Pelvic exenteration for cervical cancer

A pelvic exenteration is an operation during which your surgeon removes:

• your cervix, womb and ovaries (if they haven’t been removed already)
• part or all of your vagina
• lymph nodes
• other organs in the pelvis such as the bladder or part of the bowel

How much surgery you have depends on where the cancer is.

When you might have a pelvic exenteration

A pelvic exenteration is used to treat:

• cervical cancer that has come back
• rarely, some people with stage 4A cervical cancer

This operation aims to try to cure your cancer. Because it’s a big operation, you must be fit enough to recover well. It is not suitable for everyone.

You usually have an examination under anaesthetic and scans first to check if the operation is possible for you.

It’s important to discuss this type of operation fully with your doctor or specialist nurse so that you know exactly what to expect after the operation.

What happens?

You have the operation while you are asleep (under general anaesthetic). During the operation, the surgeon removes:

• your cervix, womb and ovaries (if they haven’t been removed already)
• part or all of your vagina
• lymph nodes
• other organs in the pelvis, such as the bladder or part of the bowel

How much surgery you have depends on where the cancer is.

How you have pelvic exenteration

Your doctor will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have.

You might need to follow a special diet for a few days before the operation and take quite strong laxatives to make sure the bowel is as clean as possible. You may also need to have an enema when you get to hospital to clear your bowel.

Having a general anaesthetic means that you won’t be able to eat or drink for a number of hours before the operation. You usually stop eating at least 6 hours beforehand. You can usually drink water up to 2 hours before the procedure. Your doctor or nurse will give you instructions about this.

There are 3 types of exenteration operation:

• an anterior (front) exenteration
• a posterior (back) exenteration
• a total exenteration

Several doctors are usually involved with the surgery, including a:

• doctor specialising in cancers of the female reproductive system (gynaecological oncologist)
• bowel surgeon
• surgeon specialising in the urinary tract (includes the bladder and tubes that go from the kidneys to the bladder)
• plastic surgeon

Anterior (front) exenteration

An anterior exenteration is used if the cancer is at the front of the area between your hip bones (pelvis). With this operation, your surgeon removes the:

• cervix, womb, ovaries and all or part of the vagina
• lymph nodes
• bladder

After this operation you have an opening on the surface of your tummy (abdomen), called a stoma or urostomy. Your urine flows down the tubes from your kidneys (the ureters) and out of the stoma into a bag.

Or you might have a continent urinary diversion. This means you have a small pouch made from part of your bowel. This stores your urine inside your abdomen. You still have a stoma but urine doesn't leak out of it. There is a natural valve inside the part of the bowel used for the operation that keeps the stoma closed. To drain off the urine, you put a thin tube (catheter) into the stoma several times a day.

Posterior (back) exenteration

 A posterior exenteration is used when the cancer is at the back of the pelvis. In this operation, your surgeon removes the:

• cervix, womb, ovaries and all or part of the vagina
• lymph nodes
• back passage (rectum) and part of the large bowel (colon)

After this operation you have an opening on the surface of your abdomen called a stoma or colostomy. You wear a bag over the stoma to collect your poo (faeces).

Total exenteration

A total exenteration is used if the cancer is in the middle of the pelvis. In this operation, your surgeon removes the:

• cervix, womb, ovaries and all or part of the vagina
• lymph nodes
• lower bowel and rectum
• bladder

After this operation, you have both a colostomy and a urostomy. You will need to have a bag to collect your poo and a bag to collect your urine. In some hospitals, you may have one opening for both poo and urine.

Vaginal reconstruction

If your doctor needs to remove all of your vagina, they might be able to make a new one from skin and tissue from other parts of your body. Your doctor will discuss this before the operation so you know what to expect.

We have some information about vaginal reconstruction in the vaginal cancer section.

After surgery

You usually stay in hospital for 14 to 21 days. It can take up to 12 months to fully recover from the operation.

Problems after surgery

There are risks with any type of surgery. Your doctor ensures the benefits of having the surgery outweigh any possible risks.

Help and support

Pelvic exenteration is major surgery and affects you emotionally as well as physically. Your doctor and specialist nurse will make sure you have all the information and support you need.

You meet a member of the stoma team before you have the operation. They will go through what happens during the surgery and what you need to do afterwards.

They may be able to introduce you to someone who has already had this type of surgery. They can help explain what it will involve and what it is like coping with this type of surgery.