Power Morcellation and Cancer
When the FDA released two safety communications about power morcellators in 2014, it came as a surprise to many. And yet, if you look at the specifics of the issue, it seems almost obvious that this problem would occur.
What is the problem? In summary, the FDA had its attention drawn to several incidents of women developing lethal forms of Leiomyosarcoma (LMS) after surgical procedures done with a power morcellator. The surgical procedures involved the uterus and were either hysterectomies or myomectomies (tissue removal).
How the Problems Emerged
The problems started with a failure on the part of the physician to recognize that the patients did not have fibroid tumors but instead had uterine LMS. This is a rare cancer that affects any of the body’s soft tissue and involuntary muscle. It does not show up on basic cancer panels and blood work, and when it is local it is treatable, but when it has become systemic, it is quite deadly.
LMS does not spread via lymphatic channels, but can travel along blood vessels (which are themselves soft tissue and involuntary muscle). The cancer is unpredictable and yet when caught early it can be surgically excised. In many cases this may cause the disease to be eliminated, but many physicians also treat tissue with radio and chemotherapy to be sure that no disease remains.
Should the initial symptoms not be recognized and the LMS metastasize, the prognosis is no longer so good. In fact, if a patient has stage 3 or 4 LMS it is usually a fatal condition.
Power Morcellation Makes it Worse
Because too many women were not being properly diagnosed, the use of a device like a morcellator created a horrific outcome. Rather than a surgical procedure removing the growths intact, and with wide margins, the morcellator effectively shredded the diseased tissue. This allowed cancer cells to be dispersed throughout the abdominal area, and for the cancer itself to spread widely.
Several well-known stories reached headlines and in them the women who had their fibroid tumors or uteruses removed with a morcellator (at the advice of their doctors) ended up with untreatable cancers. Their doctors believed that they had fibroids, and did not test the growths beyond the typical imaging and blood work. Because of that, the power morcellator allowed the cells and diseased tissue to disseminate and spread.
The 2014 safety communications from the FDA made it clear that the organization felt that power morcellators were contraindicated for the removal of the uterus or fibroid tumor tissue. The group strongly advocated for surgeons to share this information with patients and to recommend a different course of action.
Though the emphasis has been strictly on uterine extraction and the cancer it has caused when done with power morcellators, it cannot be ignored that the devices have demonstrated other problems in the past.
For example, they are common tools in the laparoscopic surgeon’s arsenal, and yet they have proven to do damage to surrounding tissue and to cause male and female patients having spleen and liver procedures to experience problems, too. Just as they are believed to have easily spread LMS in uterine patients, the devices are also thought to cause certain types of cancer tissue and parasitic tissue to cause complications for patients having laparoscopic renal (nephrectomy) or spleen (splenectomy) surgery by allowing diseased or benign tissue to spread, adhere, and present problems.
There are direct links and proven cases of power morcellation and cancer, and so it is up to surgeons and consumers to know the risks and take steps necessary to avoid them. The FDA has made its position plain, and that should be enough for anyone to choose to avoid the use of these devices.
DrugWatch.com. Power Morcellators. 2015. http://www.drugwatch.com/morcellators/