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The Debate about Morcellation and Cancer Risk

From the Pre-Op Hysterectomy Articles List

Morcellation cancer risks with hysterectomy and cancerWhat are the facts about fibroid morcellation and cancer risk for my upcoming hysterectomy?

Morcellation during a gynecologic surgery is a controversial topic. One of the biggest concerns, based on one woman’s recent experience, is the possibility of spreading undiagnosed cancer, specifically uterine leiomyosarcoma (ULMS), during minimally invasive surgery (MIS) with morcellation. Because of this woman’s experience, there has been discussion within the medical community about banning or curbing the use of morcellation altogether, which may have negative affects on other women and the surgical—hysterectomy or myomectomy—choices available to them for the best outcomes.

Though we do not claim to be medical professionals, HysterSisters.com aims to provide you with facts that can help you make the best decisions for your health. Below are some statistics and information we’ve gathered from various sources about ULMS.
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"HysterSisters.com is not intended to take the place of a personal physician. It is an online community of women who give and receive support for hysterectomy decisions, recovery and treatments. HysterSisters.com offers resources and kindness so that our visitors can discover options and make decisions for themselves."

Is Morcellation Harmful?

Uterine leiomyosarcoma is a cancerous tumor of the soft tissue of the uterus. It can sometimes be mistaken as a uterine leiomyoma, more commonly known as a fibroid. If a leiomyosarcoma is mistaken as a fibroid and morcellation is used in an open environment—meaning the pieces are not contained in a bag—cancerous cells could be spread to new areas, possibly upgrading the stage of cancer and decreasing prognosis.

Based on this information alone, it might seem like morcellation is an unsafe procedure, which it could be for some women, but there are other variables to consider before removing the option for all women.

Is Morcellation Beneficial?

An article published in the Journal of the American Medical Association (JAMA) in March 2014 reported that the pool of data on the matter is simply too small to come to any definite conclusions (a). Based on current research we cannot know if the “benefit-to-harm balance”—as JAMA calls it—is any different from other accepted medical practices.

On the other hand, the pool of women who can benefit from morcellation is much larger. For women who have an enlarged uterus or a large fibroid, for instance, morcellation gives them the option of MIS, meaning smaller incisions, fewer surgical risks, and shorter healing time. Otherwise, their only option is the large abdominal incision. Morcellation also gives women who wish to keep their cervix the option of MIS. Eliminating morcellation, therefore, could negatively affect a significant number of women seeking MIS and/or a supracervical hysterectomy.

How Common is ULMS for Women with Fibroids?

Some studies and articles indicate that 1 woman out of every 10,000 with fibroids may be diagnosed with uterine leiomyosarcoma (ULMS) (b). Others state it may be closer to 1 in 1,000, while some believe it is as many as 1 in 400 (c). Womenshealth.gov indicates that fewer than 1 in 1,000 women with fibroids will turn out to be a uterine leiomyosarcoma (d). A study (published in 2012) of 1,091 patients over a five-year period at Brigham and Women's hospital indicated that 1 patient was diagnosed with ULMS (e). The JAMA article indicates that from 1983 through 2010, there were 13 unexpected uterine sarcomas reported postoperatively among 5,666 uterine procedures in the United States, which translates to a risk of no more than 0.49%, and very few of those underwent morcellation.

What about Women with Uterine Cancer?

According to the American Cancer Society, about 1,600 out of 52,630 cases of uterine cancer will be uterine sarcomas (f). The National Cancer Institute indicates that uterine leiomyosarcoma makes up around 30% of all uterine sarcomas, which means around 480 women could be diagnosed with ULMS in 2014 (g). Statistically, that means just under 1% of all women diagnosed with cancer of the uterus will have ULMS. The Liddy Shriver Sarcoma Foundation supports those statistics (h). According to the Sarcoma Foundation of America, however, about 6 in 1,000,000 women in the United States will be diagnosed with ULMS each year (i).

In the sixth edition of Obstetrics and Gynecology, published in 2011 in collaboration with the American Congress of Obstetricians and Gynecologists, uterine sarcomas were found to account for approximately 3% of all uterine cancer, but 0.1% of all fibroids (j). The American Congress of Obstetricians and Gynecologists (ACOG) indicates that ULMS was found in 1 in 2,000 women who underwent a hysterectomy in the United States in 2008 (k).

In a general HysterSisters.com survey answered by 164,000 members (as of February 2014), over 72,800 reported that they had a hysterectomy because of fibroids and 27,400 reported a hysterectomy due to cancer or suspected cancer. Of those, 36 reported a ULMS diagnosis. Based on these numbers, it appears that a little more than 1% of women who had suspected or confirmed cancer had ULMS, or 1 in 2,000 women with fibroids reported ULMS.

What are the Risk Factors for ULMS?

Women who have had prior pelvic radiation or used tamoxifen can be at higher risk for ULMS. The American Cancer Society states that African-American women are twice as likely to have Uterine Sarcoma than Caucasian or Asian women (l). In addition, women with ULMS tend to be over 50. While some studies include some of these variables, many, including HysterSisters.com, did not specifically ask all participants about all of the risk factors and variables, including age, race, prior radiation therapy, and tamoxifen use.

So What's the Bottom Line?

Overall, the risk of uterine leiomyosarcoma is low. Morcellation can be dangerous for a small percent of women who are at risk for ULMS, but it is not a major concern for the majority of women.

HysterSisters.com continues to urge women to make informed decisions by researching, asking questions, and seeking second opinions from gynecologic surgeons. If you are scheduled for a hysterectomy with morcellation and are concerned or unsure about your risk for ULMS, discuss the topic carefully with your physician. If you suspect you have a gynecologic cancer concern, consult with a gynecologic oncologist before making any final decisions or undergoing any surgical procedure.

(a) Evaluating the Risks of Electric Uterine Morcellation
(b) Fibroid Tumors
(c) AAGL Tissue Extraction Report
(e) Fact Sheet Uterine Fibroids
(f) Is it time to Revisit Uterine Morcellation?
(g) Uterine Sarcoma Key Statistics
(h) Uterine Sarcoma Health Professional
(i) Leiomyosarcoma Cancer: Diagnosis, Treatment, Research & Support
(j) Uterine Leiomyosarcoma
(k) Obstetrics and Gynecology, 6th Edition, 2011, Charles R. B. Beckmann
(l) Alternatives to Hysterectomy in the Management of Leiomyomas
(m) RIsk Factors for Uterine Sarcoma

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

Published: 20 February 2014
Last Updated: 27 May 2014

02-20-2014 - 11:50 AM


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