Fibroids vs tumors: Symptoms of Uterine Cancer vs. Fibroids
What Every Woman Must Know
There probably isn’t a woman alive who doesn’t feel a wave of terror when their doctor mentions the word tumor. But when it’s a fibroid tumor, experts say there is little to fear.
“There is virtually no threat of malignancy — and there are a number of excellent treatment options, as well as the option to do nothing at all — so there really is no reason to worry,” says Steve Goldstein, MD, professor of obstetrics and gynecology at NYU Medical Center.
Fibroid tumors are composed of renegade muscle cells that come together to form a fibrous “knot” or “mass” within the uterus. Although all uterine fibroids are the same, they are categorized based on their location:
- Submucosal fibroids are located just under the uterine lining.
- Intramural fibroids lie between the muscles of the uterine wall.
- Subserol fibroids extend from the uterine wall into the pelvic cavity.
Fibroids most commonly occur between ages 30 and 40, with black women at greatest risk. To date, at least one genetic link has been identified, indicating that fibroids may also run in families.
For some women fibroids cause no symptoms, but when they do, doctors say problems often involve heavy menstrual periods and prolonged bleeding.
“They can also cause pelvic or abdominal pain or swelling and increased urination,” says Aydin Arici, MD, professor of obstetrics and gynecology and director of reproductive endocrinology and infertility at the Yale University School of Medicine.
Arici says that ultimately, it is a combination of your symptoms, the location of the fibroid, and the numbers and size, as well as your age and your childbearing potential, that help determine what your course of treatment should be.
Treatment Options: What You Should Know
In the not-too-distant past, doctors routinely performed a hysterectomy for fibroid tumors. And while newer, less-invasive treatments are available, studies show this dramatic operation is still being performed today — far more frequently than necessary.
“A panel convened by our own governing body — the American College of Obstetricians and Gynecologists — found that 76% of all hysterectomies performed today do not meet the criteria for this surgery. They are being done unnecessarily,” says Ernst Bartsich, MD, associate professor of obstetrics and gynecology at the New York Hospital-Cornell Medical Center in New York.
“I believe many women are conceding to a hysterectomy for fibroid tumors because they are led to believe it’s the only solution — and that is wrong,” says Bartsich.
At the same time, Goldstein says it’s also important to recognize that not all hysterectomies are alike. In particular, he says the newest form of this operation (called a supra cervical hysterectomy) could still hold the answer for some women. Why?
“In a supra cervical hysterectomy you remove only the uterine cavity holding the fibroids and you do not touch the tubes, ovaries, cervix, or vagina, or any of the support muscles in the bladder or pelvis,” says Goldstein. This, he says, means you don’t suffer any of the consequences linked to a traditional hysterectomy, including bladder and sexual dysfunction, or instant menopause.
Recovery is also fast. Most women are out of the hospital in two days and back to normal living within two weeks. It’s also a permanent treatment for fibroids that can bring much-needed relief.
Says Goldstein: “My personal choice is to always do as little treatment as possible; but at the same time, women should not routinely close their ears when the doctor mentions hysterectomy, because this one particular type can be extremely helpful and cause no more problems than some of the newer alternatives.”
That said, it’s also important that you know all your options. To this end, WebMD asked our panel of experts to help us prepare the following guide — a look at some of the alternative treatments for fibroid tumors. Though not every option will be right for every woman, the experts we consulted unanimously agreed that for each woman, there is frequently one or more alternatives to a hysterectomy.
Option 1: Myomectomy Fibroid Surgery
What it does: Removes only the fibroid tumors, leaving the uterus and all other organs completely intact.
How It’s Done: The three major approaches include traditional surgery with a large incision on the abdomen, minimally invasive laparoscopic surgery done through pin hole-sized incisions, and, depending on the site of the fibroid, some can be done through hysteroscopy, a surgery done through the vagina.
What It Accomplishes: Removes the fibroid tumor and offers relief for up to several years, after which time fibroids can sometimes grow back.
Best Suited for: Women who have fibroid tumors but wish to preserve their fertility.
What You Should Know: “Of the three approaches, hysteroscopy is the most effective if you have bleeding or fertility-related problems or recurrent pregnancy loss due to fibroid tumors,” says Arici.
That said, Arici cautions that myomectomy can cause adhesions or scar tissue to develop, which later may interfere with fertility. “A woman may need to use IVF in order to conceive after this surgery,” he says. The uterus, however, remains strong enough to support a healthy pregnancy, he says.
Option 2: Uterine Artery Embolization
What It Is: A radiological procedure that blocks blood flow to the fibroid, causing it to shrink and eventually die.
How It’s Done: A minimally invasive procedure, it involves placing a catheter into the uterine arteries through which tiny particles are injected that seal off the blood supply to the tumor.
What It Accomplishes: Without a blood supply, the fibroid withers and dies.
Best Suited for: Women who have completed childbearing.
What You Should Know: While doctors agree this is a safe, smart treatment, that opinion changes dramatically if a woman has not completed their childbearing. The reason? “Studies show that obstetric complications are higher following this treatment, including a higher rate of preterm labor,” says Arici.
The reason behind all these problems, says Bartsich, is compromised blood flow to the uterus. “If you are going to do a good job of blocking blood flow to the fibroid, then you are also blocking blood flow to the uterus, and that causes difficulties during pregnancy,” Bartsich tells WebMD. While he says some women have gone on to have a healthy pregnancy after embolization, he believes it’s “risky.”
Option 3: MRI-Guided Ultrasound
What It Is: For this procedure doctors use high focused ultrasound waves that are converted to heat and destroy the tumor. The MRI is used to guide the radio waves to the tumor site.
How It’s Done: Patients are sedated and placed inside an MRI machine that is specially equipped with the ultrasound. The procedure can take up to three hours.
What It Accomplishes: Using heat it destroys the fibroids, though frequently two or more sessions may be needed. In the past, similar methods have used lasers or some form of electric current to accomplish the same thing.
Best Suited For: Women who have completed childbearing.
What You Should Know: Although recently approved by the FDA, doctors say there is insufficient data concerning impact on future pregnancy. Bartsich says risks include potential damage to other organs and the presence of “dead” fibroid tissue, which may compromise fertility — problems akin to what was found in similar procedures that eventually fell out of favor.
Option 4: Medical Management
What It Is:Medications that shrink fibroids by reducing hormonal stimulation, primarily a GnRH angonist known as Lupron.
What It Accomplishes: Turns off the production of steroid hormones without which fibroids shrink. However, they generally return when treatment is stopped.
Best Suited for: Women with very small fibroids or those who wish to shrink tumors prior to surgery. Also frequently used to halt severe bleeding, allowing a woman to build their blood supply for transfusion prior to a myomectomy.
What You Should Know: Though this treatment does shrink tumors, Goldstein says it is unsafe to use for longer than nine months, after which time the fibroids generally return. However, he says it can be the treatment of choice for women who are very close to menopause. “If you can stop the bleeding for a year a woman will have made it to menopause, after which time the fibroids shrink on their own,” Goldstein tells WebMD.
Option 5: Medical MonitoringWhat It Is: A watchful waiting, checking the size and number of fibroids — and any resulting symptoms — at regular intervals. How It’s Done: Via vaginal ultrasound exam and a blood test for anemia. What It Accomplishes: It may help carry a woman through to their menopause without treatment, after which time hormone levels drop and fibroids disappear on their own. Best Suited for: Women with minimal symptoms who are nearing menopause and who have completed their childbearing.
What You Should Know: If symptoms are not severe, Goldstein says women should be wary of being talked into treatment they might not need.
Adds Goldstein: “As long as the fibroids are not causing severe pain or heavy bleeding, it is safe to leave them alone — even if they are fast growing.”
Is There Cancer in My Fibroid?
By Devin Namaky, MD
TriHealth Advanced Gynecologic Surgery
You may wonder: Can my fibroid lead to cancer?
It’s a good question. Media attention has recently become pandemic about women having fibroid surgery who ended up with widespread cancer, including a 2014 safety communication from the U. S. Food and Drug Administration (FDA). For those living with uterine fibroids, this can certainly provoke anxiety.
A fibroid, also known as leiomyoma, is a benign (non-cancerous) tumor of muscle arising from the uterus. It is the most common pelvic tumor in women, and the majority of women will develop them within their lifetime. But can they lead to cancer? Possibly, but don’t panic. There’s more…
By definition, leiomyomas are benign but they may actually harbor cancer, which we refer to as leiomyosarcoma. The cells in a fibroid are clones of the same original cell that decided to rebel and multiply unchecked by the body. This eventually results in a ball of muscle.
