Cancer Incidence
Power Morcellation is Associated with Cancer Incidence
Regardless of the percentages, it is of the utmost importance for consumers to understand that the use of a device known as the power morcellator does have a history, a proven history, of causing cancer in patients who were treated with it.
This history has emerged quite clearly in the past two years as several patients have made their stories known. Perhaps the most famous is that of Amy Reed. A physician and mother of six, she underwent a procedure to remove problematic uterine fibroids (benign tumors) through a laparoscopic procedure. This procedure relied upon a power morcellator to divide and shred the tissue to be removed through suction.
Unfortunately for Dr. Reed, she did not have uterine fibroids alone but also a type of cancer known as Leiomyosarcoma (LMS). This is a rare and aggressive cancer that can be disseminated easily through the use of the morcellator. When the condition is considered local (contained in one mass of tissue) it can be treated through surgical excision.
This surgery is unusual in that it demands wide margins (areas of clean tissue around the treated region), but when done properly and early in the disease, it can effectively bring the problem to an end. Some patients are also treated with radiation and chemotherapy to be doubly sure that they are free of cancer.
However, if it progresses beyond the local stage and goes systemic, the prognosis is not good. In fact, patients staged at 3 or 4 are expected to perish from the condition. The use of a morcellator tends to bump anyone into stages 3 or 4 simply because of the release of the parasitic nature of sarcomas.
Small Percentages
A recent review of various cases in which women had laparoscopic surgeries using the morcellators yielded certain facts. One of which was that .6% of women did have uterine sarcoma rather than fibroids or developed LMS within two to seven years of their surgeries. (Pullen, 2014)
Though this seems like a small figure, it cannot be ignored. Especially when organizations like the FDA have determined that 1 in 350-500 women stand at risk for the development of systemic LMS due to undiagnosed uterine LMS at the time of a morcellation procedure.
In fact, the FDA’s conclusions are strikingly similar to those of the group that conducted the recent reviews. Both advocate for in-depth patient counseling prior to any procedures. They agree that the possibility for such a deadly complication be given the same weight as the benefits of a minimally invasive procedure. While many physicians are arguing in favor of the use of morcellation because they reduce the threat of complications and urinary or sexual issues related to the surgical hysterectomy, with rates hovering near 1%, many may not feel that morcellation is worth the risk.
Major manufacturers of the devices have already agreed with the FDA and have gone so far as to recall all of their units. Several lawsuits are underway as well, with most aimed at the manufacturers of the devices for failing to identify such risks.
Temple University is among the first to consider containment bags to be put in place for such procedures, but that is something still in the future of surgical options.
For now, it is up to patients to understand the risks, physicians and surgeons to counsel patients about their options and what these involve, and medical experts to determine how to better identify risks before surgery and reduce the threat of the spread of such a lethal and untreatable form of systemic cancer. Until then, caution is the best policy.
Source
Pullen, Lara C. Power Morcellation Associated With 0.6% Cancer Incidence. MedScape.com. 2014. http://www.medscape.com/viewarticle/837250