Having your operation for anal cancer

There are a couple of different operations for anal cancer, and the following information may not apply to them both. Some people need bigger operations than others and these take longer to get over. This is a general outline for major anal cancer surgery.

Before your operation, you may need

• Blood tests to check your general health and to make sure your liver and kidneys are working normally
• A chest X-ray to check that your lungs are healthy
• An ECG to check that your heart is healthy

You may have had some of these tests when your cancer was diagnosed. If so you may not have to repeat them. You may also have

• Breathing tests (called lung function tests)
• An ECG while you are exercising

These tests ensure that you are fit enough to make a good recovery from your surgery.

Your surgeon will give you detailed information about your surgery and recovery. If you need to have a colostomy, the specialist stoma nurse will prepare you for what to expect and teach you how to care for the stoma. Do ask as many questions as you need to. It may help to make a list of questions before you go into hospital. There are some suggestions for questions at the end of this section.

On the evening before your surgery, your nurse will give you an energy rich drink. This is to help you recover more quickly from the operation.

To start with, you are likely to have several different tubes in place

• A drip (or intravenous infusion) into your arm to give you fluids until you are eating and drinking
• A fine tube, called a wound drain, into the area of the surgery to drain away any fluid that collects - this helps the wound to heal

You may also have

• A tube into your bladder (catheter) to drain urine
• A tube down your nose into your stomach (nasogastric tube) to drain fluids and stop you feeling sick

Your nurses will encourage you to get up and about as soon as possible after your operation. You are at a higher risk of developing blood clots and chest infections when you are not moving around as much as you would normally. A physiotherapist will teach you breathing and leg exercises. Breathing exercises help to stop you getting a chest infection. Leg exercises help stop clots forming in your legs. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

 

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

You will almost certainly have some pain for the first few days after your operation. But there are many pain killing drugs you can have. It is important that you tell the nurse or doctor as soon as possible if you have any pain. With your help, they will find the right type and dose of painkiller for you. Painkillers work best when you take them regularly, so take them as they are prescribed. If your pain is well controlled you will be able to do the leg and breathing exercises more easily, which reduces your risk of complications.

There is a section about pain and pain control that you may find helpful.

Surgeons usually say you can't eat or drink for a few days until your bowel has started working normally again. You start with sips of water. The amount you can have gradually increases day by day until you are able to eat a light diet. This normally takes about four or five days.

Evidence from recent research has suggested that you may recover more quickly and be less likely to get an infection if you start eating and drinking after 24 hours. This may not be suitable for everyone or in every circumstance. You will probably be more likely to be sick if you eat and drink early on. So listen to your own surgeon. But don't be afraid to ask questions if there is anything you don't understand or want to know more about.

Even though you may not feel like eating so soon after your operation, your nurse may ask you to have another energy rich drink. This may help to speed up your recovery.

If you have had an abdominoperineal resection, you will have one or more wounds on your abdomen and one in your perineal area (the area where your anus was). When you come round from the anaesthetic, you will have dressings on your wounds. Your nurse will leave them on for a couple of days. Then they will change the dressings and clean the wound.

The wound drains are left in until they stop draining fluid. Generally this is about 3 - 7 days after your operation. Most surgeons these days use stitches that dissolve away by themselves once your wound has healed. But if you have stitches or clips that have to be removed, they will be left in for at least 10 days and taken out before you go home.

Sometimes, if the wound is not quite healed, but you are otherwise well, you can go home with the stitches or clips still in. You will have to go back to the hospital to have them taken out. Or a district nurse may visit you at home and take them out there.

As well as the specialist stoma nurse, there is now usually a colorectal nurse specialist as part of the surgical team. The nurse will

• Give you advice and support
• Make the arrangements for you to go home
• Book your follow up appointments before you go

Your nurse will make sure you have their phone number so you can ring if you are worried or need advice when you get home. Some specialist colorectal nurses will visit you at home, but not all are able to do this.

You will probably be ready to go home about a week to 10 days after your operation. You will have an out patient appointment made before you leave the ward. This is usually six weeks after your operation. If you have a colostomy, a stoma nurse may arrange to see you at home.

If you live alone, or might have difficulty managing after your operation, let the nurses know when you first go into hospital so plans can be made to help you when you go home.