Dividing cells undergo a process called mitosis. The nuclei of mitotic cells appear differently than normal cells. Pathologists look at fibroids under a microscope and count the dividing cells, called mitotic figures. When they see at least ten mitotic figures under a high-power lens, the fibroid is said to be a cancer.
If a cancer is hiding in your fibroid, the ramifications can be catastrophic. Fibroid uteri (that’s like uterus, but more than one) are often quite large and may need to be broken apart to be removed. If a gynecologist morcellates, or takes apart, your fibroid uterus and it’s harboring cancer, then little pieces may spread and grow, worsening your prognosis. (i.e. you would be less likely to survive the cancer or would need more intensive treatment).
So even though the chance your fibroid has cancer may be low, you might choose not to undergo the risk of morcellation or myomectomy (fibroid removal), and instead choose a hysterectomy with a traditional belly incision. Certainly, if you have reason to suspect cancer, then a traditional hysterectomy is really the only way to go.
But let’s put leiomyosarcoma in perspective:
Based on the FDA analysis, the risk of a fibroid uterus harboring cancer at the time of hysterectomy is approximately 1 in 400.
See that pink circle in the midst of so many yellow ones? That represents the one woman that has a sarcoma in her fibroid uterus, next to the 399 that don’t. The other yellow circles are women who have non-cancerous fibroids. So the pink circle graphically represents the odds that there is a cancer in your fibroid uterus when you undergo hysterectomy.
However, many experts disagree with this estimate and believe for various reasons that the risk is actually lower. Some estimate it to be approximately 1 in 2000.
It’s pretty safe to say that the risk of cancer in this situation is pretty low either way. Now, you can see that the number of women who would have to undergo hysterectomy to find one cancer is quite high. You can use either of these estimates-the point is that the odds of your fibroid having cancer are pretty low. Look at it this way: All those yellow dots show the odds that your fibroid is NOT cancer. Feel better?
Now here is where a little more doctoring can help you decide what your individual risk might be. There are certain factors that increase the chance that your fibroid is cancerous. The most important seems to be age. As you age, the risk of cancer in fibroids increases. Being under the age of 50 reduces the likelihood that your fibroid has cancer. Factors that may increase the risk of cancer are anemia, fibroid size, or suspicion based on imaging, in addition to increasing age.
Now back to the original question – is there cancer in your fibroid?
If you believe you are at risk of fibroid cancer, seek the advice of an experienced gynecologic surgeon. But remember the overall odds – it’s pretty unlikely.
Fibroids and Cancer | The Cancer Risk of Fibroids in the Uterus
The word ‘tumor’ evokes feelings of fear largely because it is commonly associated with cancer. However, the majority of tumors are benign and unlikely to spread by metastases. This does not render them harmless, with some growths causing symptoms that are severe enough to warrant surgery.
Fibroids in uterus are muscular growths that form on the wall of the uterus or in the abdominal and endometrial cavities. When benign, they often cause heavy bleeding, abdominal enlargement, pain in the lower back, pelvic area and during periods and frequent urination. Many sufferers don’t experience any symptoms at all. In contrast, cancerous uterine fibroids grow quickly and can cause vaginal bleeding in postmenopausal women, but even benign fibroids can grow at a rapid pace.
The Difference Between Cause and Correlation
In the past, studies have shown that there is no link between fibroids in uterus and cancer, but recent studies have revealed that women who are at increased risk of fibroids are also at increased risk of uterine cancer. This research has been misconstrued to mean that there is a causal link between the two, whereas it only reveals the already-known fact that postmenopausal women between the ages of 50 and 60 are more likely to suffer both from benign fibroids and uterine cancer.
As of yet, there are still no studies that can directly and causally link benign uterine fibroids to cancer. In essence, correlation is not the same as causation. The statistics reveal the rarity of cancerous fibroids, with only 1 in 1000 cases of uterine fibroids being malignant.
The presence of fibroids is cause for concern, given that there are overlapping symptoms for benign and malignant growths. Doctors use biopsies, pelvic exams, blood tests and MRIs to diagnose whether the growths are malignant or benign. Uterine fibroids can be extremely debilitating. 35 percent of premenopausal women with uterine fibroids find that their condition interferes with their lifestyles and ability to work. One of the most drastic cures and one that was commonly used until recently is a complete hysterectomy in cases where less invasive procedures were ineffective. This left those who had not yet reached menopause with infertility and early hormonal changes that produced their own disruptive symptoms.
Common Problems with Uncommon Solutions
Despite the fact that 20 percent of premenopausal women and 80 percent of postmenopausal women have benign fibroids, effective treatments have been notoriously evasive. Apart from the dramatic solution of hysterectomy, treatments include hormone replacement therapy, which comes with its own symptoms, myomectomy and endometrial ablation. The latter two surgical options involve the removal of the fibroids themselves or removing the uterus lining respectively. Both can render the sufferer infertile.
It is also possible to cut blood flow from the uterus to force growths to shrink. Whether this nonsurgical procedure leads to infertility remains unknown. However, it can come with rare complications such as premature menopause, the formation of scar tissue and the discontinuation of menstruation. For patients with minor symptoms, medications such as non-steroidal anti-inflammatories and birth control pills can help to relieve symptoms.
Many patients seeking to avoid the drastic medical options available to them have sought help through alternative therapies that hold little proven benefit. Nutritional changes target symptoms indirectly by preventing bloating that might make uterine pain worse. Attempts to change hormonal balance through dietary changes do not make room for patients who are not overweight or who are suffering from imbalances caused by stress. Herbal formulations remain unstandardized without the control and research of guided FDA regulations and trials.
In 2012, the FDA approved a non-invasive procedure that treats benign fibroids. Acessa is a laparoscopic procedure that negates the need for harsh surgeries while removing only the fibroids rather than the tissue surrounding them. Radiofrequency energy is used to target only the tissue causing symptoms, offering a workable same-day solution that is as effective as it is safe.
Looking For More Information on Treating Fibroids?
If you feel you may have the symptoms or have been diagnosed with uterine fibroid tumors, it is a good idea to discuss all of the available treatments for fibroids.
Click on Physician Finder to find an Acessa-trained physician near you to see if the Acessa procedure is right for you. Or for more information, please contact Acessa Health at 855.331.9553.
Acessa Health encourages patients to seek medical attention for typical and atypical symptoms associated with fibroids to help achieve and maintain good health with as high a quality of life as possible. Although many patients may benefit from the Acessa Procedure, this treatment is not for everyone and results may vary. You should talk to your doctor about the potential benefits and risks and whether this treatment is right for you. Information contained on this site is not to be used as a substitute for talking to your doctor. You should always talk to your doctor about diagnosis and treatment information.
What’s the Difference Between Cysts, Fibroids, and Polyps?
If you are diagnosed with cysts, fibroids, polyps, are you aware of what could become uterine, cervical, or ovarian cancer?
The world of women’s health includes certain tests and screenings designed to help identify growths, like fibroids, polyps, and cysts, in order to protect you from the threat of cancer. How do you know what each of these growths mean, and which ones are something that you need to worry about? To understand the world of masses within the female reproductive system, you need to learn the difference between a polyp and a cyst, and how these growths differ from a fibroid. This is because not all of these growths can be cancerous, and some can become cancerous if they go undetected or untreated.
Are Fibroids Cancerous?
Within the tissues of the uterus, you can commonly develop fibroids, which are also known as leiomyomas or myomas for short. These growths can vary in shape, size, and location, as they can be found on the outside or deep within the uterine tissue. Women between the ages of 30 and 40 are the most likely to have a fibroid diagnosis, but younger and older women can develop fibroids as well. If you experience severe menstruation changes, abdominal pain, cramps, infertility, or bowel or urination problems, tell your doctor. They can check for fibroids during a routine pelvic exam, ultrasound, or laparoscopy, which involves a probe-like tube that allows a surgeon to view and treat accessible growths.
Fibroids are benign growths, which means they are not cancerous, and rarely require medical treatment. However, a small portion of women may need to have their fibroids removed if they experience chronic symptoms. Medical professionals use hormone therapy to treat severe symptoms, and in extreme cases, surgery may be an option. It’s important to note that not all surgical options leave a woman unable to carry a child because a full removal of the uterus, or hysterectomy, is not always necessary.
Can Polyps Be Cancerous?
Polyps grow on the inner lining of the uterus, called the endometrium, and can push themselves out into the inner cavity of the uterus. Polyps can also be found growing in the lining of your cervix. These ball-like structures look like they are emerging from the end of a stalk jutting from the uterine lining of your uterus or cervix. Unlike fibroids, polyps can be malignant growths (meaning they can be cancerous), but this usually only happens rarely with older, postmenopausal women.
