Fibroid patients need personalized care
by Heather Woolwine
Public Relations
Hidden inside the female body, uterine fibroids are the most common gynecological tumor and the No. 1 cause of hysterectomies each year. At MUSC, Department of Obstetrics and Gynecology physicians and other clinicians hope to decrease the number of hysterectomies related to fibroids, and are committed to minimizing the impact of a condition that can negatively affect a person’s quality of life.
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Surgeons prepare
to remove a uterine fibroid. |
According to David Soper, M.D., Obstetrics-Gynecology professor and Clinical
Affairs vice chairman, fibroids are seen every day in obstetrics and gynecology
practices throughout the country. Twenty-five percent to 30 percent of American
women experience fibroids, while that number increases to 77 percent for women
of African-American descent. Some symptoms and side effects of fibroids include
infertility, pregnancy loss, pelvic pain and excessive uterine bleeding.
As he introduced the reasons for the symposium, Soper highlighted what is
needed to better treat patients who have fibroids. “We need state-of-the-art
choices so that patients can realize their reproductive potential, minimize
morbidity and promote individualized care based on patients’ needs,”
he said.
Soper acknowledged the need to expand fibroid knowledge at MUSC and said that
an innovative approach to diagnostic imagery to help geographically map fibroids
in the uterus, as well as better understanding their physiology, would place
the MUSC Center for Uterine Fibroids at the forefront of decreasing what Soper
called the unnecessary numbers of hysterectomies for fibroids.
“A decade ago this was the only treatment, but today other options are
looking more promising,” Soper said. “We now have opportunities
to refine minimally invasive surgeries, uterine artery embolization and other
up-and-coming medical therapies. There is a lot of NIH [National Institutes
of Health] interest in this as well… We need to establish more collaborative
research with MUSC basic scientists so we can determine a standardized system
of classification for fibroids, history and racial difference studies, genetic
and molecular studies, and more clinical trials for various hysterectomy modalities.”
Thus, the goal of the MUSC Center for Uterine Fibroids is to provide comprehensive
evaluations and treatment of fibroids with a multi-disciplinary approach,
capable of offering several options for treatment, from minimally invasive
surgeries to traditional hysterectomies.
What is a fibroid?
Michael Armstrong, M.D., Obstetrics-Gynecology assistant professor, described
fibroids as benign tumors that happen because of any one or combination of
factors, including genetic predisposition, steroid hormones, peptide growth
factors and adequate blood supply. He mentioned evidence supporting the idea
that estrogen especially promotes their growth and said that some studies
show an increase in fibroid risk with the earlier onset of menarche (getting
a first period). While Armstrong said that some risk factors are still debated
among experts today, fibroid production seems to have association with age,
obesity, African-American heritage, and hormone replacement therapy.
Three kinds of fibroids are: intramural (within the wall of the uterus and
the most common); subscrosal (grow from the wall and outside the uterus);
and submucous (grow from the wall and inside the uterus).
Armstrong discussed several other interesting points from medical literature,
and said that postmenopausal women actually have 70 percent to 90 percent
reduction in risk for developing fibroids. For women aged 40-to 44-years-old,
the risk increases two- to-three fold versus other women.
The most common symptoms associated with fibroids are increased abdominal
girth and pressure, sometimes resulting in urinary frequency, outflow obstruction
or compression of the uterus and other organs. Most patients with fibroids
will have uncomplicated pregnancies, but some may experience degeneration
and pain, abruption, abortion, malpresentation and/or pre-term labor. Armstrong
reported the number of women with fibroids treated each year as approximately
600,000, with one in three of those women having a hysterectomy. He cited
hospital charges associated with hysterectomies in excess of $2 billion per
year.
Hence the mission of the Center for Uterine Fibroids is to learn more about
them through research into their causes and treatments. Investigating the
hormones and extracellular matrix proteins that promote the processes of fibroid
growth and development may lead to innovative treatment options that do not
involve removing the uterus. By combining the expertise of physicians in gynecology,
interventional radiology and basic science research, patients will obtain
access to all the current treatment options for fibroids, Armstrong said.
Bryan Toole, Ph.D., Cell Biology and Anatomy professor, discussed the similarities
and differences among fibroids, wounds and cancer, and how that information
helps scientists and physicians to better understand how fibroids function.
While Toole noted that many of the growth characteristics of fibroids and
tumors may be similar, he said it was important to note that fibroids are
non-malignant. In addition and despite similarities with some of the body’s
wound healing processes, fibroids are non-healing.
