Pelvic exenteration

If after the initial treatment, your cancer comes back in the pelvic area, it may be possible to have an operation called a pelvic exenteration . This is a major operation and involves removing some or all of the structures in the pelvis, including the womb| , cervix| , vagina, fallopian tubes and ovaries,  bladder| and the lower end of the large bowel (rectum ). This type of operation is only carried out when cancer has come back (recurred) and there are no other treatments available. It’s only suitable for a small number of women and various investigations and scans will be needed to see if it’s possible.

The surgery is divided into 2 stages:

• Removal of the tumour and nearby structures in the pelvis such as the bladder, rectum and vagina – some or all of which may be attached to the cancer and have to be removed.
• Reconstruction of the pelvic organs, such as the bladder and rectum so that it’s possible to pass water and stools (bowel motions).

Reconstructive surgery

The operation involves creating two openings ( stomas ) on the abdominal wall if both the bladder and rectum have been removed. This means you will need two stoma bags: one to collect bowel motions and one for urine. These stomas are known as a colostomy and a urostomy .

Sometimes, if only part of the rectum is removed during surgery, it may be possible for the bowel to be reconnected to the rectum at a later stage. Often, the rectum can be reconnected during the operation, but as a precaution a stoma for the bowel is made and this is then reversed some months later. In this case the bowel stoma will only be temporary. 

Occasionally if the bladder is removed it may be possible to have a new bladder created from part of the bowel. This new bladder only requires a small stoma and you don’t need to wear a bag over it. Urine is drained by putting a catheter into the stoma several times a day. You can be taught how to do this yourself. This type of surgery is complicated and only suitable for a small number of people. Your doctor will be able to discuss with you whether it is suitable for you. 

Before the operation you will see a nurse who specialises in the care of people with stomas (a stoma nurse ). The nurse will explain all about stomas and how to look after them and can answer any questions you may have. The stoma nurse will also visit you after the operation to give you practical help and emotional support.

The operation also involves making (reconstructing) a new vagina. Unfortunately because scar tissue easily forms, this often results in the new vagina being less flexible and shorter in length.