Surgical Management of Uterine Smooth-Muscle Tumors

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Author: Heidi Bright, M.Div.

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Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/

Surgical management of uterine smooth-muscle tumors was addressed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

Matthew Anderson, associate professor and director of research (gynecology) at Baylor University, said “Uterine leiomyosarcoma is a unique disease.” As many as 80 percent of women are impacted by a uterine smooth muscle tumor. About 200,000 hysterectomies are performed every year, which costs $3 to $5 billion.

“The only way to know if it’s malignant is to surgically remove it,” he said, because there are no diagnostic markers and no blood tests that can be used to determine malignancy.

Leiomyomas can arise in unusual locations. If they are morcellated, they can create other problems down the road. These myomas tend to respond to hormonal therapy.

They generally don’t tend to respond to chemotherapy or radiation.

About 70 percent of uterine LMS are discovered as isolated uterine masses. Recurrence rates are 40 to 70 percent.

With surgical debulking, doctors can increase progression-free survival from 6.8 months to 14.2 months.

Resection of pulmonary metastases can improve disease-free survival by as long as 24 months. This can include extensive resections while preserving good functional lung status.

Surgery by itself is not the answer. Unseen cells can come back. Ultimately patients have to rely on chemotherapy.

On April 17, 2014, the US FDA issued a safety communication regarding the use of power morcellation for performing hysterectomies or myomectomies. This led manufacturers to withdraw the devices and hospitals generally are not using this method.

Impact: 99 percent of the time, the uterine tumor is not cancer. Yet demand from patients for minimally invasive hysterectomies continues.

There is one case of ULMS in every 1,960 cases.

Short-term, the risk of ULMS should be discussed thoroughly with each patient.

The long-term goal is to develop a diagnostic test that can be used to determine malignancy.

One thought on “Surgical Management of Uterine Smooth-Muscle Tumors”

  1. To clarify, when Dr. Anderson said, “Uterine leiomyosarcoma is a unique disease,” he was referring to new data that shows gynecologic LMS is distinct from 2 other types of LMS. He was part of The Cancer Genome Atlas (TCGA) team that examined genomic data for LMS. At the Oct. 8 symposium, Dr. Brian Van Tine said results on LMS should come mid-December. TCGA told me recently that those results won’t come till later in 2017.

    The initial discussion of “uterine smooth muscle tumors,” “leiomyomas” and “myomas” refers to what most people call “fibroids.” This sentence follows: “They generally don’t tend to respond to chemotherapy or radiation.” That certainly is true of fibroids, which are benign. The malignant version is uterine leiomyosarcoma, and many cases do respond to chemo. The use of radiation is controversial, but it’s sometimes used to shrink a tumor so that it can be removed surgically without doing too much damage to healthy tissue or it may be used to “clean up” any cancer cells left behind, as was done in my case.

    The sentence: “Ultimately patients have to rely on chemotherapy” may refer to women whose LMS keeps coming back. A number of women who have ULMS never have a recurrence or metastasis. They don’t have to do chemo or radiation.

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