This information leaflet provides specific information about your surgery and should be read alongside the ‘Gynaeoncology patient information to prepare you for your surgery and recovery’.
What is a pelvic mass?
Pelvic mass is a term that we use to describe an abnormal growth of tissue within the pelvis. Masses can be benign (not cancerous), borderline or malignant (cancerous) growths. At this time we do not know if your pelvic mass is cancerous or not but may have features that make us suspicious that it may be cancer.
Why do I need surgery for a pelvic mass?
The majority of patients chose to undergo surgery and this can either be done by laparotomy (an ‘open’ surgery) or by laparoscopy (‘keyhole surgery’). Other than biopsy under CT or Ultrasound guidance, surgery is the only way to find out whether your pelvic mass is cancerous or noncancerous and to remove it at the same time as part of your treatment. Not every patient is suitable for a laparotomy and laparoscopy and your doctor will guide you about what type of surgery you are suitable for.
What are the alternatives of not having surgery?
Surgery is a way of getting a diagnosis of what the pelvic mass is, and if the mass is ovarian cancer to start this treatment. If you feel that you do not want to have surgery other options will be discussed with you by your medical team. If you are diagnosed with ovarian cancer, surgery alone is often not enough and you may also require chemotherapy.
What happens during surgery for a pelvic mass?
The name for this type of surgery is a laparotomy (cut on your tummy). A laparotomy is done under a general anaesthetic (you are asleep during the surgery). The surgeon will make an up and down incision (cut) on your abdomen (tummy) starting at the top of the pubic hair line and going up to, and sometimes beyond the belly button (umbilicus.)
What is a frozen section?
The surgeon will remove the mass (usually an enlarged ovary) and send this straight away to the hospital laboratory. In the laboratory, a Pathologist (specialist laboratory doctor) will freeze the tissue so they can examine it under the microscope. This process is known as a ‘frozen section’. The Pathologist will discuss the result with your surgeon during the surgery to tell them if they think the tissue is cancerous or not. This process takes approximately 30 minutes so is used to help the surgeon decide what further surgery is needed. If the frozen section shows noncancerous (benign) changes your choices will include no further removal of tissue or hysterectomy and removal of the other ovary and tube. Your doctor will discuss which option you would prefer before surgery.
If the frozen section shows that you have cancer or a borderline tumour (growth) you will usually have a total hysterectomy (removal of the womb and the neck of the womb), removal of both fallopian tubes and ovaries. You may also need to have the pelvic lymph nodes (glands) and possibly the lymph nodes around the aorta removed (a large blood vessel in the abdomen). Lymph nodes are tiny structures (usually the size of a pea) that are found throughout the body. They are important in moving fluid around the body. It is important to remove them when cancer is suspected as sometimes cancer can spread, to lymph nodes.
Most patients will have a CT scan before their surgery and your doctor will inform you if the scan suggest that there is a cancer that has spread into the abdomen from the pelvic mass. All patients having surgery for a pelvic mass will have the possibility of bowel surgery discussed with them. This is either because there may be injury to the bowel during surgery or because the bowel is involved with cancer and in order to remove the cancer the surgeon has to remove part of the bowel. The surgeon may be able to re-join the ends of the bowel once the section that was injured/involved with disease is removed. This is called an anastomosis.
Occasionally it is not possible or not safe to re-join the bowel and instead the end of the bowel is pushed through the abdomen out onto the skin to form a stoma. This lets your stool (bowel contents) empty into a stoma bag which is attached onto your skin (see below image).
A stoma can be permanent but in many cases can be reversed in the future with smaller surgery. The chance of having a stoma is low, less than 10%, and most patients do not require this extra bowel surgery.
Surgery to preserve fertility
In some cases where the suspected cancer only affects one ovary it may be possible to undergo surgery that can spare fertility that does not remove the womb and other ovary (so the patient can still have children in the future). There is always the option of having further surgery once your family is complete. This can be discussed in further detail with your medical team and clinical nurse specialist.
Can there be any complications or risks associated with this surgery?
