Breast cancer involves the uncontrolled growth of cells in the breast tissue. One manifestation is fungating breast cancer, where the tumor grows through the skin, creating an open wound. This article clarifies the nature of fungating breast cancer and its relationship to breast cancer staging systems.
Defining Fungating Breast Cancer
Fungating breast cancer describes a localized manifestation where a tumor breaks through the skin surface, forming an open wound or ulcer on the breast. The appearance of these wounds can vary, often presenting as an ulcerated mass with irregular edges that may ooze fluid, bleed, or discharge. The term “fungating” refers to the tumor’s appearance, which can resemble a fungus or cauliflower.
These wounds can be accompanied by a distinct, unpleasant odor, often due to bacterial infection, and may cause pain, discomfort, and itching. This presentation is relatively uncommon, occurring in approximately 2% to 5% of locally advanced breast cancer cases.
How Breast Cancer is Staged
Staging breast cancer is a process used to determine how far the cancer has spread within the body. This information helps medical professionals plan the most appropriate treatment and understand the likely progression of the disease. The most widely used system for this purpose is the TNM (Tumor, Node, Metastasis) system.
The TNM system evaluates three key aspects of the cancer. ‘T’ describes the original tumor’s size and extent within the breast, with higher numbers indicating larger tumors or more extensive local spread. ‘N’ signifies whether the cancer has spread to nearby lymph nodes, and if so, how many are involved. Finally, ‘M’ indicates whether the cancer has metastasized, meaning it has spread to distant organs or parts of the body, such as the bones, lungs, or liver. Based on these TNM values, breast cancer is assigned a stage from 0 to IV. Generally, a lower stage number indicates less spread, while higher stages, such as Stage III or Stage IV, suggest more advanced disease.
Fungating Breast Cancer and Its Stage
Fungating breast cancer is not a distinct stage of cancer itself but a visible manifestation of existing breast cancer. This condition is almost always indicative of locally advanced or metastatic breast cancer, typically aligning with Stage III or Stage IV disease.
The presence of skin involvement, which characterizes fungating breast cancer, directly impacts the ‘T’ (tumor) category within the TNM staging system. If the tumor has spread to the skin of the breast, it is classified as a T4b tumor, regardless of its size. A T4b classification signifies that the cancer has spread into the skin and the breast might be swollen.
This T4 classification automatically places the cancer into at least Stage III, even if there is no lymph node involvement or distant metastasis. If distant metastasis is present (M1), the cancer is classified as Stage IV, regardless of the T or N status. Fungating breast cancer is a clear sign of advanced local disease.
Managing and Treating Fungating Breast Cancer
Managing fungating breast cancer involves a comprehensive approach that addresses both the underlying cancer and the local wound itself. The primary goal is to control the disease progression, alleviate symptoms, and improve the patient’s quality of life. Treatment strategies are highly individualized, taking into account the cancer’s characteristics and the patient’s overall health.
Systemic therapies target cancer cells throughout the body. These include chemotherapy, which helps shrink the tumor; hormone therapy, if the cancer cells respond to hormones; targeted therapy, focusing on specific vulnerabilities in cancer cells; and immunotherapy, which harnesses the body’s immune system to fight cancer. Alongside systemic treatments, local management of the fungating wound is crucial. This involves specialized wound care, including regular cleaning, appropriate dressing changes to manage discharge and bleeding, and infection control to reduce odor and prevent complications. Pain management and strategies to control unpleasant odors are also important for comfort and daily living.