What is the name of the discharge from cancer wounds?

Malignant Fungating Wound Discharge

The discharge from cancer wounds is called exudate or malignant wound exudate. This discharge is a common symptom associated with malignant fungating wounds (MFWs), which occur in approximately 5-14% of patients with advanced cancer 1, 2.

Characteristics of Malignant Wound Exudate

Malignant wound exudate has several distinctive characteristics:

• Volume: Often copious and difficult to manage 3
• Consistency: Can range from serous to purulent depending on infection status
• Odor: Frequently malodorous due to bacterial colonization, particularly by anaerobic bacteria 1
• Color: May be clear, yellow, green, or blood-tinged depending on wound status

Pathophysiology of Exudate Formation

The exudate forms due to several pathological processes:

• Tumor cells infiltrating and proliferating in the skin 1
• Disruption of lymphatic drainage by tumor invasion 4
• Increased vascular permeability due to inflammatory mediators
• Angiogenesis stimulated by vascular endothelial growth factor (VEGF) 4
• Bacterial colonization and infection of the wound bed

Clinical Significance

The exudate from malignant wounds significantly impacts patient quality of life through:

• Physical discomfort from constant moisture
• Skin maceration around the wound (periwound damage)
• Social isolation due to leakage and odor
• Psychological distress from visible disease progression 2
• Increased risk of infection

Management Approaches

Management of malignant wound exudate follows the PEBO approach (Pain, Exudate, Bleeding, Odor) 5:

1. Exudate Management:

   • Non-adherent primary dressings
   • Absorbent secondary dressings to manage fluid
   • Dressing changes typically twice weekly 5
   • Avoid occlusive dressings that trap moisture 5

2. Odor Control (associated with exudate):

   • Antibacterial dressings
   • Odor-absorbent dressings 5
   • Topical metronidazole (though evidence is limited) 3
   • Silver-containing foam dressings may help reduce malodor 3

3. Bleeding Management:

   • Non-traumatic dressing removal to prevent bleeding
   • Hemostatic dressings when necessary 5

Evidence Quality

The evidence for managing malignant wound exudate is limited:

• Few randomized controlled trials exist in this area 3
• Most recommendations are based on case series and expert opinion 5, 6
• A Cochrane review found insufficient evidence to give clear direction for practice regarding improving quality of life or managing wound symptoms 3

Clinical Pitfalls to Avoid

1. Aggressive Debridement: Surgical debridement should be avoided as it may cause bleeding and tumor spread 5
2. Adherent Dressings: These can cause pain and bleeding upon removal 5
3. Delayed Diagnosis: Malignant wounds may be mistaken for other wound types, delaying appropriate treatment 6
4. Ignoring Psychological Impact: The psychosocial effects of malignant wound exudate require attention alongside physical symptoms 2

The management of malignant wound exudate remains challenging, with treatment focused on symptom palliation rather than healing, as these wounds typically occur in patients with advanced disease 1, 3.