Occult Malignancy in Gynecology Surgery

Written by Jeff Meyer on 1 Mar 2015

In 2014, the FDA took a stance on the use of devices known as power morcellators. The agency strongly stated that they believed that morcellators were contraindicated for use in hysterectomy and myomectomy. The reasons for this stance were plain: the devices had proven themselves to lead to the spread of deadly cancer cells in women who had gynecological surgeries using them.

Just what had gone wrong? What the FDA had learned from various cases in the headlines and the court systems was that a certain form of undiagnosed cancer could be easily released into the bloodstream when masses were removed using the morcellators. In other words, a form of occult malignancy that kept itself well hidden by emulating the same symptoms as benign growths was released into the body during standard gynecological surgery.

LMS

The cancer is Leiomyosarcoma (LMS), and it is rare and not easy to detect. It attacks soft tissue of the body, especially involuntary muscle, and it does not spread via the lymphatic system like other cancers. Instead, it can travel in the blood stream because blood vessels are involuntary muscles! This makes it a completely unpredictable cancer.

However, it is actually quite treatable when it is discovered early and when it is local – limited to a single tumor or growth. Surgical excision with wide margins (large areas of disease free tissue), followed by chemo or radio therapies can often eliminate it. However, if left undiscovered, it can become metastatic and systemic, which makes it almost impossible to remedy.

Uterine LMS

Women with fibroids are the most at risk because LMS is easily mistaken for the entirely benign, growths. It takes imaging and blood work to uncover that it is indeed LMS, and only one in six women actually have a proper diagnosis prior to surgery.

When a woman has a surgical removal of the tissue (either through a myomectomy or a hysterectomy) the option for laparoscopic surgery allows for the use of the morcellator. This cannot cleanly sever tissue the way a standard open surgery might, and instead it segments or shreds tissue and suctions it away.

It was the shredding that led to the FDA taking action, since this procedure allows the tiny bits of tissue and cells released throughout the body to act just like seeds that allowed the dangerous cancer to spread throughout a patient’s abdominal area. The use of morcellator gear converts a treatable single growth into a case of systemic LMS that can be impossible to treat because it is so resistant to chemo or radiation.

The occult nature of LMS in the uterus is a tremendous problem when morcellation is used. Currently, the gynecological field suggests that the best way to deal with hysterectomy or myomectomy is vaginally. However, even in light of the FDAs warnings, many surgeons still use morcellation (either robotically or manually). This is why the FDA has expressed a desire for physicians to give their patients the fullest details possible relating to laparoscopic surgery and morcellators.

What’s the Best Approach?

Because of the challenges in diagnosing LMS prior to a surgical procedure, the best and safest approach is to demand that your surgeon verify that you do indeed have harmless fibroids and not LMS growths. This will require imaging and blood work, but it is the one sure way to uphold safety.

There are currently lawsuits against the makers of morcellators because of the incidences of systemic cancer that their use has caused. Rather than allowing a physician to dictate the terms, ask them about morcellators, your particular health challenges, and what they can do to ensure you are not at risk for the spread of malignancy.

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