Uterine Fibroid Treatment Poses Cancer Threat, says FDA

Women with uterine fibroids could be subjected to a procedure to remove them that's dangerous and upping their risks of cancer, according to a warning issued this week by the Food and Drug Administration (FDA). The procedure, laparoscopic power morcellation, is used to remove fibroids but poses a small risk of spreading a very rare, but very fatal, form of cancer.

Anywhere from 20 to 80 percent of women can develop fibroids by the time they reach 50 years of age. They tend to afflict women of reproductive years, when estrogen, which fuels their growth, peaks. Not all women who get them develop the characteristic symptoms of heavy periods and pain, and nearly all fibroids are benign, meaning they aren't likely to cause tumors.

But a small percentage will—the FDA estimates that 1 in 345 women who undergo fibroid removal also have an unknown, undiagnosed form of rare uterine cancer called uterine sarcoma. "There is no reliable way to determine if a uterine fibroid is cancerous prior to removal," said William Maisel, MD, MPH, deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health, in a statement.

That's why the FDA is so concerned about this new procedure. In laparoscopic power morcellation, a small instrument with a rotating blade is inserted into the uterus and used to break up fibroids, which are then sucked out with a laparoscope. The concern is that during this process, cancerous cells can get sprayed onto healthy tissue, or even into the bloodstream, and spread to other parts of the body. In fact, one study found a nine-fold increase in risk of developing uterine sarcoma when power morcellation was used.

Even if they are benign, the broken-up fibroids can reattach to healthy tissue and cause more problems for women.

Laparoscopic power morcellation was first approved in 1995, and became popular because it's a minimally invasive procedure with lower risks of infection than other fibroid-removal procedures, and women who have it done are in and out of the hospital much more quickly; 60,000 procedures are done every year. But, says Diana Zuckerman, PhD, president of the Cancer Prevention and Treatment Fund, "FDA standards for approving medical devices are much too low." The approval process for these devices is far less stringent than the process required to get a drug to market.

In December 2013, the Cleveland Clinic and the Brigham and Women's Hospital in Boston both voiced concerns over the technique, announcing that they would begin better informing women of the risks, after an anesthesiologist who underwent power morcellation developed a very aggressive form of sarcoma.

Doctors from those hospitals conducted a study and estimated that anywhere from 1 in 400 to 1 in 1,000 cases of cancer develop from the procedure, but they also noted that a large number of women who get it aren't being told what caused it. "While many patients have been irreparably harmed by power morcellation devices that spread their undiagnosed cancer, surgeons and other health professionals rarely reported when that happened," Zuckerman says. "The voluntary system of reporting serious medical harm from devices, including deaths, is not working because most physicians are not reporting most incidents, regardless of how serious they are."

There are far more procedures to cope with fibroids that are accompanied with less risky side effects, including freezing them, ultrasounds to break them up, and medications that can shrink fibroids or control the estrogen that speeds their growth. And there's always the wait-and-see approach: If your symptoms are mild enough or only slightly annoying, you can wait it out. Fibroids can, but rarely do, interfere with pregnancy, according to the Mayo Clinic, and they usually shrink after menopause hits, when your hormone levels drop naturally. 

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What is laparoscopy, uses and advantages

Laparoscopy is a boon for surgeons and patients alike, as very small cuts are made on the belly, to insert a thin, lighted tube to look at the internal organs.

Gastrointestinal surgery
Removal of the gall bladder and appendix by laparoscopy is now a common occurrence. In advanced centres even the most complicated surgeries can be performed with ease, so a patient with severe pain due to a burst appendix or a gall bladder full of pus can have laparoscopic surgery with early recovery. Huge progress is now being made in surgeries of other conditions like hernias, the small and large intestine, liver and spleen. In fact, laparoscopy is the best way to repair hernias with the least risk of recurrence.

Emergency situations
An important application in emergency situations, especially accidents and severe pain of unknown origin, laparoscopy has been shown to play a crucial role in the management of almost every abdominal emergency offering an initial tool to evaluate the need for surgery as compared with the open surgery. It is a valid alternative in the treatment of the cause of severe pain in abdomen, where surgery can be avoided in many cases and many cases can be managed with laparoscopy leading to almost no pain and early recovery.

