What to expect before pelvic exenteration

Pelvic exenteration is a major operation. It will change your sex life and the way you go to the toilet. Recovery after the operation can be difficult, both physically and emotionally. Your surgeon or nurse can help you decide whether you want the operation or not. You may find it helpful to have a relative or close friend with you during the appointments, so they can support you.

Before you decide whether or not to have the operation, your doctors will have to make sure the cancer has not spread outside of the pelvic area. If it has, you won’t be able to have the operation as it won’t cure the cancer. You will also need tests to make sure you’re fit enough. You may also have an operation to look at your pelvic area. This is to check that the cancer can be removed successfully.

If tests show that pelvic exenteration is suitable for you and you want the operation, specialists will be involved in your care. You will meet the surgeon and a stoma nurse before the operation.

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. You’ll also need to understand how the operation will change parts of your life.

Finding out about the operation

Pelvic exenteration is a major 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. You may find it helpful to have a relative or close friend with you during the appointments, so they can support you.

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 a similar operation. These organisations include Jo's Cervical Cancer Trust and The Ileostomy & Internal Pouch Support Group.

Physical preparation for the operation

Pelvic exenteration is only possible for a small number of people. Before having the operation, you will have investigations and scans to make sure pelvic exenteration is suitable for you.

For a cure to be possible, the cancer must be contained in the pelvis. Your doctors will do tests to make sure the cancer hasn’t spread outside of the pelvic area. This usually involves having one or more scans and possibly other tests. If any cancer is found outside the pelvis, the operation would not be successful and so will not 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 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 you’ve had it.


Tests before pelvic exenteration

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 to 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.

Having a CT scan
Having a CT scan

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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 will probably be able to go home as soon as the CT scan is over.

PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) 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. You may have to travel to a specialist centre to have one. You can't eat for six hours before the scan, although you may be able to drink.

A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. It usually takes 30–90 minutes. You should be able to go home after the scan.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it's safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you've ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

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, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you'll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It's also noisy, but you'll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Biopsies

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.

Exploratory or staging operation

Before the pelvic exenteration, an exploratory operation may occasionally 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 that this can be done:

Laparoscopy

This is sometimes called keyhole surgery, as only very small cuts are made in the tummy (abdomen). The cuts may be about 1cm or half an inch long. 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.

Laparotomy

During this operation, the surgeon makes one larger cut in the tummy to look inside the pelvis. 


Going into hospital for pelvic exenteration

If tests show that pelvic exenteration may offer you the chance of a cure, and you decide to have the operation, you’ll be admitted to hospital.

A team of specialists will be involved in your care. This team will include:

  • surgeons
  • an anaesthetist, who keeps you asleep during the operation
  • specialist nurses. 

Other people who may be in the team include dietitians, physiotherapists, and a counsellor or psychologist.

Before your operation, the surgeon will come to see you and explain the operation to you. This is so you have an idea of what to expect in the days after the operation. You will also see a stoma nurse, who specialises in the care of people with stomas. They will explain what stomas are and answer any questions you have about them. After the operation, the stoma nurse will teach you how to look after your stomas. They will also give you information and support to help you cope with any problems.

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Having pelvic exenteration

Pelvic exenteration takes about eight hours. After the operation, you will have new ways for urine and bowel motions to leave your body.