UTERINE FIBROID TUMORS
Fibroid tumors, or leiomyomas, are benign tumors that grow in or around the uterus. They can grow within a smooth muscle walls, or, more rarely, they can be suspended from a stalk into the pelvic cavity or uterus. Some even hang down into the vagina. Fibroids can grow singly or in clusters, and they vary in size from being microscopic to weighing several pounds and completely filling the uterus.
The pathophysiology of uterine fibroids is not well understood. While they sometimes run in families, they are not strictly genetically linked. They seem to be stimulated by estrogen; after menopause, many shrink and ultimately disappear. Many experts believe that fibroid tumors arise as a combination of genetic, environmental, and hormonal factors.
Histology studies show that the extracellular matrix of fibroid tumors lacks a key protein, and the collagen filaments are disorganized and not discretely formed. This is especially interesting because the same growth pattern has been observed in keloid scars. Both fibroids and keloids are about three times more common in African Americans tan in the rest of the population.
Fibroids are typically classified by their location. Submucosal fibroids grow under the mucous lining of the uterus; they are the deepest type. Intramural fibroids grow on the superficial aspect of the uterus but deep to the peritoneum.
Fibroids are very seldom serious, but they can lead to some troubling consequences. They heavy periods they cause sometimes lead to anemia. They can cause infertility by obstruction fallopian tubes or interfering with the implantation of fertilized ovum. They can also interfere in pregnancies brought to term: if a fibroid is large enough, it can crowd the growing fetus or block the exit through the cervix. These problems can lead to premature births and cesarean sections.
Pedunculate fibroids, the type that dangle into the uterus or vagina, can twist on their stalk. This causes extreme pain and requires surgery for removal. It is also possible for very large fibroids to outgrow their blood supply. This leads to degeneration, in which tissue that is deprived of oxygen dies. The body slowly reabsorbs the necrotic mass, but it can be a long and painful process; more often, surgery is performed to remove the fibroid.
SIGNS AND SYMPTOMS:
Usually fibroids produce no symptoms at all. In extreme cases, the tumor may grow large enough to press on the sensory nerves inside the uterus. If they press on the bladder, they can cause urinary frequency; if on the rectum, they can cause difficulties with defecation. If they press on the fallopian (uterine) tubes, they may interfere with pregnancy. They can also cause heavy menstrual bleeding and occasionally bleeding between menstrual periods.
Fibroids typically grow slowly, but occasionally they grow fast, doubling their size with a few months.
Fibroids seldom require treatment unless they cause pain and excessive bleeding, or if they interfere with pregnancy.
Hormone therapy can shrink them, but they grow back when medication is stopped. Other options include minimally invasive procedures to shrink the growths with hormone therapy or minimally invasive procedures that remove parts of the tumors, or blocking off the supplying arteries (uterine artery embolization). Surgical possibilities include laser ablation, myomectomy (the removal of the tumor while preserving the rest of the uterus), or full hysterectomy.