This information leaflet is to help you prepare for the above procedure. Your doctor has decided that you need to come into hospital for an examination under anaesthetic. This is a pelvic examination which is carried out while you are asleep.
Why do I need examination under anaesthetic?
If a definite diagnosis has not been confirmed, your doctor will need to perform an examination under anaesthetic and possibly take a sample of tissue (biopsy) in order to achieve an accurate diagnosis.
If you have already had a diagnosis of cancer these investigations will give your medical team a much better understanding of the type and size of the cancer and will help them to plan the best possible treatment for you – this may be surgery, radiotherapy, or chemotherapy, or perhaps a combination of these.
Whilst you are asleep, during the anaesthetic, the doctor will be able to examine you more thoroughly.
The examination depends on where your suspected cancer is but may include:
- The use of a speculum (instrument used during a routine smear test) to examine the neck of the womb (cervix).
- Manual examination by gently inserting a finger into the vagina and rectum (back passage).
- Examination of your vulva (the outside genitalia).
- During the examination, a small piece of tissue may be removed and sent to a laboratory for further tests (a biopsy).
- You may also have a cystoscopy and/or a hysteroscopy if appropriate.
What is a cystoscopy?
A cystoscopy is when, under general anaesthetic, a small telescope (about 5mm or half a centimetre wide) is inserted into your urethra (the tube which drains urine from the bladder when you go to the toilet). Your bladder is then filled with fluid and the lining is examined using a camera and light on the end of the telescope.
Your doctor will then look for anything unusual. Before you go under anaesthetic you will have been asked to give your consent to remove samples (biopsies) for further tests, if this is needed.
What is a hysteroscopy?
A hysteroscopy is when, under general anaesthetic, a small telescope is inserted into the vagina, through the cervix (neck of womb) and into the womb. The womb is then filled with a small amount of fluid and the lining of the womb is examined using a camera and light on the end of the telescope. Your doctor will then look for anything unusual, take tissue samples (biopsies) or they may take a scraping of the lining of the womb, with an instrument called a curette. The sample taken is then sent to a laboratory and further tests performed.
Can there be any complications or risks associated with this procedure?
Every care is taken to ensure that you are as safe as possible, and the majority of patients do not experience any problems. Before you have your procedure, you will be informed about your individual risks. It is very important that you understand these risks and have all your questions answered before you sign your consent form.
The potential complications are listed below:
- General anaesthetic- the anaesthetic doctor will discuss your individual risks before your surgery.
- Infection is possible and could occur in your pelvis, bladder, or chest. If this does happen, it may need treatment with antibiotics (this complication is rare)
- Vaginal spotting of blood for a few days after the procedure is normal.
- Heavy bleeding (haemorrhage) following surgery is also possible, and in serious cases a blood transfusion and possibly another surgery could be required. (This complication is very rare.)
- Bladder damage – there is also a very small risk of damage to the bladder and/or womb including a puncture. If this did occur further surgery could be required. (This complication is very rare)
How do I prepare for the Examination under Anaesthetic?
The examination/procedure is usually a day case procedure (meaning that you are admitted to hospital and then discharged home the same day) unless you have any medical problems which require a longer stay in hospital.
It is important that you bring in all your medications (including tablets, inhalers, and medical sprays) with you when coming into the hospital. If you have any questions at all, please ask your doctor or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your hospital appointments.
What happens afterwards?
When the surgery is finished you will wake up and be taken to the recovery area. A nurse will stay with you until you are fully awake. When you are awake you will be taken to the day suite or ward, where you may rest until you have fully recovered. You will probably feel quite drowsy for several hours.
Going Home
You will be able to go home once you have recovered from the anaesthetic. You will need to arrange for someone to drive you home and have someone to stay with you for the first 24 hours following the anaesthetic.
General anaesthetic can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery, or sign legal documents for 24 hours after the procedure. Nausea, discomfort and tiredness are common side effects during the first few days following surgery. Prior to going home please ensure you are aware of your follow up plan, please speak to either the medical or nursing team if you do not have a follow up appointment.
Pain Relief
You may have some mild discomfort for the first few days following your procedure. Simple pain relief, such as paracetamol should help (if you are able to take it). If you require any additional pain relief, please speak with the nursing or medical staff prior to discharge.
Preventing Infection
You may experience some light bleeding. Use sanitary pads rather than tampons until your bleeding has stopped. Avoid sources of infection, such as swimming pools or saunas until bleeding has settled.
Physical Activity
You will have to take it easy for a day or so but should be able to return to normal daily activities after that.
Sexuality and Relationships
We advise you avoid sexual intercourse for the first week or at least until bleeding has settled.
What support is available for me?
You should have contact details of a clinical nurse specialist (key worker) from your local hospital. Even though you are having treatment at the Queen Elizabeth Hospital, your local nurse remains an important point of contact for you. Contact details will also be provided to you for the clinical nurse specialists from the Queen Elizabeth Hospital.
Research Projects
The Northern Gynaecological Oncology Centre is actively involved in several research projects with the aim of increasing understanding of cancer and improving care of all patients. You may be approached by a member of the research team during your investigation, treatment or during follow-up to be part of a research project that you may be eligible to participate in. Whilst we encourage all patients to consider getting involved, this is not essential, and your care will not be affected if you choose not to participate.