Unfortunately, polyps can be easily mistaken for fibroids because they look similar in imaging tests and they can both cause heavy menstrual bleeding, cramping, and abdominal pain. Therefore, in order to determine the malignant or benign nature of polyps, your doctor will need to remove them and send them to a pathologist for testing. If benign polyps cause you pain, or if your doctor discovers your polyps are malignant, surgery can be performed to remove these growths.
Are Cysts Signs of Cancer?
Cysts can become the most painful type of growth and can also be diagnosed as malignant, which is why you need to understand the difference between a polyp and a cyst. Generally, cysts develop on the ovaries as sac-like pouches that can either be solid or filled with fluid from the female reproductive system. Small cysts cause dull or slightly aching pain, but larger cysts can twist the tissues to result in severe shooting or stabbing pains. Unlike fibroids and polyps, cysts do not cause menstrual bleeding—the greatest danger with cysts, aside from cancer, comes when they burst and release their contents into other body cavities, which can causes blood-poisoning or other illnesses. Ovarian cysts can become malignant and result in cancer, but most cysts are benign.
Your doctor can diagnose cysts through blood tests, vaginal ultrasounds, or a laparoscopy. If the ovarian cysts are small, surgery can remove them; however, larger cysts threaten your health and require the removal of the entire ovary. If harmful cysts are left untreated, it is also possible that the cancerous cells will spread throughout your body.
What Should You Do?
Although fibroids, polyps, and cysts possess the potential to cause you severe pain, the majority of these growths can be easily treated before they develop into cancerous tumors. According to the National Cancer Institute, more than 50,000 women in the United States were diagnosed with uterine cancer in 2014, and nearly one-fifth of those women lost their lives. Keeping routine visits to your women’s health provider remains your strongest chance of not becoming a statistic. Please contact The Woman’s Clinic today to schedule an appointment and take control of your reproductive health.
FDA Warns of Cancer Risk in a Type of Uterine Fibroid Surgery
The US Food and Drug Administration (FDA) is warning women and doctors about the risks of a certain technique used in surgery for uterine fibroids. The procedure, called laparoscopic power morcellation, uses a medical device to break uterine fibroids into small pieces, so they can be removed through a small incision in the abdomen. According to the FDA, if the woman also has uterine cancer, this procedure can risk spreading the cancer within the abdomen and pelvis, making it harder to treat.
Uterine fibroids are non-cancerous growths in the uterus. They are very common and often do not cause symptoms. However, fibroids sometimes do cause problems such as heavy or prolonged menstrual bleeding, pelvic pressure or pain, and frequent urination. If these symptoms are severe enough, the fibroids may need to be treated.
One option has been surgery to remove the uterus (hysterectomy). One way to do this is through a large incision in the lower abdomen. Another option is to remove the uterus (or the fibroid) using laparoscopy, which only requires a few small incisions. The smaller incisions mean a much shorter recovery time for the patient. It may not be possible, though, to remove the uterus (or fibroid) through a small incision without first breaking it up into small pieces. In rare cases, a doctor may discover after the procedure that the woman doesn’t just have fibroids – she also has uterine sarcoma, a type of cancer. There is currently no reliable method for predicting whether a woman with fibroids may have uterine sarcoma.
The FDA looked at studies about the use of power morcellation to find out how often problems occur. They found that anywhere from 1 in 225 to 1 in 580 women treated for fibroids by having their uterus or fibroids removed was later found to have uterine sarcoma. Diagnosis was made when the tissue removed at surgery was examined under a microscope.
The FDA is discouraging the use of this procedure to treat fibroids in most women, and is urging women to discuss the risks and benefits with their doctor when choosing how to treat fibroids:
- Discuss with your doctor all the options available to treat the condition, including the risks and benefits of each option. A number of other treatment options are available for fibroids, including abdominal and vaginal hysterectomy, and non-surgical options.
- If laparoscopic hysterectomy (surgery to remove the uterus) or myomectomy (surgery to remove the fibroids) is recommended, ask your doctor if power morcellation will be used, and why it is the best option for you.
- If you have already had a hysterectomy or myomectomy for fibroids, you were already tested for cancer at that time. If you were informed the test was normal and you have no symptoms, continue with your regular doctor visits. If you do have symptoms, report them to your doctor.
How Is Uterine Sarcoma Diagnosed?
Many uterine sarcomas are diagnosed during or after surgery for what’s thought to be benign fibroid tumors.
Some are diagnosed because of symptoms. If you have symptoms of uterine cancer, the first step is to see your doctor.
Consultation, medical history, and physical exam
Your doctor will ask you about your personal and family medical history, examine you, and might order some tests. You also will be asked about any symptoms, risk factors, and other health problems. A general physical and a pelvic exam will be done. An ultrasound may be used to look at the inside of your uterus.
If your doctor suspects cancer, you may be referred to a gynecologist or a doctor specializing in cancers of the female reproductive system (called a gynecologic oncologist).
Sampling and testing endometrial tissue
To find the cause of abnormal uterine bleeding, a small piece of tissue (a sample) will be taken from the lining of the uterus and looked at with a microscope. The tissue can be removed by endometrial biopsy or by dilation and curettage (D&C). Often a hysteroscopy is done with the D&C..
These procedures let the doctor see if the bleeding is caused by a endometrial overgrowth that’s not cancer (hyperplasia), endometrial carcinoma, uterine sarcoma, or some other problem. The tests will find many endometrial stromal sarcomas and undifferentiated sarcomas, but less than half of leiomyosarcomas (abbreviated LMSs). These tests don’t find all LMSs because these cancers start in the muscle layer of the wall of the uterus. To be found by an endometrial biopsy or D&C, they need to have spread from the middle (muscle) layer to the inner lining of the uterus. In most cases, the only way to diagnose a LMS by removing it with surgery.
In this procedure, a very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of the uterine lining (endometrium) is taken out through the tube. Suctioning takes about a minute or less. The discomfort is a lot like severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug like ibuprofen an hour before the biopsy. This procedure is usually done in the doctor’s office.
This procedure allows doctors to look inside the uterus. A tiny telescope is put into the uterus through the cervix. To get a better view, the uterus is then expanded by filling it with salt water (saline). This lets the doctor see and take out anything abnormal, such as a cancer or a polyp. This procedure is usually done with the patient awake, using local anesthesia (numbing medicine). But if a polyp or mass has to be removed, general or regional anesthesia is sometimes used. (General anesthesia means you are given drugs that put you into a deep sleep and keep you from feeling pain. Regional anesthesia is a nerve block that numbs a larger area of the body).
Dilation and curettage
If the results of the endometrial biopsy are not clear (meaning they can’t tell for sure if cancer is present), a procedure called dilation and curettage (D&C) must be done. A D&C is usually done in the outpatient surgery area of a clinic or hospital. It’s done while the woman is under general or regional anesthesia or conscious sedation (medicine is given into a vein to make her drowsy). It takes about an hour. In a D&C, the cervix is dilated (opened) and a special surgical tool is used to scrape the endometrial tissue from inside the uterus. A hysteroscopy may be done as well. Some women have mild to moderate cramping and discomfort after this procedure.
Testing endometrial tissue
Any tissue samples taken out are looked at under a microscope to see if cancer is present. If cancer is found, the lab report will say if it’s a carcinoma or sarcoma, what type it is, and its grade.
A tumor’s grade is based on how much it looks like normal tissue under the microscope. If the tumor looks a lot like normal tissue, it’s called low grade. If it doesn’t at all look like normal tissue, it’s high grade. The rate at which the cancer cells appear to be growing is another important factor in grading a uterine sarcoma. High-grade sarcomas tend to grow and spread faster than low-grade sarcomas.
The tissue may also be tested to see if the cancer cells have estrogen receptors and progesterone receptors. These hormone receptors are found on many endometrial stromal sarcomas. Cancers with estrogen receptors on the cells are more likely to grow in response to estrogen, while those with progesterone receptors often have their growth decreased by progesterone. These cancers may stop growing (or even shrink) when treated with certain hormone drugs. Checking for these receptors helps predict which patients will benefit from treatment with these drugs.
Cystoscopy and proctoscopy
If a woman has signs or symptoms that suggest uterine sarcoma has spread to the bladder or rectum, the inside of these organs can be looked at through a lighted tube. These exams are called cystoscopy and proctoscopy, respectively. They are rarely done in the diagnosis and work-up of patients with uterine sarcoma.
Ultrasound tests use sound waves to take pictures of parts of the body. For a transvaginal ultrasound, a probe that gives off sound waves is put into the vagina. The sound waves are used to create images of the uterus and other pelvic organs. These images can often show if there’s a tumor and if it affects the myometrium (muscular layer of the uterus).
