There are new concerns about a common procedure performed on about 50,000 women a year in the United States. Researchers warn that a certain hysterectomy technique could spread cancer.
A hysterectomy is the most common gynecological surgery, and it involves removing a woman’s uterus and sometimes other reproductive organs like the ovaries, cervix, and fallopian tubes. Over half a million hysterectomies are performed each year in the U.S., mainly the traditional surgery where a woman’s entire uterus is removed. However, about 50,000 of those hysterectomies use a procedure called morcellation.
In a Laparoscopic-assisted supracervical hysterectomy, a device called a morcellator cuts the uterus into many small pieces. Doctors then remove these small pieces using laparoscopic ports. The advantage of the morcellation method is that it is much less invasive than traditional hysterectomy surgery.
However, doctors are concerned that this technique could spread rather than prevent cancer. Some women undergo a hysterectomy to remove a cancerous uterus, hoping to prevent the cancer from spreading to other parts of the body. About 27 out of ever 10,000 women who have a morcellation hysterectomy have uterine cancer. In these cases, doctors warn, the cancer could spread as the small fragments of cancerous uterus are scattered throughout the abdomen. If the uterus is removed intact, such as in a traditional hysterectomy, the risk is thought to be much smaller.
A study published in the Journal of the American Medical Association on Tuesday was the first to look in-depth at cancer rates in women undergoing morcellation procedures specifically. It was led by Jason D. Wright, MD, Associate Professor of Obstetrics and Gynecology at the Columbia University College of Physicians and Surgeons. The study revealed that uterine cancer was much more common than previously thought in women having their uterus removed using morcellation.
Some suggest that better screening for cancer before a hysterectomy could help detect the cancer, and therefore help prevent its spread during surgery. If uterine cancer was detected beforehand, doctors would likely not opt to remove the patient’s uterus using that type of procedure, knowing the risk.
If a woman does need to undergo a hysterectomy and is at risk for cancer spread through morcellation, there are other options. There is always the traditional hysterectomy procedure for removing the uterus intact. However, an abdominal hysterectomy such as this does involve about four to six weeks of recovery time for the patient, and does carry the risk of complications. There is also the vaginal hysterectomy, where the intact uterus is removed through the vagina, which is less invasive than the traditional method. However, this method cannot always be used, depending on the size of the uterus, any previous surgery, and whether doctors need to examine other reproductive structures such as the ovaries and fallopian tubes.
Women undergo a hysterectomy for various reasons, including fibroids, excessive menstrual bleeding, endometriosis, uterine prolapse, and pelvic pain, as well as to remove a cancerous organ. The researchers hope that the new statistics on uterine cancer will help doctors and their patients make better informed decisions about which hysterectomy procedure is right for them.