Breast cancer can cause different changes in the breast as it grows. In some advanced cases, a tumour may grow through the skin and create an open wound. This is known as a fungating breast wound, also called an ulcerating or malignant wound.

Fungating breast wounds are uncommon and are more often associated with advanced breast cancer. They can cause physical symptoms such as pain, bleeding, fluid leakage, and unpleasant odour. They can also affect a person's emotional wellbeing and daily life. Understanding what causes these wounds and how they can be managed can help patients and caregivers seek appropriate support.

What Is a Fungating Breast Wound?

A fungating breast wound develops when a breast cancer tumour grows into and through the skin. As the tumour damages nearby tissue and blood vessels, parts of the tissue may lose their blood supply and die. This can result in an ulcerated, open wound on the breast or chest wall.

The term “fungating” describes the appearance of the wound. Some wounds can have a raised, irregular or cauliflower-like appearance. Despite the name, a fungating wound does not mean that fungus is growing in the breast.

These wounds are usually linked with locally advanced or metastatic breast cancer, although the exact situation varies from person to person. Most people with breast cancer will not develop a fungating wound.

What Does Fungating Breast Cancer Look Like?

The appearance can vary depending on the tumour, its location and how much the skin has been affected. A fungating breast wound may:

• Appear as an open sore or ulcer on the breast

• Have an irregular or cauliflower-like growth

• Cause redness or darkening of the surrounding skin

• Leak clear, yellowish or blood-stained fluid

• Bleed easily

• Develop an unpleasant odour

• Become inflamed or infected

• Cause pain or tenderness

Not every breast wound is caused by cancer. In addition, not every breast cancer causes a wound. Any new, persistent or unusual breast skin change should be assessed by a healthcare professional.

What Causes a Fungating Breast Wound?

The wound develops because the cancerous tumour grows into the surrounding tissues and eventually breaks through the skin.

As the tumour grows, it can damage small blood vessels. This can reduce oxygen and nutrients reaching the affected tissue. Some tissue may then die, causing the skin to break down and form an ulcer. The open area can also become infected, which may contribute to increased pain, inflammation, fluid leakage or odour.

A fungating wound is therefore not a separate type of breast cancer. Instead, it is a complication that can occur when breast cancer has grown extensively and affected the skin.

Symptoms of a Fungating Breast Wound

Symptoms can vary, but several features are commonly reported.

1. Open or Ulcerated Skin

The tumour may break through the skin, leaving an open sore. The wound can have an uneven surface and may gradually change in size or appearance.

2. Fluid Leakage

The wound may produce fluid called exudate. The amount can range from small amounts to significant leakage that soaks through clothing or bedding. Absorbent dressings can help manage this symptom.

3. Unpleasant Odour

An odour may develop because of bacteria, infection or dead tissue within the wound. This can be particularly distressing for the person with the wound and their family. Healthcare professionals can recommend appropriate wound care and, when necessary, treatment for infection.

4. Pain

Pain may occur because the tumour affects nearby nerves or because the surrounding skin becomes inflamed or infected. Dressing changes can also cause discomfort, particularly if dressings stick to the wound.

5. Bleeding

Fungating wounds can bleed because the tumour damages fragile blood vessels. Some wounds bleed only occasionally, while others may bleed more frequently. Any significant or persistent bleeding requires prompt medical attention.

6. Skin Irritation and Itching

The skin around the wound may become irritated, sore or itchy. Fluid from the wound can also damage nearby skin when it remains wet for prolonged periods.

Is Fungating Breast Cancer Always Advanced?

A fungating breast wound generally occurs when breast cancer has progressed enough to invade and break through the skin. For this reason, it is commonly associated with advanced or locally advanced disease.

However, the presence of a fungating wound does not by itself tell doctors the complete stage or prognosis of someone's cancer. Doctors consider several factors, including the tumour's size, lymph node involvement, spread to other parts of the body, and biological characteristics of the cancer.

A healthcare team may use imaging, biopsy results and other tests to understand the extent and characteristics of the disease.

How Is a Fungating Breast Wound Treated?

