Earlier this year, the Food and Drug Administration warned that a device commonly used to remove fibroids called a power morcellator may inadvertently spread undiagnosed cancer. And yet, many physicians are still using morcellators, reports the Wall Street Journal.
Uterine fibroids, aka benign tumors of the uterus, are incredibly common: Up to 25% of American women in their childbearing years have them. After age 50, that number grows to 70% for white women and 80% for black women. Many are symptomless and go away on their own, but some cause pain and abnormal bleeding and need to be removed surgically. Many women opt for a hysterectomy to prevent the tumors from coming back.
The device allows surgeons to remove the tumors (and in the case of hysterectomy, the entire uterus) "laproscopically"; the morcellator chops up the tissue of the fibroids or the uterus so it can be removed through tiny incisions.
"Because some cancers, called myosarcomas, may look like benign fibroids before surgery, power morcellation can spray cancerous cells throughout the abdominal cavity, allowing malignant tumor to implant and grow all over," explains Joseph A. Lucci, III, MD, a gynecologic oncologist and professor at The University of Texas Health Science Center at Houston (UTHealth). "Myosarcomas don’t normally spread that way. That kind of recurrence in the abdomen is unique to use of that device."
As gruesome as that sounds, the FDA stopped short of an outright ban on the device, which is used in around 50,000 procedures each year. And according to the American College of Obstetricians and Gynecologists (ACOG), there are women who may benefit from this type of surgery, which has fewer risks compared to traditional procedures in which the abdomen is opened. Meanwhile, other experts believe the device should be cast aside completely until there's more evidence supporting its safety.
So what should you do if you need to have fibroids removed? Here are three questions to ask your surgeon that may help you decide.
What exactly are you going to do?
Definitely, you want to know whether your doctor plans on using a power morcellator, and what each step of the procedure will entail. There are a variety of minimally invasive surgical techniques for dealing with fibroids, some of which, like laproscopically assisted vaginal hysterectomy, offer similarly quick recovery times and low risks, Dr. Lucci says. "Other tools, such as scissors, can be used to cut up the tissue, and make it small enough to be removed without a big incision. There are also surgical bags that can be placed around the uterus before power morcellation, which theoretically reduces the chance that if it is cancer, it can spread."
And, Dr. Lucci adds, "If the doctor is set on one technique, especially if it's power morcellation, get a second opinion."
What are the risks?
Every surgery comes with risks; your doctor should be able to lay out all of them. In the case of power morcellation, the major issue is the risk of cancer. "The problem is we're not sure how frequent it is. Some data put it at 1 in 350 patients (which is still less than 1%) with fibroids will actually have myosarcoma, while other studies suggest it's more like 1 in 7,400," Dr. Lucci says. The bottom line is that the risk is small, but it does happen.
What do my imaging tests reveal?
If you're considering fibroid surgery, you've likely had an ultrasound and maybe even an MRI. "Ask your doctor: Are my fibroids large and fast-growing? Are the margins clearly defined or irregular?" Dr. Lucci says. "Both fast-growing and irregular margins are suggestive of cancer." Now, that doesn't necessarily mean you're dealing with a malignancy for sure (so don't freak out), but it does mean power morcellation probably isn't worth the risk.