Before having pelvic exenteration

Pelvic exenteration is a major operation (surgery). It is not suitable for everyone. It will affect you physically and emotionally. Your surgeon and specialist nurse can help you decide whether it is right for you. You may find it helpful to have a family member or close friend with you during appointments.

Your doctors will also make sure the cancer has not spread outside of the pelvic area. This is to find out if surgery is possible. You will also need tests and scans to make sure you are fit enough for the operation and that it is suitable for you.

If the operation is suitable for you and you decide to have it, there will be specialists involved in your care. These will include a specialist surgeon and a stoma nurse. You will meet them before the operation. You can ask them any questions you have.

Before having the surgery

Pelvic exenteration is a major operation (surgery). It is not suitable for everyone. You will have tests to make sure you are fit enough to have the operation. Your cancer doctor may talk to you about having other cancer treatments before the surgery, to shrink the cancer. This is called neo-adjuvant treatment.

If you decide (consent) to have pelvic exenteration, you will be referred to a specialist centre for the operation. You will be seen by a surgeon who is experienced in doing this type of surgery.

Before the operation, you will see a specialist cancer nurse. They will give you information and emotional support. Your specialist nurse and surgeon will talk to you about how the operation will change parts of your life.


Understanding the surgery

Recovery after pelvic exenteration can be difficult, both physically and emotionally. To help you decide whether to have the surgery, you need to understand what it involves.

Your surgeon or specialist nurse will explain the operation to you and can help you decide whether it is right for you. They will tell you about any permanent changes you may have. This include changes to your sex life and how you go to the toilet. You may find it helpful to have a family member or close friend with you during the appointments.

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


Preparing for the surgery

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 dietician. 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.

An image of a woman holding a recipe book.

Deanne talks about help from her dietitian

Cancer treatment had a big impact on Deanne's body, but dietitian Michelle worked on a personalised eating plan to help Deanne regain her strength.

Deanne talks about help from her dietitian

Cancer treatment had a big impact on Deanne's body, but dietitian Michelle worked on a personalised eating plan to help Deanne regain her strength.


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 build up a three-dimensional picture of the inside of the 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 will not harm anyone you come into contact with.

CT scan
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 is important to let your doctor know if you are 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 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 cannot 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. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.

MRI scan

An MRI scan 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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Examination under anaesthetic (EUA)

This is an internal examination of the rectum, done under a general anaesthetic. It allows your surgeon to examine you thoroughly and check the extent of the cancer, without causing you discomfort. They may also take small samples of tissue (biopsies). This helps them plan your operation.

You can go home once you have recovered from the anaesthetic. This is usually on the same day.

You may have some slight bleeding for a few days after an EUA. Your surgeon or nurse can tell you more about the examination and what to expect.

Exploratory or staging surgery

Before pelvic exenteration, your surgeon may do an exploratory surgery. This lets the surgeon look inside your pelvis to check that the cancer can be removed with surgery. This is done under a general anaesthetic. There are two ways that this can be done:

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

Biopsies

You may have tissue samples taken during tests. This is called a biopsy. The sample of cells is then sent to the laboratory to be checked. This will 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). After a biopsy, you can usually go home the same day.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Going into hospital

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 multi-disciplinary 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. This is so you know what to expect in the days before and 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 how to take care of them. They can also answer any questions you have.

Tips for talking to your doctor

Find out how to get the most out of your appointments with a GP or doctor.

About our cancer information videos

Tips for talking to your doctor

Find out how to get the most out of your appointments with a GP or doctor.

About our cancer information videos

Back to Pelvic exenteration in women

Having pelvic exenteration

Pelvic exenteration takes about 8 hours – after the surgery, urine (pee) and stools (poo) will leave your body in a new way.