For an ultrahysterosonogram or saline infusion sonogram, salt water (saline) is put into the uterus through a small tube before the transvaginal sonogram. This allows the doctor to see changes in the uterine lining more clearly.
The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.
CT scans are rarely used to diagnose uterine cancer, but they may be helpful in seeing if the cancer has spread to other organs.
CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the tumor. A fine needle biopsy sample or a larger core needle biopsy sample is then removed to be looked at with a microscope. This isn’t done to biopsy tumors in the uterus, but might be used to biopsy areas that look like metastasis (cancer spread).
Magnetic resonance imaging
MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. MRI scans can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure.
MRI scans are also very helpful in looking for cancer that has spread to the brain and spinal cord.
Positron emission tomography scan
In a PET scan, radioactive glucose (sugar) is injected into the patient’s vein. Because many cancers use glucose much faster than normal tissues, the radioactivity tends to collect in the cancer. A scanner can then spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells that have spread beyond the uterus (metastasized).
A regular (plain) x-ray of the chest may be done to see if a uterine sarcoma has spread to the lungs and as part of the testing before surgery.
Can uterine fibroids turn into cancer?
3 months ago
Uterine fibroids do not turn into cancer—they are entirely benign tumours arising from smooth muscle tissues within the uterus.
Fibroids are the most common pelvic tumours in women and they are non-cancerous. We don’t know exactly what causes uterine fibroids, and you can have a single fibroid or multiple ones.
We do know that women’s chances of developing cancer are not related to uterine fibroids, and having uterine fibroids doesn’t increase the chances of getting other gynaecological cancers.
Should I worry about uterine fibroids?
Most women with fibroids do not have any symptoms and only a small percentage of uterine fibroids will require treatment.
Some women with fibroids may have the following symptoms: heavy, painful or erratic periods, pelvic pressure, enlargement of the lower abdomen, frequent urination, pain during intercourse and infertility. For some these symptoms may be mild, while for others these can be severely debilitating.
What is not known and uncertain?
While fibroids are very common, no single test will differentiate them from malignant uterine tumours, such as aggressive uterine sarcomas.
Uterine sarcomas also arise from the smooth muscle tissue of the uterus; sarcomas, leiomyosarcoma and carcinosarcomas are rare but highly aggressive cancers.
How do I know a uterine fibroid is not a sarcoma?
Sometimes it can be difficult to distinguish between uterine fibroids (benign tumours) and sarcomas (malignant tumours).
Symptoms are unspecific and can be confused with uterine fibroids. Diagnosis by medical imaging (for e.g. CT, MRI), blood tests, and pelvic exams are unreliable, and therefore requires a biopsy. As a rule, all patients with abnormal uterine bleeding need to have some tissue taken from the uterus to be examined under a microscope. A definitive diagnosis requires tissue which can be obtained through a Pipelle, myomectomy (to remove the fibroids and preserve the uterus) or a hysterectomy (removal of uterus).
Sarcomas are more common in women over the age of 55 years and any sudden growth in those groups of women needs to be explored carefully.
Unfortunately, a significant percentage of uterine sarcomas are nevertheless diagnosed incidentally following a hysterectomy or a myomectomy due to lack of any reliable screening options.
How are uterine fibroids treated?
Treatment for fibroids depends on the size and location of the fibroids, symptoms, and other factors. In general when there are no symptoms or the fibroids are small, no treatment is needed. More information on treatment of uterine fibroids here.
When to see a doctor?
Visit a doctor if you have pelvic pain that does not go away, any abnormal bleeding, or heavy, painful and prolonged periods. Speaking to a gynaecological oncologist will help you to be informed.
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90,000 Uterine fibroids – fibroids treatment in Germany. Doctors, prices, reviews
Uterine fibroids – what is it and how to treat
Fibroids are benign tumors of the muscle tissue of the uterus or cervix that can cause menstrual cramps, urinary disorders and constipation. In most cases, they are harmless.
Myomatosis of the uterus occurs in 90% of women. Only 25-30% of them need treatment.
Most often, pathological growths of the muscle tissue of the uterus occur at the age of 35 to 50 years.
Uterine fibroids – symptoms of the disease
“When patients complain of prolonged and profuse uterine bleeding during the menstrual cycle, the cause may be submucous myoma. It is located under the mucous membrane of the organ and protrudes into the uterine cavity, ”explains Matthias David, chief physician at the Charité Clinic for Gynecology in Berlin.
Subserous nodes that grow on the outer lining of the uterus usually do not cause any symptoms. However, if subserous fibroids grow large and compress the bladder or rectum, patients complain of back pain, urinary disorders and constipation.
Intramural nodes within the muscle fibers of the uterus, as a rule, are the cause of complaints during the menstrual cycle. In addition, they can cause long-term infertility. Less commonly, fibroids cause anemia, urinary tract infections, and kidney damage. “However, in most women, fibroids do not cause any problems,” says Mathias David.
What is fibroids?
Myoma is the most common benign tumor in women. They have a rounded shape ranging in size from a few millimeters to several centimeters.“In some patients, these are small nodules, in others, they grow so much that the volume of the abdomen increases to a size comparable to pregnancy at 5 months,” says Dr. Markus Walviner, chief physician of the certified gynecology center at the University Hospital Heidelberg.
How do fibroids arise?
“We assume that the female sex hormone estrogen stimulates the growth of the nodules in the muscle tissue of the uterus,” says Matthias David. “This explains why fibroids no longer grow and even shrink during menopause, when the ovaries stop producing estrogen.”Genetic predisposition, inflammatory processes in the genitals, metabolic disorders, an inactive lifestyle and chronic systemic diseases can also cause fibroids.
How dangerous are fibroids?
80-90% of women develop fibroids during their lifetime. During the reproductive period, only a quarter of them need therapy. If during menopause, the fibroid rapidly increases in size, it may be a malignant tumor – sarcoma. To confirm or refute this suspicion, a hysterectomy is performed – removal of the uterus.
Diagnosis of fibroids in Germany
First, the gynecologist palpates the vagina, rectum and abdominal wall. To clarify the diagnosis, a vaginal ultrasound examination is performed. If suspicious formations are found, hysteroscopy is prescribed – an examination of the uterine cavity through the vagina using a special device.
What treatments are available for uterine fibroids in Germany?
When myomatous nodes grow large or cause complaints, they need treatment.The need for therapy is also determined by the woman’s desire to become pregnant. “There is no one solution for all patients. Each individual case is considered individually, depending on the background of the disease and the wishes of the patient, ”explains Markus Valviner.
Various drugs are used for drug therapy, including progesterone receptor blockers, which slow down the growth of myomatous formations. Ideally, they even decrease in size.Another group of medicines reduces menstrual bleeding, thereby relieving symptoms. If the quality of life is severely impaired or the medication is ineffective, the only solution is surgery. “We remove almost all fibroids using a minimally invasive method,” says Dr. Valviner, “depending on the type of fibroid, the optimal method of fibroid removal is selected.”
During laparoscopic surgery, the surgeon makes three small punctures in the abdominal cavity, 5-10 mm in size, through which surgical instruments are inserted: ultrasonic “scissors”, an instrument for electrothermal tissue alloying, a camera and others.“With the morcellation method, fibroids are removed piece by piece – in small pieces,” explains Markus Walviner. Removal of submucous fibroids is performed through the vagina.
In rare cases, when the formation is in a hard-to-reach place, laparotomy or abdominal surgery is used.
Embolization of the uterine arteries
The next method of treatment is embolization of uterine fibroids, when the doctor blocks the blood vessels feeding the fibroids through a thin tube (catheter).A formation deprived of a blood supply dies and is eventually replaced by connective tissue.
FUS-ablation of uterine fibroids
Another non-surgical treatment for uterine fibroids in Germany is MRI-guided ultrasound ablation. The essence of the method lies in the “evaporation” of the myomatous node with focused ultrasound. Powerful high-frequency waves heat the tumor to a certain temperature and destroy it, after which the cells of the immune system eliminate the dead tissue.
Radical removal of the uterus using hysterectomy is used only in extreme cases when other methods have proved ineffective.
In the section “treatment examples” you will find recommendations of the leading gynecologists in Germany and examples of fibroid treatment in certified gynecological centers.
For treatment of uterine fibroids in Germany and to obtain a cost estimate for treatment, contact our coordinators or fill out an online application on the website.
90,000 Complicated case of atypical location of uterine fibroids – Our news
OUR WORKERS: A complex case of atypical location of uterine fibroids
In the city hospital number 15 named afterO. M. Filatov recently analyzed one interesting clinical case. Patient B., 46 years old, was treated in the 12th gynecological department (base – University Clinic of the Moscow State Medical University) and was admitted for a planned surgical removal of uterine fibroids. Of interest is the cervical localization of the node (myomatous node up to 9 cm in diameter).
