Morcellator Complications

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.

*Please seek the advice of a medical professional before discontinuing the use of this medical device.

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.

Morcellators and Uterine Cancer Risks

When power morcellators spread uterine cancer, it often isn’t detected until it has advanced to later stages and is difficult to treat.

What is Uterine Cancer?

Uterine cancer occurs when cells within the uterus begin to grow abnormally, multiplying rapidly to form tissue masses known as tumors.

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).

Power Morcellators can Spread Leiomyosarcoma

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.

Power Morcellator device
Power Morcellator

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 patients for 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"

- Anita Austin, patient of laparoscopic power morcellation surgery


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.

Early Diagnosis and Survival of Uterine Cancers

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.

Uterine cancer diagnose

The remaining 1 in 20 uterine cancer diagnoses are sarcomas, which are much more aggressive.

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.

How Many Women Survive 5 Years or More After Uterine Sarcoma Diagnosis

Diagram showing number of women that survive after an LMS diagnosis

Leiomyosarcoma (LMS)

  • Localized - 6 in 10
  • Regionalized - 4 in 10
  • Distant - 1 in 10
Diagram showing number of women that survive after undifferentiated sarcoma diagnosis

Undifferentiated Sarcoma

  • Localized - 7 in 10
  • Regionalized - 4 in 10
  • Distant - 2 in 10
Diagram showing number of women that survive after endometrial stromal sarcoma

Endometrial Stromal Sarcoma

  • Localized - Almost 10 in 10
  • Regionalized - 9 in 10
  • Distant - 7 in 10

Causes of Uterine Cancer

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.

COMPLICATIONS ASSOCIATED WITH POWER MORCELLATOR SURGERY INCLUDE:

  • High levels of estrogen in the body
  • Being over age 40
  • Obesity
  • Family history of uterine cancer

Uterine Cancer Symptoms after Morcellation

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.

lower body x-ray

SOME SYMPTOMS THAT COULD SIGNAL UPSTAGED CANCER AFTER MORCELLATION INCLUDE:

  • Vaginal bleeding or spotting, between periods or especially after menopause
  • Vaginal discharge
  • Pelvic or abdominal pain or a mass
  • Pelvic or abdominal swelling
  • Weight loss
  • Nausea or vomiting

If tumors affect other organs or bones such as the spine, symptoms could include back pain or nerve issues.

Other Complications of Morcellators

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.

COMPLICATIONS ASSOCIATED WITH POWER MORCELLATOR SURGERY INCLUDE:

  • Additional surgery
  • Bleeding or infection
  • Bowel obstruction
  • Bruising
  • Fibroid reoccurrence
  • Intestinal obstruction from new fibroids
  • Intra-abdominal abscesses
  • Muscle soreness
  • Oozing at incision site
  • Organ damage
  • Pain at incision site
  • Pelvic and abdominal pain
  • Peritonitis (inflammation of the abdominal lining)

Author

Terry Turner is an Emmy-winning, former television journalist. He is an associate member of the American Bar Association, the ABA’s Health Law group and a member of the Alliance of Professional Health Advocates. He holds six certificates in Health Literacy for Healthcare Professionals from the Centers for Disease Control and Prevention. As a Washington-based investigative reporter, he routinely reported on health and medical policy issues before Congress, the FDA and other federal agencies. Terry received his B.A. in Media Arts from Lyon College.


Hide Sources

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