If fluid is the cause of the swelling, it is usually lying within the peritoneal cavity. The peritoneum is a fine double membrane that lines our abdominal cavity. Fluid can form between the two layers of this membrane (the peritoneal cavity) for example, when cancer cells start growing on it. This fluid is called ascites. Ascites can also be caused by liver diseases — both cancer and some noncancerous conditions.

Severe bloating due to wind can develop when the bowel is partly or completely blocked. Abdominal swelling can also be due to cancer itself — perhaps greatly enlarging your liver, spleen, or kidney(s).

If your swelling is due to fluid, the resulting discomfort, lack of appetite, nausea and indigestion can usually be quickly and simply relieved by draining the fluid away. This can be done under a local anaesthetic through a plastic tube inserted through the abdominal wall. Unfortunately, the relief will be temporary unless something is done to stop the fluid from forming again. Reducing your salt intake and taking tablets to help you pass urine (diuretics) may help. Treating the responsible cancer itself, say with chemo^ therapy, may be an attractive possibility if you have a type of cancer which has a good chance of responding favourably to chemotherapy.

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If you normally take a contraceptive pill or hormone replacement tablets, you may have been told to stop these for a time before your operation. If you are still taking them when you enter hospital, for example if you have been called for your operation at short notice, you should tell the doctor. Contraceptive pills used to contain much larger amounts of hormones than do the more modern ones, and these were sometimes associated with complications from blood clots. The newer pills are almost entirely free from these risks, but some surgeons still prefer their patients to stop taking them for at least a month before surgery.

A medical examination is carried out to identify any illness or infection you may have which could complicate the use of a general anesthetic. If you are over 50 years of age or a heavy smoker, you will probably have to have a chest X-ray and an electrocardiogram so that any potential anesthetic complications due to breathing or heart problems can be picked up.

If you are having a lump removed from your breast, the doctor will try to locate it and will mark the appropriate area on the surface of your breast with an indelible felt-tip pen. If the entire breast is to be removed, the appropriate one will be identified in the same way.

Consent forms

The house surgeon will probably also ask you to sign a consent form. Although it can be assumed that your consent to the operation is implied by the fact that you have entered hospital willingly, consent forms are widely used. By signing this form you are declaring that your operation has been explained to you and that you understand what it entails and have agreed to it taking place. You are also giving your permission for the doctors to take whatever action they feel to be appropriate should some emergency occur during your operation, and for any necessary anesthetic to be given to you. Do read this form carefully, and ask the doctor to explain anything you do not understand.

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