Before having a pelvic exenteration operation
Pelvic exenteration is a big operation that isn’t possible for everyone. You’ll need tests to make sure you’re fit enough to have the operation, and you’ll need to understand how the operation will change your sex life and the way you go to the toilet.
Preparing for pelvic exenteration
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Finding out about the operation
Pelvic exenteration is a big operation that will mean changes to your sex life and how you go to the toilet.
Recovery afterwards can be difficult, both physically and emotionally. To help you make an informed decision about whether to go ahead with the operation, it’s important you understand what’s involved. Your surgeon or specialist nurse can explain the operation to you and support you in deciding whether it’s right for you. It can be helpful to involve your partner (if you have one) or someone close to you in these discussions, so they can support you in your decision.
It can also be helpful to talk to someone who has had the operation. Your surgeon or specialist nurse may be able to arrange this for you. Some support organisations may also be able to put you in touch with someone who has had similar surgery.
Pelvic exenteration is only possible for a small number of people. Before having the operation, you will have investigations and scans to make sure it’s suitable for you.
For a cure to be possible, the cancer needs to be contained in the pelvis. So, your doctors will do tests to look for cancer elsewhere. This usually involves having one or more scans and possibly other tests. If any cancer is found outside the pelvis, the operation wouldn’t be successful and so won’t be done.
Your doctors also need to make sure you’re physically able to cope with the operation and it isn’t too risky for you. You may have tests, such as heart and lung tests, to check your general health and fitness.
If you’ve been having problems with eating and have lost weight, you may be given extra help and support with your diet to help prepare you for the operation. If you smoke, stopping smoking or cutting down before your operation will help reduce the risk of complications after your surgery.
You may have some of the following tests.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of your body. The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and won’t harm anyone you come into contact with. You’ll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the CT scan is over.
This scan combines a CT scan and a PET (positron emission tomography) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body. PET-CT scans give more detailed information about the part of the body being scanned. Sometimes, they can show up areas of cancer that may be missed by other scans.
Before you have the scan, you’ll have a mildly radioactive liquid injected into a vein, usually in your arm. The radiation dose used is very small. The scan will be done about an hour later and usually takes 30-90 minutes.
MRI (magnetic resonance imaging) scan
This scan may be done to help plan the operation. It’s similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. It may be done to help the surgeons plan the operation you’re going to have.
Before the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you’ll be asked to lie very still on a couch inside a long tube (cylinder) for about 30 minutes. It’s painless, but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
If scans or other tests suggest there may be cancer in an area of your body outside your pelvis, you may have samples (biopsies) taken to check. A biopsy is usually taken by putting a fine needle into the area to be tested and withdrawing a sample of cells. This is called a fine needle biopsy or fine needle aspiration (FNA). The sample of cells is then sent to the laboratory to be checked.
This test can generally be done as an outpatient, so you can go home on the same day.
Before the pelvic exenteration, an exploratory operation may be needed so your surgeon can look inside your pelvis to check the cancer can be removed with surgery. This is done under a general anaesthetic.
There are two ways in which this can be done: laparocscopy and laparotomy.
This is sometimes called keyhole surgery, as only very small cuts (about 1cm or half an inch long) are made in the tummy. The surgeon puts a thin, flexible tube with a camera on the end (laparoscope) through these cuts. By looking through the laparoscope, the doctor can examine inside the pelvis.
In this operation, the surgeon makes one larger cut in the tummy to examine inside the pelvis.
Going into hospital for pelvic exenteration
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If tests show that pelvic exenteration may offer you the chance of a cure, and you decide to go ahead with the operation, you’ll be admitted to hospital for the surgery.
A team of specialists will be involved in your care. This team will include surgeons, an anaesthetist (who keeps you asleep during the operation) and specialist nurses. Other people who may be in the team include dietitians, physiotherapists and a counsellor or psychologist.
Before your surgery, the surgeon will come to see you and explain the operation to you, so you have an idea of what to expect in the days following the operation. You’ll also see a nurse who specialises in the care of people with stomas (called a stoma nurse). They will explain about stomas and answer any questions you have about them. After the operation, the stoma nurse will teach you how to look after your stomas and give you information and support to help you cope with any problems.