Two kinds of cancer-related wounds
Cancer-related wound care covers two different situations.
The first is a wound caused by the cancer itself. A tumor in or near the skin can grow through the surface and form an open area that may drain, bleed or develop an odor. Clinicians call this a malignant wound.
The second is a wound that follows cancer treatment. Examples include a surgical incision that is slow to close, a radiation skin injury, skin breakdown in a limb swollen after lymph node removal, and pressure injuries that develop during long periods of weakness.
Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.
Why the goal of care comes first
For a treatment-related wound, the goal is usually healing. It may be slower than expected, because some cancer medicines, steroids, low blood counts and poor appetite all affect how the body repairs tissue.
A wound caused by a tumor is different. Whether it can close usually depends on whether the cancer underneath responds to treatment. When it does not, the aim shifts from closing the wound to keeping the person comfortable, clean and able to do what matters to them. This is the focus of palliative wound care.
It is fair to ask the treating clinician plainly, “What is the goal for this wound?” The answer shapes every other choice, and it can change over time.
Comfort, odor and drainage goals
When comfort is the aim, the treating clinician builds the plan around the symptoms that trouble the person most.
- Pain. Steady pain and pain during dressing changes both count. The plan may involve gentler dressings, different timing and the prescriber who manages pain medicine.
- Odor. Clinicians have several ways to reduce it, so describe it honestly. Our guide on wound odor and what to tell your care team can help.
- Drainage. Heavy drainage soaks clothing and irritates skin. The goals are dressings that hold more fluid, protected skin and fewer changes in a day.
- Bleeding. Tumor tissue is fragile. Dressings that do not stick, and a clear plan for what to do if bleeding starts, lower both the risk and the fear.
- Appearance and daily life. Dressings that sit flat under clothing and stay in place make it easier to see visitors or leave the house.
Working with oncology and palliative teams
The oncology team leads cancer treatment, and wound decisions have to fit around it. A procedure that is routine for another wound may need to wait if blood counts are low or radiation is underway. The wound care clinician shares measurements and changes so the oncologist has a current picture.
Palliative care teams focus on symptom relief at any stage of illness. Hospice teams care for people near the end of life. When either is involved, the wound plan should match theirs, including the medicines used for pain and comfort.
Changes to report and when to call 911
Tell the treating clinician or the oncology team about:
- New or increasing bleeding, even if it stops
- A sudden change in pain
- More drainage, or a new or stronger odor
- Redness, warmth or swelling spreading into nearby skin
- Fever or chills (during chemotherapy, call the oncology team immediately)
- A wound that is growing quickly, or new lumps in the skin nearby
Call 911 for bleeding that is heavy or will not stop with firm pressure, trouble breathing or sudden confusion. If the person is enrolled in hospice, follow the hospice team’s instructions about whom to call first.
Support for family caregivers
Odor, drainage and the look of the wound can be upsetting, and dressing changes can tire both of you. Saying so to the care team is not a complaint. It is information they need.
Ask what you are expected to do between visits and what you can leave to the clinicians. The guide on comfort goals for wound care at the end of life and our page for family caregivers offer more help.
How Gateway coordinates cancer-related wound care
Gateway arranges wound care with partner clinicians in private homes, assisted living, skilled nursing and other settings across Greater St. Louis and the Metro East. We coordinate the request, scheduling, records from the oncology office, clinician orders, supplies and updates among the teams. Every clinical decision belongs to the treating clinician.
Patients and relatives can call 314-325-0126 or request care online, with no referral needed. Hospice and palliative programs can read how we work with hospice and palliative care teams. We confirm visit availability by location and care setting.
Common questions
Can a wound caused by a tumor heal?
Sometimes, when cancer treatment shrinks the tumor beneath it. When the cancer does not respond, the wound usually will not close with dressings alone, and it may slowly enlarge. Pain, odor, drainage and bleeding can still often be reduced with a plan built for comfort. Ask the oncologist and the wound care clinician what is realistic in your situation.
Why does the wound smell, and can anything be done about it?
Odor usually comes from bacteria living in tissue that has lost its blood supply. It is common with tumor wounds and is not a sign of poor hygiene. Clinicians can often lessen it through the choice of dressing, how the wound is cleaned and treatments they order.
What should we do if the wound starts to bleed?
Ask for a written bleeding plan before it ever happens. It should say what to keep on hand, what to do first and whom to call. Light oozing during a dressing change is common with fragile tumor tissue and should still be reported. Heavy bleeding that continues despite firm pressure is an emergency. Call 911 unless a hospice team has given you different instructions.
Does choosing palliative wound care mean stopping cancer treatment?
No. Palliative care relieves symptoms and can be given alongside chemotherapy, radiation or surgery. Hospice is a separate decision made with the oncology team and family. To talk through wishes for future care, ask about an advance care planning conversation.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.