quality wound care. A wound-care nurse or physician can help you assess the wound, ensure you're using the best dressings for the wound, and show you how to care for it.

Fungating wounds are often associated with locally advanced cancer that is very large or has spread within the chest. Often they are due to cancers that are not surgically removable or that are not being adequately treated.

There's uncertainty regarding how the presence of an ulcerating wound impacts breast cancer prognosis, especially if the tumor is smaller or surgically removable.

A Word From Verywell

An ulcerating or fungating wound associated with breast cancer can be a huge stressor. Your body may not feel like your own, and you may feel anxious or depressed about your illness. Ask about talking to a mental health expert to deal with the feelings the wound brings up.

Talk to your healthcare team about the best ways to deal with the symptoms of a fungating tumor, especially the smell and the pain. A fungating tumor doesn't always mean a dire prognosis. Your healthcare provider will help you care for the wound, manage symptoms, and discuss a prognosis with you.