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This April, the Food and Drug Administration held hearings to evaluate a minimally invasive surgery known as “morcellation” and stated that it should be discouraged.
Morcellation is a method for performing a hysterectomy, which is the removal of the uterus to prevent the spread of cancer. In morcellation, a device (cleverly called a “morcellator”) is used to cut the uterine tissue into pieces before removing these pieces through small incisions. (This method is also used to remove fibroid tumors.) Morcellation is performed on an estimated 50,000 Americans per year.
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Recently, the Journal of the American Medical Association published an article describing a study spanning from 2006-2012, and even though the FDA was correct to discourage the procedure, the quantified results were still surprising — negative consequences of morcellation are even more common than previously guessed!
The greatest concern with morcellation comes from reports that the morcellator sometimes slices through unknown tumors, subsequently spreading cancer cells throughout the abdomen. Past estimates of these undetected tumors ranged from 1 in 500 — 1 in 10,000 cases.
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However, this new study reveals a new estimate of 1 in 368! 1 in 368 people had cancerous tumors that were at risk of being spread through morcellation.
In a New York Times article, a review of the cases collected at Dana-Farber Cancer Institute found that “cancer spread significantly faster after morcellation than after major abdominal surgery to remove the uterus.” The chances of spreading cancer via morcellation are also significantly higher for women age 50 and older.
According to Dr. Suzanne George, an oncologist at Dana-Farber Cancer Institute, morcellations only make up around 16% of minimally invasive hysterectomy procedures, so there are other options for hysterectomy methods. Hopefully, this new information about the risks of morcellation will impact hysterectomy-candidates and allow for better, more-informed decisions.
Oh, great. My best friend literally just had this done. Last week. Now I will be terrified.
Also, she tends to assume the worst of everything is going to happen to her, so I’m just going to not share this with her.
this is really terrifying and i am protectively clutching my abdomen right now
Augh. So. Morcellation is a huge topic in gynecology right now. Most of the public outcry on this issue is a result of one well-connected patient who was unfortunately affected by this publicizing her case.
A few clarifications for the above article:
– Most important to know: morcellation is not used in people with known or suspected cancer!! It’s known that it’s not a good idea to spread potentially cancerous tissue around to other parts of the body. For example, when you do a double mastectomy for a person with cancer in only one breast, you would do the entire mastectomy on the no-cancer side before doing anything on the affected side in order not to spread cancerous cells to the unaffected tissue.
– The majority of women have fibroids (benign tumors also called leiomyomas) and sometimes they have symptoms like pelvic pain, infertility, heavy bleeding, or urinary issues. In a small percentage of cases, what is thought to be a benign tumor is infact a leiomyosarcoma, or a type of cancer. This is the risk with morcellation- that what is thought to be benign is actually cancer. Unfortunately, there is no good way to tell in advance whether what looks like a fibroid is in fact cancerous.
– We don’t have data on how many cases where morcellation of a cancerous mass actually ends up spreading the cancer, nor do we have data on whether morcellation affects death rates or other outcomes.
– Morcellation is not used in all surgeries, or even most. It is used in laparoscopic and/or robotic cases where it wouldn’t make sense to remove the uterus whole (for example, a uterus that was really big due to fibroids would have a hard time coming out of an inch-long laparoscopy incision!)
– In a way, no matter what way you take the uterus out, simply cutting into the uterus and surrounding tissues also has the potential to spread cancer in the same way.
– Notes from the JAMA article linked above: “Hospitals within this database are more frequently urban teaching centers and located in the southern United States,” which is unfortunately not an accurate cross section of the whole population.
– The quote from the NYT article is not actually from a published paper, as far as I can tell. It certainly makes sense for seeding to cause faster progression from a physiological perspective, but we just don’t have that data. Also, the article states that women over 50 are at higher risk of having uterine cancer in general, not that they are at higher risk of spread from morcellation.
Hope this is helpful to calm some fears and to get a better idea of the real risks.
Thanks for the clarifications.
Thank you. This actually made me feel a lot better!!
are there other laproscopic methods for hysterectomy? how do the risks of spreading cancer through laproscopic methods compare with the risks (besides what you already addressed above) inherent in more invasive abdominal surgery methods? thanks.
If the uterus is small enough (which is not all that likely if the person needs a hysterectomy for fibroids), you can take it out through the vagina. You can’t do this if it is a subtotal hysterectomy (leaving the cervix in place). You can also enlarge one of the incisions to take the uterus out, but there’s a fine line between doing that and doing the surgery as an open procedure. You can put a bag inside the abdomen, put the uterus in the bag, and morcellate inside the bag. You can cut the uterus into a few pieces using a scalpel or scissors (plus or minus the bag). Again, there’s no great data about which of these is actually helpful in preventing spread of a very rare cancer.
I couldn’t quote you any statistics regarding your second question, but due to the rarity of leiomyosarcoma in general, you’re more likely to have a postop complication from abdominal surgery than disseminated cancer from a laparoscopic surgery.
thanks!
I agree with Welly’s analysis, we don’t use this technology if there is any suspicion of cancer. It really bothers me when I see sensationalized science reporting like this on Autostraddle, it certainly doesn’t help hysterectomy candidates decision making to get bad information.
obvs biased but I don’t think this article is sensationalist (beyond its title tbh). The research stats are that the risk of undetected tumors is higher than we thought and that this can be a problem in the case of morcellation especially
The title isn’t sensationalist, it’s misleading. Morcellation isn’t a “Uterine Cancer Treatment”.
I think it’d be awesome if there were an AS staff member who is actually a scientist or medical professional to write articles pertaining to women’s health.
This only encourages you to think seriously about your health once again! I have recently become more and more interested in the issue of treatment. Every year people talk about stem cells more and more often: they are used in various fields of medicine, as well as in cosmetology. Here https://www.startstemcells.com/COPD-treatment.html there is useful information about this. Their main features are the ability to self-renew and form new cells of the same type, divide, and take on the functions of any tissues and organs (this is called cell differentiation).