Treatment Algorithm for Cancerous Wounds: A Systematic Review

Abstract

Background: In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment strategy, symptoms progress, and adversely influence quality of life. Methods: Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information. Results: Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases. Conclusions: This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.

Management of malignant cutaneous wounds in oncologic patients

“…There are many clinical challenges in providing medical care for patients with neoplastic wounds. Since there are no clearly defined wound care guidelines, many centers follow their own protocols to treat this type of wounds [ 2 , 15 ].…”

“…Patients included in the current case series did not complain about malodor. The use of silver dressings can be very effective to reduce malignant fungating wound malodor [ 15 ]. A heavy exudate, sometimes over a liter per day, often complicates malignant wounds.…”

“…Local methods to manage bleeding can include special dressing, radiotherapy, and systemic treatments like etamsylate, increasing the endothelial resistance of capillaries and promoting platelet adhesion. Tranexamic acid can be also used but it can be risky to apply for patients affected by thrombogenic paraneoplastic syndrome [ 15 ]. Bleeding is associated with a poor prognosis, so an early identification of bleeding in malignant lesions may help to evaluate and start palliative care with the objective to improve the quality of patient life.…”

Managing a malignant wound in palliative care

“…Topical agents applied to the peri-wound skin, including moisturisers, topical corticosteroids, menthol, capsaicin and lidocaine creams, may be of benefit 47 . Antihistamines generally do not improve wound-associated pruritus 49,50 . Medications used for neuropathic pain, including antidepressants (amitriptyline, mirtazapine) and antiepileptics (pregabalin, gabapentin, sodium valproate), may be trialled for pruritus not responsive to other treatments 49 .…”

“…Antihistamines generally do not improve wound-associated pruritus 49,50 . Medications used for neuropathic pain, including antidepressants (amitriptyline, mirtazapine) and antiepileptics (pregabalin, gabapentin, sodium valproate), may be trialled for pruritus not responsive to other treatments 49 . Transcutaneous electrical nerve stimulation (TENS) has also been used for refractory chronic pruritus in other skin conditions and reported among those with malignant wounds, but requires further evidence to support its use 33,51 .…”