Morcellators are used in minimally invasive surgery to remove fibroids from the uterus, or to completely remove the uterus in a hysterectomy. They use rapidly spinning blades to tear tissue into tiny pieces that can be removed through a small incision. But if they hit an undetected cancer tumor, they can spread the cancer and make it difficult to treat.
Power morcellators do not cause cancer, but they can spread it inside the abdominal cavity. This is the part of the body that contains the intestines, liver, kidneys, reproductive and other organs.
Studies have found that roughly 1 in 350 women who undergo a hysterectomy or myomectomy have undetected uterine cancer. When the spinning blades of a power morcellator hit these cancer tumors, it can tear them into tiny pieces and spread the cells like seeds through the area around the surgical site. These cells effectively take root and can grow into new tumors.
When power morcellators spread uterine cancer, it often isn’t detected until it has advanced to later stages and is difficult to treat.
It is the fourth most common type of cancer among women, behind breast cancer, lung cancer and colorectal cancer.
The American Association of Gynecologic Laparoscopists reviewed one study of 1,091 power morcellator surgeries and found 12 women had irregular tissue samples not previously diagnosed. Ten of these women had malignant cancer cells. Types of cancer found included uterine myoma, endometrial stromal sarcoma (ESS) and leiomyosarcoma (LMS).
Leiomyosarcoma (LMS) is one of the more serious types of uterine cancer power morcellators can spread. LMS is a type of soft tissue sarcoma that is most common in the uterus, abdomen or pelvis. Left untreated, it can spread through the bloodstream, affecting the lungs, liver, blood vessels or any other soft tissue in the body.
It is one of the types of cancer power morcellators have been known to spread. It is also particularly deadly and aggressive.
MRIs, CT scans and even biopsies are not 100 percent reliable in detecting these hidden cancer cells. But, endometrial cancers are easier to find than more aggressive forms like LMS. Before undergoing surgery, women should have a biopsy of the uterine lining.
In a pivotal study by Dr. Jason D. Wright and colleagues published in the September 2014 issue of JAMA, the authors stressed the importance of screening hysterectomy or myomectomy patientsfor any history of cancer before laparoscopic power morcellation. Women with any history of cancer should not undergo morcellation.
Anita Austin had laparoscopic power morcellation surgery to remove a uterine fibroid. Doctors told Austin that the procedure would be less invasive and she would recover faster, but they did not inform her of the cancer risk, even though she had previously had thyroid cancer. Her cells were only Stage I, but the procedure seeded the cells all over her abdomen, effectively advancing the cancer to a higher stage.
“The big issue for me is that no one mentioned cancer,” Anita Austin told Fred Hutch News, “Not at all. And I question things. I’d had thyroid cancer [in the early ‘80s], and I would have probably done something different. Given my history, honestly, I should have been advised not to do it.”
“The big issue for me is that no one mentioned cancer”
Frequently, LMS is diagnosed post-surgery after pathologists examine tissue samples. Unfortunately, if a power morcellator was used to extract that tissue, the hidden cancer may have spread, becoming metastatic LMS.
Treatment for LMS typically involves a combination of surgery, chemotherapy and radiation therapy.
A woman’s chances of survival improve dramatically if the cancer is detected early for LMS and other uterine sarcomas.
About 19 in 20 uterine cancer diagnoses are cancers of the endometrium, the inner lining of the uterus. Endometrial cancer is one of the most curable cancers. On average, about 8 in 10 women diagnosed with these types of uterine cancers will live five years or longer after they are diagnosed.
Typically, cancer is easiest to treat if it is “localized” — meaning it has not spread from the uterine. Treatment becomes more difficult if cancer becomes “regionalized” — meaning it has spread to other organs or tissue in the abdomen; or if it has become “distant” — meaning the cancer has spread to the rest of the body.
Being aware of causes and potential risks can help a woman know if she is at risk and should be screened for uterine cancer. Identifying uterine cancer early can improve a woman’s chances of survival.
While the exact causes of uterine cancer are not known, a number of risk factors have been identified that can increase a woman’s chances of developing the disease.
The risk of uterine cancer rises with age. Women over age 65 had the most risk. The FDA does not recommend power morcellation for women in this age group.
Some drugs may increase risk as well, including those used in hormone replacement therapy and some medications used in the treatment of breast cancer.
When doctors diagnose cancer after morcellation, it is typically stage III or IV — a very advanced stage with poor prognosis. A tumor is considered stage IV when it has spread to the lymph nodes, bladder, rectum and/or distant organs. Some patients had LMS spread to their spine or lungs.
If tumors affect other organs or bones such as the spine, symptoms could include back pain or nerve issues.
In addition to the risk of spreading cancer, surgery with a power morcellator has other risks as well. The devices can even scatter noncancerous fibroid tissue. This can attach to other tissues and organs in the abdominal cavity, causing more fibroids to grow.
Please seek the advice of a medical professional before making health care decisions.
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