In a planned manner, professor, d.m.s. S.I. Kiselev performed a minimally invasive organ-preserving operation in the scope of laparoscopy and myomectomy.
The complexity of this operation lies in the atypical location of uterine fibroids, which occurs in only 5-8% of cases.
Surgical treatment of patients with atypical location of fibroids belongs to the category of traumatic, technically difficult operations and has a high risk of intra- and postoperative complications.
Due to the high professionalism of the operating surgeons, the postoperative period in this patient was uneventful, the patient was discharged on the fifth day in a satisfactory condition.
Uterine myoma (also fibroids , leiomyoma ) is a benign tumor that occurs in the muscle layer of the uterus – the myometrium.It is one of the most common ailments in women at the time of the late reproductive period and before menopause, reaching a frequency of 12-25% of all gynecological diseases. There is an opinion that the true prevalence of fibroids is much higher and reaches more than 70% both in Russia and abroad.
Fibroid node is a ball of chaotically intertwining smooth muscle fibers of a round shape. Most knots have diameters ranging from a few millimeters to several centimeters, but sometimes they can reach very large sizes and weights of several kilograms.
The causes of fibroids are not fully understood.
Surgical removal of nodes (exfoliation) and removal of the uterus have been used for many decades for the treatment of uterine fibroids.
By number of nodes:
- single myoma;
- multiple fibroids.
By the location of the nodes in the uterus:
- Submucosal nodes (submucous myoma) – located closer to the uterine cavity.They are relatively rare, sometimes have a thin leg and can descend from the uterus into the cervix or vagina; in this case, they speak of a “nascent” fibroid node.
- Intermuscular nodes (interstitial, intramural) – nodes are located in the wall of the uterus in the muscle layer.
- Subperitoneal nodes (subserous myoma) – located on the outside of the uterus, closer to the abdominal cavity. May have a base with a smaller diameter than the node itself; in this case, the term “peduncle” is used.
- Interstellar nodes (intraligamentary myoma).
- Cervical fibroids.
The most common is interstitial uterine myoma. According to various authors, its frequency ranges from 50 to 61% or more. The frequency of subserous myoma is from 26 to 35%, submucous – no more than 13%.
In 50% of cases, this disease is asymptomatic. It is more common in small, single or multiple fibroids with intermuscular and subperitoneal locations.
The most common symptoms are heavy menstrual bleeding (menorrhagia), pressure and pain in the lower abdomen.Menorrhagias are more common in submucosal fibroids. With the growth of fibroids, menstruation gradually becomes more abundant and prolonged, often leading to the development of anemia (anemia). A feeling of heaviness or pressure in the lower abdomen is more typical for intermuscular and subperitoneal fibroids, especially with large nodes. Pain usually occurs during menstruation and is cramping, but can be constant. Pain can also have a sudden cutting character, which is noted with a very rare complication – torsion of the legs of the subperitoneal node.More rare symptoms of uterine fibroids include infertility and dysfunction of neighboring organs: the bladder and rectum.
For the diagnosis of uterine fibroids, ultrasound is considered the most informative method, in which the fibroid is found in the form of rounded foci of reduced echogenicity (having a less dense structure than the myometrium). In some cases, magnetic resonance imaging is used for the differential diagnosis of uterine fibroids and ovarian tumors.
Symptoms of uterine fibroids
Symptoms of uterine fibroids depend on the location of the formation. Subserous nodes can compress nearby organs (ureters, bladder, rectum), which can cause heaviness in the lower abdomen and pain, as well as dysfunction of the bladder and intestines.
Submucous and interstitial fibroids are characterized by abundant prolonged menstruation, as well as spotting during the intermenstrual period.Therefore, women with uterine fibroids often develop anemia, which is accompanied by weakness, increased fatigue, and dizziness.
Small interstitial fibroids may be asymptomatic.
If untreated, myomatous nodes may grow with more pronounced symptoms.
With submucous (submucous) myomatous nodes, there are often profuse bleeding that requires emergency hospitalization.
Subserous uterine myoma on the pedicle can be complicated by torsion of the pedicle, which can be accompanied by sudden cutting pains in the lower abdomen and is an indication for surgical treatment.
In addition, at large sizes, a malnutrition in the node may occur, which leads to necrosis of the node and purulent inflammation, which, as in the case of torsion of the leg of the node, requires emergency hospitalization and surgery up to removal of the uterus.
Another possible complication of uterine fibroids is infertility.By itself, fibroids are not a cause of infertility, however, it reduces the likelihood of natural conception, since it can squeeze the fallopian tubes, making it difficult for sperm to move, submucous uterine fibroids can disrupt the process of implantation of the ovum in the uterine cavity
If a woman was able to become pregnant naturally, the presence of fibroids increases the risk of spontaneous abortion or premature birth. Therefore, when planning a natural pregnancy or IVF, conservative or surgical treatment of uterine fibroids is necessary.
Diagnosis and treatment of uterine fibroids
Due to the fact that uterine fibroids in the early stages of development may not give pronounced symptoms, it is very difficult to suspect it. Therefore, women are recommended to undergo systematic preventive examinations by a gynecologist at least once a year.
The diagnosis is made on the basis of simple diagnostic tests, all of which are carried out by our specialists at the K + 31 Clinic.
In the presence of uterine fibroids on a gynecological examination, the doctor diagnoses an enlarged uterus, the surface of which is usually dense and bumpy.
In order to clarify the localization of nodes, their number and structure, as well as to control the dynamics of growth of education, we conduct a gynecological ultrasound (US) . It is possible to diagnose the presence of myomatous nodes even with the normal size of the uterus. If necessary, to clarify the details, you may need a MRI study .
In addition, the patient needs to pass laboratory tests (clinical blood test, biochemical blood test, hormonal tests, etc.)
Based on the results of the research carried out, our doctors choose the tactics of treatment. Treatment of uterine fibroids does not always involve surgery, as many women mistakenly believe.
The list of therapeutic measures depends on the cause of fibroids, its localization, the number of nodes, the course of the disease.Today, there are two methods of treating uterine fibroids: medical and surgical.
Drug therapy , as a rule, is carried out with hormonal drugs that stabilize the growth of fibroids. In addition, therapy for concomitant conditions is carried out, for example, iron preparations are prescribed for anemia.
The choice of a surgical method for the treatment of uterine fibroids depends primarily on the location and number of myomatous nodes.
With a submucous node location, our specialists can perform such an operation as hysteroresectoscopy – removal of a node using an optical system through the uterine cavity.
With subserous node or mixed myomatous node, it is possible to perform conservative myomectomy (removal of only myoma node) laparotomy or laparoscopic access .
If myomatous nodes are large or multiple and there are additionally concomitant gynecological diseases, then doctors have to decide on the removal of the uterus
To prevent further growth of uterine fibroids and avoid surgery, a woman needs to see a specialist as soon as possible, who will prescribe effective treatment for her.
Treatment of uterine fibroids | Gynecology
Obstetrician-gynecologist, primary appointment
Obstetrician-gynecologist, follow-up appointment
Obstetrician-gynecologist (higher category / candidate of medical sciences / doctor of medical sciences), primary appointment
Obstetrician-gynecologist (higher category / candidate of medical sciences / doctor of medical sciences), repeated appointment
Obstetrician-gynecologist E. V., initial appointment
Obstetrician-gynecologist Tanchuk E.V., follow-up appointment
Obstetrician-gynecologist Ph.D. Basos A.S., initial appointment
Obstetrician-gynecologist Ph.D. Basos A.S., repeat appointment
Obstetrician-gynecologist Volkova A.V., primary appointment
Obstetrician-gynecologist Volkova A.V., repeated admission
Obstetrician-gynecologist Zakharova O.V., initial appointment
Obstetrician-gynecologist Zakharova O.V., follow-up appointment
Obstetrician-gynecologist Bokach O.M., initial appointment
Obstetrician-gynecologist Bokach O.M., follow-up appointment
Obstetrician-gynecologist endocrinologist, primary appointment
Obstetrician-gynecologist endocrinologist, follow-up
Obstetrician-gynecologist for adolescents and children, primary appointment
Adolescent and children’s obstetrician-gynecologist, follow-up
Obstetrician-gynecologist, pregnancy appointment, initial appointment
Obstetrician-gynecologist, pregnancy appointment, follow-up appointment
Adolescent and pediatric obstetrician-gynecologist (higher category / candidate of medical sciences / doctor of medical sciences), primary appointment
Adolescent and pediatric obstetrician-gynecologist (higher category / candidate of medical sciences / doctor of medical sciences), repeated admission
Family planning consultation with an obstetrician-gynecologist, initial appointment
Family planning consultation with an obstetrician-gynecologist, follow-up
Treatment of uterine fibroids
2. Basic approaches to the treatment of uterine fibroids
4. Cost of operations
Uterine fibroids – causes, symptoms, diagnosis
Myoma of the uterus is a fibroma, a tumor of benign etiology. Its main places of localization can be the walls of the uterus, or inside the walls of the uterus.
