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A fungating wound is an injury caused by the growth of a cancerous tumor through the skin. This type of cancer complication is rare and occurs most commonly in cases where people are receiving palliative care only for cancer, as usually surgery, chemotherapy, and radiation suppress cancer growth enough to prevent the development of fungating wounds. These injuries can superficially resemble a cauliflower or fungus protruding from the skin, and they can cause significant hardships for patients, in addition to presenting a nursing challenge.
Fungating wounds develop as a cancer spreads under the skin and eventually pushes through the layers of skin to the surface. Along the way, it causes necrosis or tissue death, usually leading to inflammation and infection. The open wound tends to attract bacteria, leading to secondary infection. Usually, there is a strong smelling discharge and the wound will feel hot and moist to the touch.
Management of a fungating wound includes administering medication to inhibit bacterial growth, debriding dead tissue, and regularly cleaning and bandaging it. Drains may be placed to allow pus and other fluids to freely drain from the injury. Bandages can help control odor, although it is important to change them regularly to avoid exacerbating inflammation or promoting the development of further infection. The fungating wound can increase in size as the cancer grows, causing a very large lesion to appear.
Patients often experience emotional distress when a fungating wound develops. The injury is a reminder of the terminal nature of the cancer and patients may express regret about not pursuing more aggressive treatments. In addition, the pain and smell can cause emotional distress as patients feel increasingly uncomfortable and may be worried about how other people will respond to the wound. Skilled nursing care paired with appropriate mental health interventions can help cancer patients in the end stages of their lives.
When a fungating wound develops, patients should talk to their doctors about options for managing and treating the injury. Every patient's case is slightly different, and a wound care specialist may be called in to provide assistance. It is also advisable to prepare friends and family members when they visit the patient so they know what to expect and are not startled by the patient's declining health. While the wound may not be visible, it can produce an odor and it is important for visitors to know that the wound is being cared for, not neglected or ignored.