Pelvic exenteration for women and people assigned female at birth

Pelvic exenteration is a major operation to remove multiple organs in the pelvis. It can be used to treat cancer in the pelvis. The pelvis is the area of the body between the hips, in the lower part of the tummy (abdomen). It contains:

• the sex organs
• the bladder
• a section of the small bowel
• the lower end of the large bowel (colon, rectum and anus).

The pelvis also contains the pelvic bones, lymph nodes (glands), blood vessels and nerves.

For women, trans men and other people assigned female at birth, the sex organs you are born with include the:

• ovaries
• fallopian tubes
• uterus (womb)
• cervix
• vagina.

There are different types of pelvic exenteration:

• anterior exenteration
• posterior exenteration
• total exenteration
• other exenteration operations.

Your surgeon decides on the type of exenteration you need, depending on the results of the tests and scans you have had. They will discuss these at a multi-disciplinary team (MDT) meeting. It also depends on:

• the type of cancer you have
• where the cancer is in the pelvis
• what treatments you have had before.

If you have had genital gender-affirming surgery, you may have additional questions about how this affects the treatment you need. Your doctor or nurse can give you more information about what your operation will involve.

We also have more information for trans and non-binary people about cancer, cancer treatment and finding support, that you may find helpful.

This operation involves removing organs in the front part of the pelvis. The surgeon will remove:

• the bladder
• the cervix
• part or all of the vagina
• the womb
• the ovaries if necessary.

This operation involves removing organs in the back part of the pelvis. The surgeon will remove:

• the cervix
• the womb
• part or all of the vagina
• the lower part of the bowel – the rectum and sometimes the anus
• the ovaries if necessary.

This surgery involves removing all the organs in the pelvis. The surgeon will remove:

• the womb
• the cervix
• part or all of the vagina
• the bladder
• the lower part of the bowel - the rectum and sometimes the anus
• the ovaries if necessary.

Sometimes your surgeon may suggest an operation that involves taking more areas of tissue. For example, as part of the operation they may need to remove:

• muscles
• nerves
• bones
• blood vessels.

If you need more extensive surgery like this, your surgeon will explain what is involved.

Depending on what type of pelvic exenteration you have, parts of the body may need to be reconstructed. This means having plastic surgery to rebuild parts of the body that have been removed.

To do this the surgeon may use flaps of skin, fat and muscle. These are taken from other parts of the body such as the buttocks, thighs or tummy. These flaps are shaped and stitched into place. This may be done at the same time as your pelvic exenteration operation, or at a later date.

You will have a wound where these flaps are taken from. A nurse will look after this when you are in hospital and will arrange for it to be looked after when you get home.

If part or all of the vagina is removed, sometimes the surgeon can make a new one. This is called vaginal reconstruction.

If the bladder or rectum are removed during your surgery, the surgeon will make a new way for urine (pee) or stools (poo) to leave the body. Your surgeon or nurse will talk to you about this before surgery. It usually means you will have a stoma after surgery.

A stoma is an opening that the surgeon makes on your tummy (abdomen). You may have a stoma that:

• allows stools to pass out of the body, called a colostomy
• allows urine to pass out of the body, called a urostomy
• allows urine and stools to pass out of the body, called a Carter stoma or double barrel stoma.

You wear a disposable bag over the stoma to collect the stools or urine.

This type of surgery removes the parts of the body needed to get pregnant. For some people, this can be difficult to cope with. It is important to talk to someone you trust, or you may find it easier to talk to a counsellor. Your GP can refer you.

Macmillan is also here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online
• Visit our Online Community to talk to people who have been affected by cancer, share your experience, and ask an expert your questions.

If you have not been through the menopause, it will start after pelvic exenteration. Your doctor or a menopause specialist should support you. They will talk to you about how to manage menopausal symptoms.

You can ask to be referred to a fertility specialist before having cancer treatment. You may be able to store your eggs or embryos. These are fertilised eggs.

If you decide you want to try and have a child in the future, you may be able to use a surrogate. A surrogate is someone who may be able to carry the child for you in their womb. Or you may want to consider adoption in the future.

We have more information about fertility in women.

As well as the support available from Macmillan, there are other organisations that can offer you practical and emotional support.