Treatment usually focuses on two areas: controlling the underlying cancer and managing the wound and its symptoms.

Cancer treatment may include systemic or local therapies depending on the type, stage and characteristics of the breast cancer. Options can include chemotherapy, hormone therapy, targeted therapy, immunotherapy, radiation therapy or surgery when appropriate.

Radiation therapy may be used to help control painful or fungating breast or chest wall lesions. In selected cases, surgery may also be considered, particularly when the wound is causing significant symptoms.

The appropriate treatment depends on the individual's cancer and overall health. A multidisciplinary team may be involved in deciding the best approach.

Wound Care for Fungating Breast Cancer

Wound care is an important part of managing a fungating breast wound. The goal is not always to make the wound heal completely. Instead, care often focuses on controlling symptoms, protecting the surrounding skin and improving comfort and quality of life.

Managing Fluid Leakage

Specialist dressings can absorb wound fluid and help prevent leakage onto clothing and bedding. Soft silicone and foam absorbent dressings may be recommended depending on the wound.

A healthcare professional can advise which dressing is appropriate and how frequently it should be changed. A barrier cream may also help protect the skin around the wound.

Managing Odour

If an infection contributes to the smell, a healthcare professional may recommend appropriate antimicrobial treatment. Odour-absorbing dressings may also be used in some situations.

Good ventilation and appropriate wound care can help reduce unpleasant smells at home. Patients should avoid applying products directly to the wound unless their healthcare team recommends them.

Managing Pain

Pain management should be tailored to the individual. Healthcare professionals can recommend appropriate pain relief and ways to make dressing changes more comfortable.

For example, gently soaking a dressing with water or saline before removal may help reduce discomfort when the dressing has adhered to the wound.

Managing Bleeding

Because fungating wounds can bleed easily, patients and caregivers should receive clear instructions on what to do if bleeding occurs. The healthcare team may recommend specific dressings or other measures based on the individual's wound and bleeding risk.

Heavy or difficult-to-control bleeding requires urgent medical assessment.

Can a Fungating Breast Wound Heal?

Because the wound is caused by an underlying cancerous tumour, it may not heal completely unless the cancer itself can be effectively controlled. Fungating wounds can be difficult to heal, particularly when the underlying cancer continues to grow.

However, treatment can still make a significant difference. Cancer-directed treatment may reduce tumour activity, while specialist wound care can help control pain, leakage, odour and bleeding.

The goal of care is therefore not only to address the wound itself but also to support comfort, dignity and quality of life.

Emotional Impact of Fungating Breast Cancer

Living with a fungating breast wound can be emotionally challenging. Changes in appearance, odour, leakage and pain may affect confidence and make some people uncomfortable leaving home or spending time with others.

Some people may experience anxiety, sadness, embarrassment or social isolation. These reactions are understandable, and patients do not have to manage them alone. Support from breast care nurses, counsellors, psychologists, social workers and other members of the healthcare team can be helpful.

Caregivers may also need support. Caring for a wound can feel overwhelming, particularly when symptoms change or dressing care becomes difficult.

When Should You Contact a Doctor?

If you notice a new breast wound, persistent skin breakdown, bleeding, unusual discharge, increasing pain, redness, swelling or changes in the appearance of the breast, speak with a healthcare professional.

People who already have a fungating breast wound should contact their treatment team if they notice:

• Increasing pain

• New or worsening redness and swelling

• Changes in the amount or appearance of wound fluid

• Increasing odour

• New or worsening bleeding

• Fever or other signs of infection

• Difficulty managing the wound at home

Prompt medical advice can help the healthcare team identify complications and adjust treatment or wound care when needed.

Conclusion

Fungating breast cancer can cause open wounds, pain, bleeding, fluid leakage, odour, and emotional distress. Although these wounds can be challenging to manage, cancer treatment and specialist wound care can help control symptoms and improve comfort.

If you or someone you know is living with advanced breast cancer, speak with a healthcare professional about available care options. Furthermore, metastatic breast cancer clinical trials are enrolling, so consider enrolling in metastatic breast cancer research to learn whether you may qualify to participate.