Uterine Tumors - Diagnosis

When a woman is diagnosed with having a tumor on the uterus, it obviously is a reason for significant anxiety. Even if everything points to the fact that the tumor is benign, most likely leiomyoma, the diagnosis cannot be one-hundred percent guaranteed, and in the back of the woman's mind is the obvious concern that the doctor could possibly be wrong, and losing time for appropriate treatment of potential malignancy can have quite serious consequences. We can understand that very well.

Benign tumors of the uterus can be symptomatic or asymptomatic. Most frequent symptoms of uterine tumors are bleeding, feeling of fullness or "something bouncing" in the pelvis when jogging or exercising, pelvic pain, and dysmenorrhea (painful menstrual periods, when the uterus seems to be trying to expel something on the inside of it).

Diagnosis of uterine tumors can be done by pelvic examination, ultrasonography, x-ray, MRI and other sophisticated diagnostic techniques. They all will add some information, but none of them will rule out the concern on the female's mind that the tumors may be malignant.

The treatment of the tumors will depend on several significant factors. The treating physician will consider what the symptoms are, what the age of the patient is, and what the plans for plans on pregnancy and having babies are. If the tumors produce few symptoms and the patient is in the perimenopausal age (close to menopause), it might be prudent to simply observe the patient, repeat ultrasonography in fair intervals to appreciate the changes in the size of the tumors, and be ready to proceed with therapy only if there is a call for it. That happens mostly if the tumors are found to suddenly grow at a significant rate. If they are symptomatic or the female does not plan on using her uterus to get pregnant, diligent observation of the patient is appropriate. Unfortunately, the only medication which could shrink the size of the tumors works only temporarily. After it is discontinued, the uterus returns very quickly to the original size. If a decisive treatment is called for, it means surgery.

Uterine Tumors - Treatment

As we discussed previously, there is no medical treatment for uterine tumors. There is only medication which could reduce some of the symptoms of uterine tumors, if the patient is in a situation where the growth will be forestalled by "natural causes." That happens in the time shortly prior to menopause (perimenopause).

Thus, the only way to decisively treat uterine tumors is surgery. The classical, old-fashioned procedure is to open the abdomen and remove the tumor or tumors one by one, and repair the defect in the uterine wall as well as possible. Opening of the abdomen (laparotomy) is considered a major procedure, which usually calls for a few days in the hospital and a recovery period of several weeks. With the invention of laparoscopy, there were a number of techniques introduced to deal with benign uterine tumors.

Laparoscopic laser treatment was embraced with large expectations, but unfortunately these did not work out, and this technique has been, for all practical purposes, abandoned. Remaining techniques are mainly removal of fibroids, cauterization of the fibroids with the goal to stop blood circulation with subsequent atrophy of the tumor, or a radiology technique introduced fairly recently - artery embolization with small particles, meant to cause atrophy of the tumor by cutting the blood supply. For one or the other reason this procedure usually is quite painful.

Available information suggests that the therapy of the tumors only causes them to shrink. Recently, it has been found that this technique causes significant problems in trying to conceive, and sometimes complication at the time of delivery. Cauterization of uterine tumors (myolysis) uses electrical current and heat to interfere with the blood supply to the uterus. The advantage of myolysis is that the treatment of the tumor is done under direct vision, and is limited only to the desired area compared to embolization, where there is no control of where the individual particles can go, possibly flowing to vital organs. If myolysis is done too vigorously, it can cause a similar problem as uterine artery embolization, that is, adversely affect the chances of conception and increase complications at the time of delivery. Thus, to produce the best possible results both of these procedures need to be done by practitioners who are experienced in their particular specialty.