Types of uterine fibroids
Drawing – Types of uterine fibroids
- Intermuscular (intramural) pathological formation is located inside the layer of the myometrium.
- The abdominal (subserous) site of localization of the neoplasm occurs under the mucous membrane of the uterine layer.
- Submucous (submucous) This type of pathology is characterized by the fact that the neoplasm is located inside the mucous membrane.
- An inter-ligamentous (intraligamentary) tumor appears in the region of the uterine ligaments.
Every year the disease “gets younger”, affecting more and more patients of active childbearing age.For many years, doctors have preferred to tackle the problem radically by sending women with fibroids under a surgical scalpel.
Why are fibroids dangerous?
Myoma of the uterus does not pose a threat to a woman’s life, but if timely treatment is not carried out, the appearance of complications poses a threat to the patient’s life:
1. A dangerous consequence is that myoma begins to move from a benign neoplasm to a malignant one, manifesting itself in the form of cervical cancer.This pathological process is facilitated by a decrease in immunity. Such a degeneration is observed in 2% of patients with this pathology.
2. Development of iron deficiency anemia as a result of prolonged bleeding. In this state, a woman experiences:
- Headache and dizziness.
- Pallor and cyanosis of the skin.
- Fainting conditions appear.
- Fatigue and shortness of breath.
- Impaired concentration and distraction.
3. Tissue necrotization occurs due to impaired blood flow in the leg of the fibroid node. This most often occurs after prolonged physical work, and is characterized by the appearance of an acute clinical picture:
- A woman has a sharp dagger pain in the lower abdomen.
- The body temperature rises sharply to critical levels.
- Nausea may appear, turning into vomiting.
four.If the wrong method of treatment is chosen, then the growing large fibroid can exert multiple pressure on adjacent organs. With excessive pressure on the intestines, a woman cannot poop, constipation occurs. If the bladder is under pressure, it may be difficult to pass urine.
5. Sometimes during this pathological process, pregnancy occurs, but carrying it is accompanied by constant threats of miscarriage. And in the case of its normal course, at the time of delivery, not only a giant, but even a small myoma node, can prevent the normal exit of the fetus from the birth canal.
Drawing – a diagram of the location of the pelvic organs with a neoplasm in the uterus
In the early stages, this pathological condition is usually asymptomatic. When the size of the neoplasm is 2 cm in diameter, the first symptoms of the clinical picture may appear:
- At the beginning of the menstrual cycle, a woman has spastic, cramping pains in the lower abdomen.
- The menstrual cycle is accompanied by constant pain throughout its duration.
- It should be alarming that menstruation looks abundant.
- In the intervals between the menstrual cycle, spotting discharge with impurities of blood appears.
- The duration of menstruation is violated, they can be reduced or, on the contrary, lengthened.
- The most alarming symptom is that a woman cannot conceive a child.
At later and later stages of the disease, more severe symptoms may be added to this clinical picture:
- Increased abdominal pain, which often radiates to the legs or lumbar region.Their strengthening can occur against the background of an increase in physical work, and at rest.
- There is an increase in the abdomen, while the body weight does not change.
- Due to its proliferation, the fibroid begins to put pressure on nearby organs (bladder, intestines), which causes the woman to have a stool disorder (constipation), and painful urination.
- A very alarming symptom may be the appearance of a picture of an acute abdomen. Such symptoms are observed if the leg of the neoplasm is twisted, and necrosis has developed as a result of necrosis.This condition requires urgent surgical intervention.
The exact diagnosis of uterine fibroids is established by a gynecologist. With a gynecological examination, the first sign is its increase.
Drawing – Ultrasound of the abdominal organs
- Ultrasound or MRI is prescribed for accurate confirmation.With it, you can establish the size of the neoplasm, determine the type of node, its location and the number of myoma nodes.
- Hysteroscopy is prescribed for the purpose of biopsy, for subsequent histological analysis. It allows you to establish the structure of the fibroid.
- Laparoscopic method (modern) is used in parallel with the diagnosis and treatment of subserous neoplasms.
Basic approaches to the treatment of uterine fibroids
If a woman whose age has passed the 40-year mark, and she is in a state of menopause, and the size of the neoplasm does not exceed the 12-week level, then the treatment of a woman during menopause can be carried out without surgery. At the same time, it is very important that she is not disturbed by pain, and the clinical picture does not have aggravated symptoms.
Medication . The action of such treatment contributes to the resorption of fibroids, reduction of neoplasms, only if the fibroid is small and does not exceed one and a half cm. These dosage forms are best used as an additional method of treatment.
FUS-ablation. This treatment technique has only recently become widespread. Such a procedure takes place using an ultrasound beam, it focuses on the center of the myoma node, and under its influence the fibroids evaporate, and its disintegration occurs. This is the most progressive, non-traumatic method of treatment. This procedure can take place within 4 hours, after which a magnetic resonance imaging is performed. Which gives an accurate picture of the manipulation performed.
This type of treatment has a number of positive aspects:
- With this therapy technique, no special postoperative care is required.
- No complications were observed during its implementation.
- The integrity of the uterus and its reproductive function is respected.
- Short rehabilitation period.
- Absence of the disease recurrence process.
- The presence of many neoplasms and large nodules does not affect the effectiveness of the technique.
- By removing the uterine fibroids, unwanted symptoms disappear.
Sometimes there is a lack of drug treatment, it is not always possible to achieve positive dynamics in the treatment of this pathological process.
There are a number of reasons for which surgical intervention becomes an inevitable condition:
- Changes in the size of the uterus that are more than 12 weeks old.At the same time, there is an increase in pressure on the nearest organs.
- Development of fibroid growth is accompanied by profuse uterine bleeding.
- Malnutrition and necrosis of the myomatous node.
- Combination of uterine fibroids with adenomyosis.
After a detailed examination, the doctor decides whether or not to operate on the patient.
Drawing – laparoscopic operation
Type of surgical intervention:
one.Laparoscopy. To carry it out, a small incision is made on the anterior abdominal wall, through which surgery takes place:
- myomectomy – removal of myomatous nodes;
- subtotal hysterectomy – removal of the uterus with nodes without a cervix;
- total hysterectomy – removal of the uterus with the cervix).
2. Hysteroresectoscopy. For such an operation, an incision is not required. The entire course of the operation is carried out through the vagina (myomectomy – removal of nodes located in the uterine cavity).
3. Transvaginal hysterectomy. The entire course of the operation is carried out through the vagina (removal of the uterus with nodes).
4. Laparotomy. This is a type of abdominal surgery, in which an incision is made in the lower abdomen, mainly for giant tumors of the uterus:
- myomectomy – removal of myomatous nodes;
- subtotal hysterectomy – removal of the uterus with nodes without a cervix;
- total hysterectomy – removal of the uterus with the cervix.
The first three options for surgical intervention can be considered the most popular. Their most important advantage is the absence of surgical sutures, quick rehabilitation of a sick woman, and the ability to preserve fertility.
If the growth of fibroids occurs very quickly and within a short period of time, a radical method is used, the complete removal of the body of the uterus (hysterectomy).
Removing the uterus is not just a painful procedure.By agreeing to a hysterectomy, a woman exposes herself to the risk of negative consequences: mental changes, autonomic disorders, pressure disorders, weight gain, etc. It also increases the likelihood of thyroid and breast cancer. Sometimes removal of the uterus is a forced decision when fibroids do not respond to alternative treatment.
Embolization of the uterine arteries (UAE)
Clinic “Grand Medica” uses organ-saving surgeries and more effective methods of tumor treatment – uterine artery embolization (UAE).This is a minimally invasive procedure that reduces the risks of complications and relapse to almost zero, allowing a woman to return to her usual life in a short time.
Embolization of the uterine arteries with uterine myoma is a method that allows you to fight a benign tumor without active surgical intervention, preserving the patient’s fully functioning uterus, the ability to become pregnant and carry a child. The essence of the method is to block the uterine arteries to stop the supply of myomatous nodes and their independent death.
Picture – Myomatous nodes of different localization and vessels that embolize
Uterine artery embolization is performed not by a gynecologist, but by an endovascular surgeon. Clinic “Grand Medica” is equipped with modern X-ray operating rooms with angiographs. These operations are performed in Novokuznetsk only at the Grand Medica clinic.
