Fungating tumours in palliative care in adults (Guidelines)

A fungating tumour is a primary or secondary cancer that has ulcerated the skin. The management of fungating tumours focuses on alleviating the distressing symptoms associated with the wound and providing emotional support to the patient and family/carers.  They most commonly develop from cancer of the head and neck, breast, melanoma and soft tissue sarcoma.  Treatment is directed towards control of bleeding, odour restriction, absorption of exudates, control of pain associated with the lesion and comfort/cosmetic appearance. This information is a guide and a comprehensive wound assessment should be undertaken.

If the wound is moist/dry and clean the primary dressing should be a non-adherent foam dressing (semi-permeable), see wound formulary. 

The consequences of having a fungating lesion secondary to cancer can be far reaching and encompass physical, psychological, social, sexual and spiritual dimensions. Each patient will react in their own way and a sensitive, skilled approach to care is vital. Patients may experience depression, embarrassment, social isolation, fear, repulsion, shame, altered body image, and a constant reminder of advanced, incurable disease.

Health professionals need to establish trust with patients and family and use tact and sensitivity.

There are strategies for managing these psychosocial problems. Interventions should aim to boost patient confidence and improve their ability to socialise wherever possible.

• cosmetic appearance – dressings need to effectively manage odour and exudates but where possible restore body symmetry
• access to counselling services
• appropriate social support decreases stress and anxiety at home
• spiritual care according to individual’s beliefs
• involvement of the patient, family and carers in decisions about care
• open, honest communication of goals and decisions
• appropriate use of touch/physical contact
• access to complementary therapies.