Cancers
Cancers, which are surgically resectable can be removed by carefully following all the principles, thus significantly reducing the treatment time and allowing vigorous treatments to be given.

Obesity
Another important application is in the field of obesity surgery. Operating on obese patients is a big challenge and bigger incisions lead to severe pain. However, laparoscopy takes away all these disadvantages and makes it possible to perform weight-loss surgery with lesser complications.

Gynecology and infertility
Another important application of laparoscopy is in the field of gynecology and infertility. It is now possible to treat disorders like endometriosis, which is a common cause of infertility and also to document any other causes of infertility. Removal of the uterus and ovaries is also done by this technique along with surgery for ectopic pregnancy (condition in which pregnancy takes place in a place other than the uterine cavity).

Use of laparoscopy for the diagnosis of acute pain during pregnancy is safe and effective. In fact, one in 500 pregnant women will require surgery for conditions like gallstones, acute appendicitis or other surgical conditions and many studies have proved that laparoscopy improves maternal and fetal outcome.

Laparoscopy involves creating small holes in the abdomen after filling it up with CO2 and inserting the camera through one of these holes, instruments through other holes and operating while visualising on the monitor. The two major advantages as opposed to open surgery are illumination and magnification.

Advantages of laparoscopy
-Smaller incisions-as small as 5 mm
-Minimal blood loss
-Reduction of infection
-Negligible postoperative pain, patients are can walk 2 hours after the surgery
-Speedy recovery, much faster than open surgery
-Early return to normal activity. Patients go back to their office in around 1 week, they can drive and take the stairs
-Minimum respiratory and digestive complications, as breathing and eating is not restricted because of the pain

The wonders of technology when applied to surgery continue to surprise the patients and doctors alike, but here they are all pleasant ones. The biggest reward for a surgeon is when a patient remains pain free and returns back to routine life as fast as a patient without any surgery.

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Inguinal Hernia, Causes, Symptoms And Treatment

A hernia is a weakness in the lining of the abdomen (tummy). This weakness may allow a part of intestine (bowel) or fat to bulge out under the skin.

The most common site for a hernia is in the groin (the area between the thigh and the tummy). This hernia is called an inguinal hernia. An inguinal hernia can occur on either the right or left side or both sides. The bulge may appear during vigorous activity, or when coughing or straining, and usually disappears when lying down

Causes of Inguinal Hernia

Groin is a Potential weak spot in humans

Men have a weak spot in their groin muscles where the tube that carries sperm from the testicles to the penis passes through.

Straining associated with coughing and lifting may stretch this natural gap enough to form a hernia - an inguinal hernia. This is also a weak spot in women because a structure known as the 'round ligament' passes through the gap.

Some inguinal hernias have no apparent cause. Others occur as a result of:

• Increased pressure within the abdomen
• A pre-existing weak spot in the abdominal wall
• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
• Persistent straining during bowel movements or urination
• Heavy weight lifting
• Fluid in the abdomen (ascites)
• Pregnancy
• Excess weight
• Chronic coughing or sneezing

Symptoms of Inguinal Hernia

Some inguinal hernias don't cause any symptoms. You might not know until your doctor discovers it during a routine medical exam.

Often, however, you can see and feel the bulge in the groin area. The bulge is usually more obvious when you stand, especially if you cough or strain.

Inguinal hernia signs and symptoms include:

• A bulge in the groin
• A burning, gurgling or aching sensation at the bulge
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
• A heavy or dragging sensation in your groin

Severe pain with increase in size of the groin swelling associated with vomiting, abdominal distension and pain may indicate a complication usually due to the intestine getting obstructed in the hernia. This usually requires emergency surgery.

Treatment of Inguinal Hernia

Treatment of inguinal hernia is surgery. There is no medical treatment of inguinal hernia. Use of belts to treat a hernia is associated with increased risk of complications

Surgery involves reducing the hernia and strengthening the abdominal wall using a mesh (made up of polypropylene material).

This can be done by the traditional open method or the recent laprascopic method.

In the laparoscopic method, the surgeon operates through several small incisions in your abdomen. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through another incision to repair the hernia using synthetic mesh.

Most people who have laparoscopic repair experience less discomfort and scarring after surgery and a quicker return to normal activities.

Laparoscopy is particularly useful for bilateral inguinal hernia and hernias which have recurred after previous open surgery.

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