Talking to your healthcare team about pelvic exenteration

If pelvic exenteration may be suitable for you, you will be referred to a specialist centre to talk to:

  • a surgeon, who has experience of this type of surgery.
  • a specialist cancer nurse, who can give you information and emotional support

They will talk with you about:

  • Whether the operation is right for you
    Your surgeon or specialist nurse and can help you decide whether the operation is right for you. They will tell you about any permanent changes you may have. You may find it helpful to have a family member or friend with you during the appointments.
  • How you will cope with recovery
    Recovery after pelvic exenteration can be difficult, both physically and emotionally. Your specialist nurse or surgeon can help you understand more about what recovery will be like.

It can be helpful to talk to someone who has had the operation. Your surgeon or specialist nurse may be able to arrange this for you.

Your cancer doctor may also talk to you about having other cancer treatments before the surgery, to shrink the cancer. This is called neo-adjuvant treatment.

We have more information about:

Deciding if pelvic exenteration is suitable

Pelvic exenteration is only suitable for a small number of people. You will have tests and scans to see if it is suitable for you.

Your doctors need to make sure you can cope with the surgery. You may have heart and lung tests. This is to check your general health and fitness. If you have other health problems it may be more difficult for you to recover from the operation. Your doctors will also do tests to see if the cancer has spread.

If you have been having problems with eating, or have lost weight, you may be referred to a dietitian. This is to give you extra help and support with your diet and nutrition before and after the surgery. If you smoke, stopping smoking or cutting down before your surgery may make your recovery easier.

Having tests before pelvic exenteration

You will have tests to make sure you are fit enough to have the operation.

You may have some of the following tests:

CT scan

A CT scan takes a series of x-rays, which build up a 3D picture of the inside of the body.

PET-CT scan

A PET-CT scan is a combination of a CT scan and a positron emission tomography (PET) scan. Combining the scans give more detailed information about the part of the body being scanned.

MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.

Examination under anaesthetic (EUA)

You may have an EUA so your surgeon can find out the extent of the cancer. They may take small samples of tissue (biopsies).

Exploratory or staging surgery

You may have an exploratory or staging surgery so your surgeon can look inside the pelvis to check that the cancer can be removed with pelvic exenteration. This is done under a general anaesthetic. There are two ways:

  • Laparoscopy or keyhole surgery
    Very small cuts are made in the tummy (abdomen. They cuts are usually about 1cm (half an inch) long. The surgeon puts a thin tube with a camera on the end (laparoscope) through them. The camera sends images to a monitor, so the surgeon can see inside the pelvis.
  • Laparotomy
    One larger cut is made in the tummy (abdomen) to look inside the pelvis.

Biopsies

You may have biopsies taken to help doctors understand the cancer. Biopsies may also be taken to check that the cancer has not spread outside the pelvis.

A biopsy is usually done by putting a fine needle into the area to be tested. The needle can take a sample of cells. This is called a fine needle biopsy (FNB) or fine needle aspiration (FNA).

Biopsies are usually done as part of an EUA or exploratory or staging operation. They may also be done when you have an examination of your bowel (colonoscopy) or bladder (cystoscopy).

Going into hospital for pelvic exenteration

If you and your doctors agree pelvic exenteration is the right treatment for you, you will be admitted to a specialist centre.

A team of specialists will be involved in your care. This team is called a multidisciplinary team (MDT). This team includes:

  • surgeons
  • an anaesthetist, who keeps you asleep during the operation
  • specialist cancer nurses
  • specialist stoma nurses
  • dietitians
  • physiotherapists.

Your MDT may also include a counsellor or psychologist.

Before your operation, the surgeon will explain the operation to you so you know what to expect before and after the operation. You will also see a stoma nurse, who specialises in the care of people with stomas.

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