Locally Advanced Cancers

Abstract

In the setting of locally advanced, unresectable, and recurrent tumors, radiation therapy may be used for palliation of pain, bleeding, ulceration, and drainage.

Fungating malignant wounds are often a mixture of viable vascular tumor and necrotic tissue. Their exudates can severely macerate normal dermal tissue. Chronic non-healing malignant wounds may have a profound impact on the patient’s quality of life and activities of daily living. Treatment should be individualized and should take into consideration some of the following: pain, management of drainage, odor, bleeding, infection, prevention of healthy skin maceration, cost-effectiveness of dressing supplies, and the patient/caregiver’s ability to dress the wound. The goal of wound healing and closure is usually not realistic or expected in this setting.

General principles in the care of malignant chronic wounds include cleansing of the area, the use of dressings to facilitate a balance between a moist and dry environment, minimizing infection, and minimizing scab formation which can trap bacteria. Certain products should be avoided, so as not to irritate the wound more. These include neosporin and polysporin which may cause an allergic reaction and skin sensitivity, Betadine which inhibits healing by damaging fibroblasts, and over-the-counter products such as Ben-Gay, Gold Bond, milk of magnesia, menthol camphor, and occlusive dressings. Alginate dressings should be selectively chosen as they have the potential to break apart, leaving debris in the wound that can form a granuloma. Silvadene may result in an allergic reaction, especially in patients with a known allergy to sulfa, as well as cause the patient discomfort with the dressing changes.