Treating and looking at fibroids
Donald Fylstra, M.D., Obstetrics-Gynecology associate professor, explained
the importance of using imaging techniques to look at fibroids. “It’s
important to use imaging to look at fibroids, because patients may have symptoms
that are not easily explained by a pelvic exam. There may be another need
to evaluate the pelvic mass, and it helps to pinpoint the location of the
fibroid,” he said. “Imaging gives us a better picture of what
treatment options a patient has, as well as providing a sound method for post-treatment
follow-up.”
Another promising approach to reducing the impact of hysterectomies is via
removal of uterine fibroids laproscopically, thus rendering the surgical experience
easier for the patient. James Carter, M.D., Obstetrics-Gynecology associate
professor, briefly discussed dramatic advances made in instrumentation that
gave rise to the current landscape of minimally invasive surgical procedures.
“In the mid-90s, 70 percent of hysterectomies were done abdominally,
while 29 percent were done vaginally,” he said. “About this time,
the debate began over which method was better, the traditional abdominal incision,
or the use of laproscopic hysterectomy. Laproscopic surgeries are consumer-driven,
the patients are asking for them and they offer better alternatives in terms
of scarring and recovery.”
Carter outlined the six overall hysterectomy techniques available, and presented
information showing laproscopic hysterectomies as promoting lower pain scores,
better sexual function, decreased pain, quicker recovery and decreased complications
and urinary symptoms. Noting varying opinions among practitioners, Carter
acknowledged that little actual study data have made some in the medical community
skeptical. “It’s a promising, minimally invasive procedure, but
the techniques need to be standardized,” he said.
It is also the center’s priority to facilitate research studies conducted
on the cause and treatment of fibroids. By looking at fibroids via advanced
imaging techniques and working with basic scientists to better understand
physiology, physicians can better determine the proper medical management
of fibroids. Ashlyn Savage, M.D., Obstetrics-gynecology assistant professor,
said that around $3 billion to $5 billion is spent annually on the diagnostic
measures and treatments for fibroids. Savage presented information that she
believes supports the ideal situation of having medical therapies replace
the need for surgery. “By doing that, medical costs are lower, we minimize
side effects and risks to the patient, and we promote little to no impact
on reproduction,” she said.
Savage presented several current hormone treatments and therapies, showcasing
a variety of results when the treatments were used individually or in combination.
She emphasized that any new therapies should focus on the reproductive goals
of the patient, the side effects and the patient’s primary treatment
goals.
Why a fibroid center?
With a growing need for research aimed at developing less invasive alternatives
for uterine fibroids, uterine artery embolization (UAE) has shown promise
in controlling symptoms caused by fibroids. UAE is performed by specialists
in interventional radiology. While radiologists are experienced in angiographic
X-ray procedures, they have little experience in the treatment of fibroids.
Conversely, gynecologists see fibroids often, but are not trained to perform
UAE. Working together, the two disciplines can offer a unique, minimally invasive
way to treat fibroids.
The finale delivered by J. Bayne Selby, M.D.,
Radiology professor, included information about how, through better relationships,
radiology and OB/GYN can work together to solve fibroid issues for some patients.
According to Selby, in the 90s physicians in France were embolizing fibroids
prior to hysterectomies to minimize bleeding during surgery. What they found,
however, was that some of those patients did not need surgery because the
fibroids did not cause anymore problems after embolization.
“Acceptance of embolization has been slow because traditionally OB/GYN
and interventional radiology don’t work together often,” he said.
“But we’re working on establishing a better relationship so we
can look at this as a viable treatment option for patients with fibroids.”
Selby outlined the process for patients undergoing the procedure, including
post-embolization follow-up plans. He cautioned attendees that “pain
or lack thereof is not a predictor of the outcome, nor can the level of pain
be predicted by the size or number of fibroids.”
While all of these innovative techniques for the alternative treatment of
fibroids and related conditions may prove to be effective treatments when
compared to traditional hysterectomy, the number of patients treated by these
methods has been small. Armstrong said, “The MUSC Center for Uterine
Fibroids will focus on alternatives to hysterectomy for the treatment of fibroids
and follow-up, which to date has been relatively short term. Furthermore,
the Center for Fibroids will evaluate the safety of these alternatives with
respect to women desiring pregnancy. To date, this has not been well established
in the medical literature. The center will offer comprehensive evaluation
and treatment of uterine fibroids and related conditions.”
For more information about the Center for Uterine Fibroids, visit http://www.muschealth.com
or call 1-800-424-MUSC (6872).
Friday, March 2, 2007
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