Before your operation for anal cancer
Before surgery, you meet members of your treatment team. And you usually have a pre operative assessment appointment and some tests. These are to check your fitness and to make sure you are ready for the 
and operation.
There are also things you can do to prepare yourself for the operation and going home afterwards.
Deciding to have surgery
It may be difficult to decide to have surgery for cancer. There are lots of things you might need to consider. This could include how big the operation is and what to expect afterwards.
You see members of your health care team before the operation. They explain all about the surgery, anaesthetic and afterwards. This may help you make the decision.
You might see some of the team at your pre operative assessment appointment. Or you might have an appointment to see them at a different time.
Who you see before your operation
Before you have an operation, you see your surgeon. You may also see:
- an anaesthetist
- cancer specialist nurse
- other members of your healthcare team
Who you see depends on which operation you are having and if you have any other health problems.
Surgeon
Your surgeon talks with you about:
- the operation
- the benefits of having surgery
- the possible risks
- what to expect afterwards
You have a chance to ask them any questions.
It is important that you understand about the operation and the risks and benefits. So ask them to explain anything that isn’t clear.
If you decide to have surgery, your surgeon asks you to sign a consent form. This is to say that you agree to have the operation.
Anaesthetist
An anaesthetist is a doctor who specialises in giving anaesthetic. They look after you while your surgeon is doing the operation and for a short while afterwards.
Before your operation, your anaesthetist makes sure you’re well enough for the anaesthetic and surgery. They explain about the type of anaesthetic you are going to have. They also explain what painkillers you will have after the surgery.
Colorectal specialist nurse
The colorectal specialist nurse is a qualified nurse who looks after people with bowel, back passage (rectum) and anal cancers. They help to organise the care between doctors and other health professionals. And make sure you have the information you need to understand the treatment.
They support you before, during and after treatment. And are normally your first point of contact if you have any questions or concerns.
Stoma nurse
If you are having a large operation called an abdominoperineal resection, you have a afterwards. This is because your surgeon removes your anus so you cannot pass poo from your bottom anymore.
The type of stoma you have for anal cancer is called a colostomy. This is where your surgeon brings the end of your large bowel (colon) out onto your tummy (abdomen). You wear a stoma bag over the colostomy to collect the poo.
You normally see your stoma nurse before your operation. This is a specialist nurse who looks after people with stomas. They talk with you about having a stoma and make sure you are prepared. And they help you find the best stoma bags.
Before your operation your stoma nurse marks on your tummy (abdomen) where your stoma is going to be. This is so you can find a place for it that suits your normal lifestyle.
Waiting for your surgery date
You may have to wait a couple of weeks for your operation date. This may feel like a long time and you might find it difficult emotionally. But it gives you time to have your pre operative assessment appointment and any tests you need.
It also gives you time to prepare yourself. This might include trying to cut down or stop if you smoke or drink alcohol. Or taking part in a programme.
Your pre operative assessment appointment
This appointment is to make sure you are well enough for the operation. And to prepare you for it.
At your appointment the pre operative assessment team checks your:
- general health
- weight
- blood pressure
- pulse
- temperature
They also explain how to prepare for your operation. This includes:
- when you need to stop eating and drinking beforehand
- if you need to stop taking any of your medicines before the operation
- if you need to take any medicine to clean your bowel before surgery and how to take it
- breathing and leg exercises – these are to help stop you getting a blot clot or chest infection after the operation
You can ask the pre operative assessment team any questions you have about going into hospital, your operation and going home afterwards. It helps to write down any questions you have beforehand and take them with you.
You can ask more questions when you go into hospital so don’t worry if you forget to ask some.
If you are having a large operation
If you are having a larger operation, the pre operative assessment team talk to you about the Enhanced Recovery After Surgery (ERAS) programme. This uses research to help people recover quicker after an operation. How they do this depends on what operation you are having. But it might include:
- setting goals before surgery for when you go home
- having carbohydrate drinks before your operation
- removing drips and drains as soon as possible
- sitting out in the chair soon after your operation
Tests before your operation
You have tests before your operation to check:
- you are well enough to have an operation and anaesthetic
- that you’ll make a good recovery from surgery
The tests you have depend on what operation you are having and any other health conditions you have. You might have some or all of the following tests:
- blood tests to check the level of
blood cells and how well your kidneys are working - a swab test to rule out some infections
- an
ECG (electrocardiogram) or echo (echocardiogram) to check that your heart is healthy - some people might have both - breathing tests (called lung function tests)
- a chest x-ray to check that your lungs are healthy
- a
cardiopulmonary exercise test
The pre operative assessment team will explain what these tests are for and how to prepare for them. You might have these tests as part of your pre operative assessment appointment. Sometimes you have them at a separate appointment.
Learning breathing and leg exercises
Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.
Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.
You start the injections after your operation. You might also wear anti embolism stockings or have pumps on your calves to help the circulation.
Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.
This 3-minute video shows you how to do the breathing and leg exercises.
Breathing and circulation exercises after surgery
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a huff. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
More information on preparing for surgery
We have more information on what happens before cancer surgery and how to prepare. This includes:
- questions you may want to ask about your admission
- what to take with you into hospital
- arrangements you need to make for while you are away
- planning for when you get home
How you might feel
It is normal to feel nervous about going into hospital and having an operation. You may find it helpful to try some relaxation techniques.
If you need help to manage your feelings about your operation, speak to your GP or the hospital where you are having the surgery.
