Fungating breast wounds

A fungating breast wound happens when cancer cells damage the healthy cells and blood vessels in the breast. This causes a breast cancer tumour to break through the skin of the breast or chest.

Fungating breast wounds are rare. They’re called “fungating” because they can look like a fungus or cauliflower. This doesn’t mean there’s fungus growing in the wound.

You might also hear it called an ulcerating wound.

A fungating breast wound can be seen on the outside of the breast or chest.

The wound can:

• Look like an open sore on the skin (ulcerated)
• Become infected or inflamed
• Look red or darker than your usual skin tone
• Be painful
• Have a bad smell
• Bleed
• Leak fluid (exudate)

If you have any of these symptoms, speak to your treatment team or GP as soon as possible.

Fungating breast wounds can be difficult to manage and often don’t heal completely.

Treatment aims to:

• Control the symptoms of the wound
• Keep the wound clean, dry and free from infection
• Stop the wound from getting bigger

Because the wound is caused by a breast cancer tumour, treatments that help treat the cancer can help the wound.

These may include:

• Radiotherapy
• Chemotherapy
• Electrochemotherapy
• Hormone therapy
• Targeted therapy

Your treatment team will discuss a treatment plan with you depending on the features of your breast cancer and the wound. They will usually ask the tissue viability team at your hospital to be involved in your care. These are nurses who specialise in the care and treatment of wounds that are more complex or difficult to heal.

Leakage

Fungating breast wounds can leak fluid. This can be distressing, especially if it leaks through to your clothes. The fluid can damage the skin around the wound if it stays wet for a long time.

Dressings are an important part of managing a fungating breast wound. They can help with leakage and stop fluid from getting on your clothes or bedding.

There are different types of dressing, such as soft silicone or foam absorbent dressings. Your treatment team, breast care nurse or tissue viability nurse will recommend the right type of dressing for your wound and advise you about how often it needs to be changed. The dressings might be changed in hospital if you’re an inpatient or by a district nurse if you’re at home. The practice nurse at your GP surgery may also help with dressing changes.

Your treatment team may also recommend a barrier cream to put on the skin around the wound. This may help prevent the skin from becoming sore or damaged by the leakage and the dressing changes.

If your wound is leaking a lot, your treatment team might refer you to a dietitian for nutritional advice. This is because you can lose protein through the leakage.

Smell

The smell of a fungating breast wound can be very upsetting for some people and their family members or carers. Some people worry about going out or having visitors at home in case others notice the smell.

If the smell is caused by an infection in the wound, antibiotics may help. Your treatment team or GP will prescribe antibiotics, usually as a cream, gel or tablets. Sometimes they might also recommend antimicrobial dressings, which help reduce the level of bacteria in the wound.

Your treatment team may use specific odour-absorbing dressings, such as charcoal, honey or cinnamon dressings, or use essential oils with dressings. You should only use essential oils if your treatment team has recommended them, as they can be harmful if used incorrectly.

If you’re finding the smell distressing when you’re at home, you could try:

• Using plug in or spray odour eliminators or neutralisers
• Burning incense or candles
• Keeping fragrant flowers around
• Keeping the room you’re in well-ventilated by opening windows

Pain

Fungating breast wounds can be painful for different reasons, such as the tumour pressing on nerves in the breast or chest. It can also be painful if the skin around the wound becomes sore, inflamed or infected.

Taking painkillers regularly can help you stay comfortable day-to-day. Your treatment team will advise you about what to take.

You may find it painful when the dressings are changed. Soaking the dressing with water or saline before it’s removed, or using an adhesive remover, can make the dressing changes less painful. However, you may also need painkillers before you have your dressings changed.

Bleeding

Some fungating wounds can bleed. Rarely, this is severe.

You may be on medication for your cancer or other health conditions that increases the risk of bleeding. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Blood thinning medication (anti-coagulants)
• Steroids

Your treatment team will advise on the best way to manage any bleeding, or risk of bleeding, from your wound. This may include specific dressings that can help with bleeding.

If you notice bleeding from anywhere else, such as coughing up blood or blood in your pee or poo, let your treatment team know as soon as possible.

Itching

Your skin may be itchy around the wound. This can be because the nerve endings are irritated.

Talk to your treatment team if you experience itchy skin around the wound. They may recommend moisturising creams that can make your skin more comfortable, or dressings called hydrogel sheets that keep the skin well-hydrated.

It can also help to wear cool, natural fabrics against your skin, like 100% cotton.

It can be difficult to cope emotionally with a fungating breast wound. Some people may feel anxious, depressed or distressed.

Some may feel embarrassed about smell or leakage, which can make it hard to be around others or leave the house. This can lead to isolation and feeling lonely.

Some people also feel like they’ve lost control of their body or their cancer. This can make it hard to look at their body, or let others look, for example when getting dressings changed.

If you’re struggling emotionally with a fungating breast wound, speak to your GP or treatment team. They’ll be able to give you advice and refer you to services that can help, like counselling.

Occupational therapists and physiotherapists may be able to help with practical issues at home. They are part of the multidisciplinary team who will take care of you.

You may also be under the care of a palliative care team either in hospital or at home. The palliative care team can help manage your symptoms as well as provide you and your family with emotional support.

Caring for someone with a fungating breast wound can be challenging.

The sight and smell of the wound can be distressing. You may also worry about hurting the person you’re caring for.

The person may withdraw from others and not want to leave the house if they’re worried about the smell of the wound or leakage.

It’s important to take care of yourself when you’re caring for someone else.

If you’re struggling emotionally, speak to your GP. They’ll be able to help you access support like counselling and refer you to other services for carers in your area.

Here are some other organisations that can help:

• Carers UK
• Carers Trust
• Citizens Advice for more information about practical support and benefits when you’re caring for someone

Living with, or caring for someone with, a fungating breast wound can bring a lot of uncertainty and feel isolating.

Our helpline is here to support you if have any questions or just want to talk. See the bottom of this page for how to get in touch.

And you can talk to others going through similar circumstances on our online forum.