fungating growths (palliative care)

Last reviewed 01/2018

Fungating wounds arise from malignant disease (primary, secondary or recurrent) and are usually associated with advanced cancer. These wounds are often seen in elderly patients with metastatic cancer, who are in the terminal stages of the disease (1,2).

Palliative care through the use of appropriate dressings and medications helps in alleviating various problems arising from these lesions, including (1,2):

• pain
• exudate
• odour
• itch
• bleeding
• psychosocial effects

Fungating growths may be treated by cleansing with a mixture of one part 4% Povidone-iodine skin cleanser solution and four parts of liquid paraffin. However, when cleansing is required, a soft shower or gentle cleansing with isotonic saline may be advisable because this helps in pain control and reduces the possibility of bleeding (2).

Excess exudate may be managed with absorbent alginate and foam dressings (2).

Oral Metronidazole or topical Metrotop gel may eradicate the anaerobes responsible for the odour. Wound cleansing and gentle debridement to remove exudate, debris, and necrotic tissue may help in controlling malodour. Dressings containing activated charcoal may also be useful in odour control (2). In certain cases, experts may consider the use of honey or maggot therapy in the management of these wounds (3).

Reference:

• (1) Adderley U, Smith R. Topical agents and dressings for fungating wounds. Cochrane Database Syst Rev. 2009;(1):CD003948
• (2) National Healing (2007). Wound healing perspectives – Malignant wounds
• (3) Cooper R, Gray D. The control of wound malodour with honey-based wound dressings and ointments.  Wounds UK (Suppl) 2005;1: s26-s31.