Leiomyosarcoma and Fibroid Removal
There has been a great deal of media coverage since the end of 2014 regarding the removal of fibroid tumors (often called “fibroids) and the risk of the spread of Leiomyosarcoma (LMS). In short, the concern is around a procedure called morcellation that effectively shreds tissue for laproscopic removal. When a woman has this done, but also has undiagnosed LMS, it puts her at great risk for the rapid spread of the disease throughout her abdominal area.
Conflicting figures appear throughout the various websites and news stories touching on this subject, with one report saying that the FDA indicates one in every 350 women undergoing fibroid removal has undiagnosed LMS (Fleming Law.com, 2015) to a noted physician arguing that the rates given were shocking and disgusting because they were so inaccurate.
What does this mean to the woman with fibroids? It means that knowledge is the key to the best outcome.
If you have struggled with the discomfort of fibroids throughout your life, and they are now causing you gynecological problems, your physician may suggest that you have them removed. There are many reasons that a woman may be told that fibroid removal is to her advantage, and yet it never hurts to also seek a second opinion. Whether it is because of heavy uterine bleeding, the desire to become pregnant, because of pain or discomfort, because the fibroids cause bowel or bladder discomfort, or due to fear of cancer, the decision to have them surgically removed must not be made lightly.
Should a second physician advocate for the treatment, usually called a myomectomy (which the removal of the fibroid and nothing else) or a hysterectomy (which is the removal of the uterus), you can discuss any concerns about LMS with them.
For example, if your gynecologist has done initial studies and determined that you have what appear to be fibroids and that they should be removed, you can request that you are also tested for LMS. This would require some blood work, and perhaps even a biopsy, and you may even find yourself pushing the physician to do the test, but if you feel you are at risk for the condition, it is best to discuss it and be tested.
There are certain people who do carry a higher risk for the development of LMS, and they include women over the age of 40 but in premenopausal stages. Women who have used estrogen changing drugs during their lifetime and who may have had radiation therapy to the uterus within five to 25 years earlier. While it is unknown precisely why women who have been exposed to such things are more likely to develop LMS, it is helpful to keep such risk factors in mind if your physician says that fibroid removal is to be done.
Unlike surgical procedures in the past, the typical hysterectomy or myomectomy does use that shredding process that allows a less invasive procedure to be done. That means your physician will not get a look at the uterus before performing the morcellation. However, it is important to note that in a recent set of studies, it was only one in six patients whose LMS was diagnosed before surgery. That means that while the risk of LMS, in general, is low, that any possibility of its existing should not be ignored.
Studies have proven that imaging techniques may be inadequate to diagnosing LMS preoperatively, and if you are showing symptoms of this rare cancer, and have not had the initial blood work done, simply ask your doctor to do it before having fibroids removed. It is simply a matter of better safe than sorry.
Fahim. F. Leiomyosarcomas:Analysis of Clinical Presentations in 6 patients. http://www.jpma.org.pk/full_article_text.php?article_id=2378.