At the initial stage, gynecologists examine patients, prepare them for surgery, observe them after surgery in a hospital, as well as after discharge on an outpatient basis.Embolizing surgery is performed by cardiovascular surgeons in the Department of Vascular and Endovascular Surgery. The essence of the procedure is to insert a catheter into the arteries of the uterus. Surgeons receive information about the state of her vascular system, identify the vessels that supply blood to the fibroids (myoma) of the uterus. After that, small particles (emboli) are injected into the vessels of the fibroid, clogging these vessels and depriving the fibroid of nutrition. After 3-6 months, the myomatous node decreases significantly in size. On average, the embolization procedure takes 15 to 40 minutes.After that, the patient is transferred to a hospital, where she is under the supervision of two specialists at once: a gynecologist and a vascular surgeon for a day. A few days later, the woman is discharged from the hospital and returns to her usual way of life.
Drawing – Myoma “before” and “after” EMA
No additional treatment is required after embolization. It allows you to achieve complete replacement of myomatous nodes with connective tissue, defeat negative symptoms, and normalize the work of a woman’s reproductive function.
A distinctive feature of UAE is the extremely low probability of recurrence of uterine fibroids. In those cases when the tumor is diagnosed again, it is not about the resumption of the growth of nodes, but about the appearance of new fibroids.
At the Grand Medica clinic, the procedure for embolization of the uterine arteries is carried out under the compulsory medical insurance policy.
Indications for uterine artery embolization in uterine myoma:
Any woman can carry out embolization, regardless of the size of the tumor, the number of nodes and age.
Embolization is indicated in a situation where there are many nodes and they are located in areas that are difficult to access for surgical intervention. Patients with heart disease and respiratory failure, who are contraindicated for abdominal surgery, are also allowed to the procedure.
The doctor decides on the advisability of embolization, taking into account the wishes of the patient and accompanying factors: the age of the patient; the severity of symptoms, their nature; the size of the nodes and their localization; a tendency to the growth of nodes; the woman’s intention to become pregnant in the future.
Contraindications for uterine artery embolization:
This is an allergy to iodine preparations, pregnancy, oncology and acute inflammatory processes in the uterus and adjacent organs.
To avoid the appearance of this pathology, it is necessary to observe a set of measures aimed at maintaining the normal functioning of the body, and observe the rules of a healthy lifestyle, namely:
- Monitor your psycho-emotional state, control stressful situations, if possible, maintain peace of mind, and not give in to panic in a difficult environment.
- Adhere to the rules of a balanced diet. Correctly use the mode of work and rest. Take daily walks in the fresh air.
- Monitor your appearance and control your weight.
- Strengthen the immune system by hardening the body using water treatments.
- Within 1 year, undergo a medical examination and be examined by a gynecologist. Upon reaching the age of 40, once a year, undergo an ultrasound examination of the abdominal and pelvic organs.
- Correctly protect yourself from unwanted pregnancy, avoid abortion.
- Have a regular sex life.
- Avoid excessive exposure to direct sunlight.
- In the autumn and spring period, additionally consume fortified complexes, which include vitamins of groups A, C, E, as well as iron and iodine, copper and zinc.
The complex of these measures will avoid the development of uterine fibroids.
City Clinical Hospital No. 31 – Questions about myoma
Our conversation is devoted to one of the most frequent problems faced by women 35-50 years old. This is a uterine fibroid. Sergey Vyacheslavovich, what are the reasons for its occurrence and can it be avoided?
The causes of uterine fibroids are not fully understood, but there is no doubt that the growth of this benign tumor is stimulated by the female hormones estrogens. You have correctly noted that this disease, as a rule, affects women after 35 years, when age-related restructuring of the body begins, but there are cases of the disease at a younger age.With the onset of menopause, fibroids usually decrease against the background of a decrease in estrogen. Undoubtedly, there is a genetic predisposition to this disease.
Are there any effective conservative treatments for this disease?
Unfortunately, today there are no effective conservative methods for the complete cure of uterine fibroids. As a rule, hormone therapy is used. However, despite 40 years of experience with its use, there is no absolute evidence of its effectiveness.There is evidence of the successful use of hormone-producing uterine systems in women with small fibroids. They can reduce the amount of blood loss and slow down the growth of fibroids somewhat. As an auxiliary treatment, a specially selected cyclic vitamin therapy is prescribed, as well as general methods of healing that normalize the course of biochemical processes in a woman’s body. It is very important that a woman understands well the essence of her illness in order to overcome the stress that has arisen.
Women often look for a solution to their problems, using various kinds of nutritional supplements, herbal medicine and other non-traditional methods of treatment …
We are still experiencing a boom in nutritional supplements.I think time will put everything in its place. All over the world they are drunk by practically healthy people to prevent the aging process of the body and they should be used for a long time. It is impossible to cure serious diseases with their help.
With regard to herbal medicine, I would like to somewhat dispel the myth of its complete safety. If a woman suffers from uterine fibroids, improperly selected components of herbs and their ratio in fees can lead to the growth of fibroids. As you know, in the composition of most herbs.includes phytoestrogens, analogs of female hormones. In addition, the chemical composition of herbs grown in a particular area varies greatly, so it is almost impossible to find the exact dosage required for each particular woman.
At the same time, it is a woman’s right to try different, including non-traditional, methods of treatment. An objective confirmation of their effectiveness should be ultrasound control carried out regularly on the same days of the menstrual cycle.
Usually women are afraid of the very word tumor and often they themselves demand more radical methods from the doctor, that is, surgical intervention?
At one time it was believed that with uterine fibroids, the likelihood of cancer increases sharply, and the uterus was very often removed, as it were, prophylactically.And if a woman was misdirected, then it is quite possible that, being in a state of chronic stress, she may insist on surgical treatment, considering it the solution to all problems. However, it has now been proven that there is no clear relationship between these diseases. In addition, today gynecology offers a woman modern examination methods that make it possible to diagnose oncopathology in time. For example, such as hysteroscopy, when a doctor examines the uterine cavity using a hysteroscope (optical device), doppler ultrasound (when the doctor can examine the blood flow of an organ), as well as the use of special laboratory tests (tumor markers).
I had to listen to the opinion of gynecologists that at a certain age, when a woman already has children, such an operation as removing the uterus will not significantly affect a woman’s health. How harmless is the removal of the uterus from a woman?
Let’s start all the same with the fact that this is a complex surgical intervention, which means there is always a risk of various kinds of complications, especially when a woman is already aged. After removing the uterus, a woman may also face a number of new problems.These are pelvic pain, loss of sex drive, premature menopause (even if the ovaries are not removed).
What can we say about those cases when gynecologists “for prophylaxis” remove the ovaries along with the uterus. Only in the body there is nothing superfluous. And the ovary is the organ that shapes the health of a woman. Estrogens – female hormones ensure the strength of blood vessels and bones, beauty and youthfulness of the skin. Therefore, the gynecologist must think not only about the prevention of cancer, but also about how this woman can continue to live with new, sometimes more formidable problems that may arise after such a radical intervention.I must say that often the post-castration syndrome is worse than the “cured” disease.
When is surgical intervention unavoidable?
Unfortunately, sometimes it is necessary. The main indications are the rapid growth of fibroids; pain syndrome; large fibroids, disrupting the activity of other organs; not amenable to conservative therapy, debilitating bleeding. If, nevertheless, surgical intervention cannot be avoided, then, if possible, the volume of the operation should be minimal (sometimes it is possible to remove only the myomatous node, and not the entire uterus), and performed using laparoscopy, that is, without dissecting the anterior abdominal wall. Of course, not every tumor can be operated laparoscopically, but there is a way out too. There are drugs that allow you to first reduce the size of the tumor, and then perform the necessary surgery.
In conclusion, I would like to advise all women with uterine fibroids to be monitored by an experienced doctor, at least once every six months to undergo ultrasound control on the same days of the menstrual cycle. It is critical to be critical of those advertisements that guarantee a 100% cure for this disease.
90,000 Uterine fibroids – free treatment in Moscow
The diagnosis of “cervical fibroids”, perhaps, can be attributed to the number of the worst female nightmares. Hearing such a verdict from a doctor, many fall into a stupor, since the word “myoma” evokes a persistent association with oncology. Let’s dot the i right away: fibroids are not cancer, but a benign tumor arising from muscle tissue. Let’s take a closer look at what a disease is and how it can be cured.
Causes of the disease
Unambiguously answer the question “What causes fibroids?” impossible. The reasons are different: from infectious and inflammatory diseases of the female genital area and ending with a hereditary predisposition on the maternal side.
