February 13, 2021

I don’t know if anyone reading this blog also has cancer but, if you’re out there, I’ve put together a list of questions for the surgeon. Some of the questions are general and others are specific to my situation but they may get you thinking about other/different questions to ask your doctor if you’re confronting surgery too.

It has been my experience that people often don’t like to be asked questions when it comes to their field of expertise. I hope that my questions are understood for what they are – a patient’s attempt to understand what’s going to happen to her body during the surgery and AFTER the surgeons go home – if I have the surgery.

For me, getting the facts and understanding them is important.

So here goes:

General
  1. What is the rationale for performing the surgery?
  2. What is the rationale for performing the surgery now and not at a later date?
  3. Will I have a surgeon from gynecology and urology in addition to colon/rectal performing the operation as a team? When can I speak with the other surgeons?
  4. Approximately how long will the operation take?
  5. Is there a potential negative effect from being under anesthesia for the length of the operation (assuming a lengthy operation)?
  6. Will I need to give blood prior to the surgery?
  7. Will I likely need a transfusion during or after surgery?
  8. How long do I need to be off chemo prior to the operation?
  9. How long after the operation can I re-start chemo?
  10. Will the surgery interfere with the stoma/stoma appliance?
  11. Will I need to do wound packing?
  12. Will I need to go to a rehab facility?
  13. How long will the recovery take?
  14. Will the pelvic muscles be removed or damaged as a result of the surgery? Abdominal muscles?
  15. What will happen to the pelvic floor?
  16. Is it accurate that organs could fall out of the vagina if the pelvic floor is sufficiently weakened?
  17. Will nerve bundles be cut or permanently damaged? If so, where?
  18. After recovery, how many pounds will I be able to lift?
  19. After recovery, how long will I be able to sit? Drive?
  20. After recovery, how likely is it that I will experience ongoing pain? In what areas?
  21. Post-surgery issues:
    1. Organ dysfunction
    1. Slow recovery of other body functions (i.e., bowel)
    1. Lymphedema
    1. Complications from surgery (e.g. infection, others that are site-specific)
Peritoneum/Pelvic Wall
  1. Based on the scans, is it possible to determine whether the tumor is still attached to the pelvic wall?
  2. If the tumor is still attached to the pelvic wall:
    1. Can you remove it?
    1. Will you abort the operation?
    1. Will you debulk it?
      1. Why would you choose to debulk or not debulk the tumor if you cannot remove it entirely? What is the goal of debulking?
      1. If it is debulked, will a specialist surgeon (colon/rectal, gynecology, urology) debulk the tumor in each of those areas?
  3. Will you be able to determine if the tumor is still attached to the pelvic wall prior to removing any organs?
  4. If you cannot remove the tumor, will you refrain from removing any organs?
  5. Are there any circumstances under which an organ would be removed but the tumor would remain in part or in whole?
  6. What are the potential side effects/complications/physical impairments that could result from surgery on the pelvic wall?
Colon
  1. How much of the colon will need to be removed?
  2. Will the digestive system and ability to absorb protein, vitamins, etc. be negatively affected?
  3. What are the potential side effects/complications/physical impairments that could result from the surgery on the colon?
Rectum
  1. Based on the scans, is it possible to determine whether the tumor is still in the upper rectum? If it is, is the entire rectum removed or just a portion?
  2. Is it possible to determine prior to surgery how much of the rectum needs to be removed?
  3. Is it possible that I will have difficulty sitting or experience a sensation such as a phantom rectum? If so, for how long? (Had difficulty sitting after colostomy for months.)
  4. What are the potential side effects/complications/physical impairments that could result from the surgery on the rectum?
Bladder
  1. Based on the scans, is it possible to determine whether the tumor is attached to or touching the bladder?
  2. If the tumor is touching the bladder and/or bladder tissue is used to construct a new ureter:
    1. Will I become incontinent? During the day or at night?
    1. How long will I be able to hold urine? Can you make this determination based on the size of the bladder as it is being surgically altered?
  3. What are the potential side effects/complications/physical impairments that could result from the surgery on the bladder?
Ureter
  1. Is it possible to determine from the scans how much of the ureter will need to be removed? If so, how much?
  2. Is it possible to attach the remaining ureter to the bladder without constructing a new ureter out of bladder tissue?
  3. Will a constructed ureter have to be replaced in the future or potentially fail? What are the risks/potential complications of constructing a new ureter out of bladder tissue?
  4. Would the kidney associated with the ureter ever be removed?
  5. What are the potential side effects/complications/physical impairments that could result from the surgery on the ureter?
Uterus/Ovaries
  1. Why has it been determined that the ovaries and uterus must be removed?
  2. Is it possible to leave one or both ovaries intact due to their continuing role in hormone production?
  3. Is it preferable to remove the ovaries and, if so, why?
  4. What is the impact of the loss of those hormones on the body? (i.e., skin, osteoporosis?) How might one ameliorate the impact?
  5. If the uterus is removed, is the cervix removed as well? What about the upper portion of the vagina? If so, under what circumstances?
  6. What are the potential side effects/complications/physical impairments that could result from the surgery on the uterus/ovaries/cervix/vagina?

Those are my thoughts. Hope they’re helpful …

Love, Molly

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