Before you have your surgery you will be told about the risks of the surgery and you will be asked to sign a consent form which will list the potential risks. Please ask questions at any time. More ‘serious’ complications can include:
- General anaesthetic carries a small chance of complication. This will be discussed with your anaesthetic doctor before your surgery. It is important to realise that these risks and complications are rare and every care is taken to keep the risks as low as possible.
- Infection- The risk of after surgery infections is reduced by giving “preventative” antibiotics around the time of surgery but infection can still sometimes occur in the chest, wound, pelvis or urine. Infections are usually easily treated with antibiotics.
- Bleeding (haemorrhage) – This may occur during the surgery or rarely afterwards. Blood transfusion is required in around one in five surgeries. You may need to return to theatre in the rare case of internal bleeding after the surgery.
- Injury to the ureters or bladder- the ureters carry the urine from the kidneys to the bladder, where the urine is stored before being urinated out. The ureters and kidneys can be damaged at the time of the surgery due to being so close to where the pelvic mass is being removed. This damage will be repaired during the surgery. Some people may have some difficult passing urine after the surgery, this may mean needing a catheter in your bladder for a period of time. This is usually only for a few days but sometimes longer. 5 www.qegateshead.nhs.uk
- Clots (thrombosis) – It is possible for clots of bloods to form in the deep veins of the legs and pelvis, this is called a deep vein thrombosis (DVT). This will normally cause pain and swelling in the affected leg and is relatively simply to treat using blood thinning drugs. In rare cases it is possible for a clot to break away and be deposited in the heart or lungs. If this occurs it is a potentially serious complication but several measures will be taken to reduce the risk of this happening. Moving around as soon as possible after your surgery can help as can wearing special surgical stockings and having injections to thin your blood.
- With every surgery there is a very small risk of death.
More common risks that can occur from this surgery
- Anaemia
- Fatigue / tiredness
- Urinary frequency or loss of control
- Numbness, tingling or burning sensation around the scar which may take weeks or months to resolve.
- Pain/discomfort
- Bruising
- Delayed wound healing
- Scarring of the skin or scar tissue inside (adhesions)
- Lymphodema
- Menopause
Possible longer term implications of treatment
Following your surgery you may experience some of these problems. Your medical and nursing teams are available to support you and to help to address any problems that may occur.
- Leg swelling (lymphoedema) – In some cases when the lymph nodes are removed. This is a build-up of lymph fluid which mostly affects the legs. But it can develop in other body areas such as the abdomen (tummy area), genitals and pelvic area. If this were to occur you would be referred to a nurse led lymphoedema clinic.
- Menopause (if not already menopausal) – some of the main physical effects are vaginal dryness, hot flushes, mood changes and low libido (sex drive). In some cases women can start hormone replacement therapy however this will depend on the outcome of your surgery.
- Change in bladder/bowel habit.
- Effects on sexual functioning (reduced libido, discomfort and bleeding) – Some women find that their libido decreases this is normal.
- Emotional/social concerns of diagnosis and treatment
How will I feel emotionally after the surgery?
A laparotomy for a pelvic mass can be a very stressful event and many women feel tearful and emotional at first. Being tired and in pain can make these feelings worse. Some women find that once they are at home and have more time to think things through that they can feel very low in mood. It may help for you to speak about your feelings at this time with your gynaecological oncology nurse specialist. They are able to offer increased levels of support, advice and guidance about your illness and can point you in the direction of other forms of support as you need it.
When can I have sex?
Following surgery, you may not feel physically or emotionally ready to start having sex again for a while. We normally advise women not to have sexual intercourse for 6 weeks following surgery. During this time, it may feel important for you and your partner to maintain intimacy, despite refraining from sexual intercourse. However, some couples are both physically and emotionally ready to resume having sex much sooner and this can feel like a positive step. If you have any worries or concerns, please discuss them with the gynaecology CNS. It can be a worrying time for your partner. He or she should be encouraged to be involved in discussions about the surgery and how it is likely to affect your relationship afterwards. If you do not have a partner at the moment, you may have concerns either now or in the future about starting a relationship.
Please do not hesitate to contact the Gynaeoncology CNS if you have any queries or concerns about your sexuality, change in body image or your sexual relationship either before or after surgery.