Among the provoking factors are endocrine and autoimmune diseases, obesity and various surgical interventions in the uterine cavity (instrumental abortion, diagnostic curettage, removal of polyps), which the woman underwent earlier.
At first, the uterine fibroids node can be tiny (about 3 – 5 mm) and stay “in one pore” for a long time, and then begin to increase in size. Depending on the location, there are fibroids of the walls, body and fundus of the uterus.
One interesting fact should be noted. Previously, it was believed that the risk of the disease increases with age, and often it can first manifest itself in a woman with menopause. Today, an unprecedented “rejuvenation” can be traced: such a diagnosis is no longer uncommon in young women under 35 years old.
Timely fibroids can be detected if two simple rules are observed: regular observation by an obstetrician-gynecologist at the place of residence and an ultrasound scan of the pelvic organs once every six months.
“The only effective prevention of fibroids is a regular visit to a gynecologist once every six months. Nothing else is required from a woman! ”
Yulia Vladimirovna Kovpiy
gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the GKB im.S.I. Spasokukotsky
Symptoms and signs of uterine fibroids
Is it possible to identify the disease on my own? Gynecologists use a term such as “asymptomatic uterine myoma”, when the tumor does not manifest itself for years and is discovered by chance during an ultrasound examination.
But most often a woman herself may suspect the following signs of uterine fibroids:
- Pain with uterine fibroids. Pain sensations occur in the lower abdomen and lower back.
- Bleeding. Menstruation with uterine fibroids is always profuse and prolonged.
- Discharge with uterine fibroids. Generally bloody, brown or yellow in color, and can be viscous or liquid in consistency.
Even if you have noticed one of these symptoms (not to mention their combination) for a long time, this is a reason to immediately consult a doctor!
What is uterine fibroids: sizes, types, stages
Fibroids in medical terminology can be called differently.If we talk about a nodular myoma, then there is only one node in the uterine cavity. Multiple (multinodular) fibroids suggest the presence of several nodes, sometimes they are located in different parts of the uterus.
According to the type of location of myomatous nodes, doctors distinguish three main types of fibroids:
- 1. Submucous. It is also called submucous myoma. As a rule, such a tumor either penetrates the vagina or grows into the uterine cavity. It is characterized by profuse menstruation.
- 2. Subserous. The second name is subperitoneal. It is subserous myamatous nodes that most often grow to gigantic sizes and a weight of the order of 10 – 12 kg.
- 3. Interstitial. Intramural, or intermuscular. It grows in the thickness of the myometrium and is considered the most common type of fibroids.
At the same time, mixed fibroids (for example, submucous-intramural, etc.) are not uncommon. But regardless of its type, uterine myoma goes through 3 stages: the formation of the myomatous node, its growth and maturation of a large tumor from it.And, unfortunately, most of the patients seek help only at the 3rd stage of the disease, when the myoma is “visible to the naked eye” and has the size of a full-term pregnancy.
When is deletion required?
“When is an operation to remove uterine fibroids necessary?” – probably the second most common question of interest to women who are faced with this disease.
According to modern medical protocols in force in gynecology, uterine myoma of small size (up to 4 cm), asymptomatic, requires only regular observation by a doctor without any therapy.
Myoma of small size (more than 4 cm), which at the same time increases by 3 – 4 weeks per year, by analogy with the size of the pregnant uterus, already requires surgical intervention.
“Today there are several effective methods of treating uterine fibroids, and the operative one is far from being the first among them. Only if there are large myamatous nodes that are not amenable to any type of therapy, including medication and embolization of the uterine arteries, does the question of surgical treatment arise.But at the same time, obstetricians-gynecologists always face the task of preserving the uterus of a patient of any age ”
Yulia Vladimirovna Kovpiy
gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the GKB im. S.I. Spasokukotsky
Methods for removal of uterine fibroids
Methods of treatment of uterine fibroids are subdivided into radical (when there is a need to remove the uterus) and organ-preserving (when only myoma nodes are removed in one way or another).
Treatment of uterine fibroids without surgery, unfortunately, is not always effective.Drug therapy is aimed only at restraining the growth of nodes, making their size smaller, but it is impossible to completely get rid of the tumor in this way.
Today, the following types of operations are most effective for removing uterine fibroids.
Performed under intravenous anesthesia using a hysteroresectoscope with an electric loop at the end. It is introduced through the cervical canal and the node is gradually cut off. As a rule, it is used for submucous myoma of small sizes up to 4 centimeters.Has a short rehabilitation period.
Under the control of a video camera, special instruments are introduced into the abdominal cavity through small incisions. Refers to high-tech surgical interventions. Has a fairly short recovery period.
For large tumors, an abdominal operation is performed. Its main advantage is the possibility of forming a full-fledged scar on the uterus, which will preserve it for future childbirth. It is carried out through an incision on the anterior abdominal wall up to 10 cm in size.Requires a long period of rehabilitation.
UAE (Embolization of the uterine arteries)
Refers to minimally invasive surgical interventions. The goal of the method is to cut off the blood supply to the myomatous nodes with the help of a special medication that is delivered to the arteries through a catheter on the thigh. Despite its obvious attractiveness from the point of view of a short rehabilitation period, UAE is not the # 1 method. A positive effect from the application of the technique is achieved only when many factors coincide: the size of the fibroid, the patient’s age, the location of the tumor, etc.n. Therefore, embolization of the uterine arteries is used exclusively according to indications.
FUS-ablation of uterine fibroids
Another example of minimally invasive surgery. FUS ablation is a rather rare technique performed according to strict indications, and not by ordinary gynecologists, but by endovascular surgeons. Myomatous nodes are removed using ultrasound waves under the guidance of MRI. In fact, they are “evaporated”. Unlike ultrasound used in ultrasound diagnostics, ultrasound therapeutic waves have a lower frequency, but they are superior in power.As a rule, this is a first-aid method in case of extensive uterine bleeding. In inpatient treatment of fibroids, FUS-ablation is practically not used.
* Please note that the decision to choose one or another method of treatment is made by the doctor, depending on the individual indications and contraindications of the patient.
“The uterus, together with the myoma, is removed only in the most extreme cases. As a rule, we are talking about elderly patients who have already fulfilled their reproductive function and, in addition to fibroids, suffer from age-related prolapse of the pelvic organs (prolapse).This is done through a vaginal operation and involves a fairly quick rehabilitation “
Yulia Vladimirovna Kovpiy
gynecologist of the highest category, candidate of medical sciences,
head of the gynecological department of the GKB im. S.I. Spasokukotsky
Compulsory medical insurance policy and treatment of uterine fibroids
Hysteroresectoscopy, laparoscopy and laparotomy are methods for removing fibroids that are available to patients under the compulsory health insurance program. If you have been diagnosed with uterine fibroids and an operation is required, then remember that all residents of Russia have the right to treatment in Moscow for free under the compulsory medical insurance policy.
You can find out about the possibility of planned hospitalization in one of the 46 city Moscow hospitals by calling the hotline of the project “Moscow – the capital of health”: +7 (495) 587-70-88 or by leaving a request on the website msz.rf.
The project’s services for informing citizens, as well as medical care for patients in the hospital, are provided free of charge.
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Pregnancy and uterine fibroids
“Is it possible to get pregnant with fibroids?” – this is the question that worries everyone who wants to become a mother.Doctors’ forecasts on this score are quite optimistic. If the uterine fibroids are small, then the pregnancy proceeds without complications, and the delivery takes place naturally.
If the myomatous node is located so that it prevents the attachment of the ovum, it must be removed six months before planning pregnancy. The method of removal is chosen by the doctor, based on the individual characteristics of the patient: age, presence of pathologies, etc. After removal of fibroids, you can give birth, but the method of delivery is selected by the doctor individually in each case.
“Fibroids can sometimes cause infertility or miscarriage, but not always. Everything is individual. First of all, this occurs with the submucous location of the myomatous nodes. And in this case, if the patient is a young nulliparous woman, who still has everything ahead, our task is to minimize all surgical interventions on the uterus as much as possible so that she can carry the baby. When it comes to surgical treatment, we often make a choice in favor of laparotomic myomectomy, which allows us to form a full-fledged scar on the uterus ”
Yulia Vladimirovna Kovpiy
gynecologist of the highest category, Ph.MD,
Head of the Gynecological Department, GKB named after S.I. Spasokukotsky
What is the danger of fibroids?
If treatment is not completed on time, the consequences of uterine fibroids can be very serious.
Firstly, when myomatous nodes are actively growing, they begin to squeeze adjacent organs and disrupt their work. If it is the ureters or bladder, then urination is disturbed, and if the rectum, then constipation begins.