Fungating Breast Cancer

Tumors that break down the skin of the breast are rare, but they can be treated. Many common breast cancer therapies — including chemotherapy, radiation therapy, hormonal therapy, and immunotherapy — can be used to shrink what’s known as a “fungating” tumor. When combined with wound care, these treatments can also help to reduce pain and infection.

Fungating (or ulcerating) breast tumors are rare tumors that grow through the skin of the breast. The term fungating refers to how the tumor looks when it breaks through the skin — resembling the shape of a mushroom or cauliflower. Only about 2% to 5% of locally advanced breast cancers — where the tumor has spread outside the breast — will develop into fungating breast wounds. 

“Many different types of cancer can eventually break through the skin, including head and neck, skin, and breast cancers,” says Anne Peled, MD, a breast cancer surgeon and co-director of the Breast Care Center of Excellence at Sutter Health California Pacific Medical Center. 

If cancer forms close to the breast skin and continues to grow without being treated, the tumor may eventually enter the skin layers and destroy the skin tissue, causing an open wound. It’s at this point that the tumor is considered to be fungating. 

Fungating breast cancer starts like other breast cancers start — with abnormal cells in the breast growing and multiplying.

Fungating tumors start small, but when they’re left undiagnosed and untreated, they can potentially grow to be quite large in size, says Dhivya Srinivasa, MD, FACS, a plastic and reconstructive microsurgeon and founder of The Institute for Advanced Breast Reconstruction located in both California and Texas. “How fast this happens depends on the tumor. Some are aggressive and the process is quick. Less aggressive tumors will grow at slower rates.” 

Because these tumors can appear so small, Peled says they may be overlooked or misdiagnosed as an infection or an insect bite that’s gotten irritated. “Often when they get very large, it’s because they’ve gone unrecognized or undiagnosed for a while,” she says.

The best way to spot concerning changes to your breasts is to pay attention to what your breasts look and feel like through regular breast self-exams and mammograms. 

If you identify a lump or wound on your breast that doesn’t go away, you may want to have it checked out. This way, if something is wrong, the issue can be addressed before it becomes a bigger problem. 

The symptoms of fungating breast cancer can include:

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  an ulcer or open wound on the breast

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  infected or inflamed skin with redness and swelling

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  darkened skin, which may represent areas where tissue has died

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  pain at the site

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  foul odor

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  leaking from the wound

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  bleeding

“If you develop any new breast lumps or changes in the appearance of your breasts, make sure to get them checked out by your healthcare provider,” advises Peled. 

Usually, fungating breast cancer is diagnosed when a person comes in with a wound they’ve noticed or was spotted by a healthcare provider during a physical exam, explains Peled. “While some providers may not think of breast cancer initially, we usually recommend that any new breast finding that hasn’t gone away in a few weeks be evaluated with … breast imaging or a biopsy to rule out cancer.”  

Breast imaging may include mammogram, ultrasound, or both — to see if there’s a tumor under the skin, says Peled. You may also have a skin biopsy or needle biopsy to see if the tumor is cancerous or noncancerous (benign). 

Often, fungating breast cancers are diagnosed in advanced stages, but not always, explains Srinivasa. “It is possible to have a locally aggressive tumor that has not otherwise spread.”

Treatment of fungating breast cancer will depend on the tumor type, as well as the age and health of the person affected. Both Srinivasa and Peled agree it’s typically a combination of treatments, which can include:

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  surgery

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  chemotherapy

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  radiation therapy

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  hormonal therapy

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  immunotherapy 

Peled says chemotherapy, immunotherapy, or hormonal therapy can be used first to shrink the tumor, sometimes to the point that the tumor has almost disappeared. At that point, surgery can remove any cancer that’s still present and a surgeon can close up the wound. 

It’s possible to fully heal from fungating breast cancer, Peled says. However, sometimes if the tumor is too large to effectively remove and close the wound safely, surgery might not be possible. Radiation therapy may be used to control bleeding and pain if the tumor can’t be removed.

If it isn’t possible to close the wound with surgery, a healthcare team that specializes in wound care will step in as you continue to receive other treatments to continue to try and shrink the tumor. Wound care is usually overseen by a surgeon.

“It’s important to minimize bleeding, optimize comfort, and manage pain. You also want to make sure the wound stays clean and free of infection,” advises Srinivasa. 

Your care team will walk you through exactly what to do to treat the fungating tumor, but in general, here’s what you can expect when caring for the site:

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  Sterile water, tap water, and liquid medicinal soap are used to clean the wound.

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  Absorbent dressings and adhesives help to keep the wound dry. If the wound is producing an odor, your healthcare team may advise the use of dressings with activated charcoal or a medical-grade honey.

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  Antibiotics or other antimicrobials may be used to treat or prevent infection.

The wound care team will be able to recommend and help apply the right kind of dressings and can help manage your pain. They will also keep track of the size and color of the wound, how much draining is coming from the wound, and the appearance, as well as managing the infected tissue. This helps you and the team know if the wound is getting worse. 

Treating fungating breast cancer isn’t always just managing physical concerns. Having this type of tumor can affect your mental well-being. Research shows people who have this type of tumor might experience embarrassment, shame, anxiety, and concerns with self-image due to the nature of the sometimes large ulcers on the breast. Because of this, treatment may also include counseling and medications such as antidepressants. 

According to Peled, the best way to reduce the risk of fungating breast tumors early is to get regular breast cancer screenings. Breast cancer screening is recommended every two years for people ages 40 through 74 by the U.S. Preventive Services Task Force.