Treatment for uterine tumors pleases patients, not doctors

Innovative alternative gets touted on Internet

April 16, 2000|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Women who suffer from benign tumors, or fibroids, can now take advantage of a minimally invasive procedure that might significantly cut down on hysterectomies, one of the most common surgeries in women.

Using an old technique in a new way, physicians inject tiny particles into blood vessels, blocking the blood flow to the tumors, which gradually shrink and die. About 15 published studies have found good results, including some that show an 80 percent success rate.

Women are spreading the word among themselves, often through the Internet. But the medical community has not endorsed the procedure.

Many physicians say more studies must be done on the new therapy, uterine fibroid embolization. Some are unaware of it.

Susan Littleton, 44, had the treatment a few weeks ago, and it appears to be a success.

"This, to me, was a blessing," said the Arnold woman. But learning about it wasn't easy. She saw two gynecologists in the past two years, telling them she didn't want a hysterectomy. But they did not discuss the embolization therapy. When she found out about it through a friend, she canceled her hysterectomy and had the new treatment.

"It upset me that they don't mention it at all. They didn't even say, `Gee, let's at least look into it,'" she said. "Most women are learning by word of mouth, because we're not learning from our doctors."

Patients undergoing the therapy usually stay one night in the hospital, receiving intravenous pain medication. Recovery takes about a week. Over the months, the fibroids shrink. That means the heavy menstrual periods, frequent urination, constipation and other symptoms fade away, too.

But some doctors say some Internet sites are irresponsibly promoting the procedure, without mentioning complications, such as the unknown impact on fertility.

"Women are desperate. They're having a lot of problems with fibroids and bleeding, and it's really impairing their lives," said Dr. Kristen Kjerulff, an epidemiologist at University of Maryland Medical Center. "But my feeling about it is it's too soon to tell, because there have not been any large-scale ... studies."

The stakes are big. Of the about 600,000 hysterectomies performed in the United States every year, about a third are because of fibroids.

The tumors grow in the uterus or the uterine walls and lining. They tap into blood supplies, developing into hard masses that can press on organs. Fibroids can get as big as a basketball.

While fibroids are much more common in African-American women, as many as a third of women in their 30s and 40 percent of women in their 40s will develop fibroids.

The new therapy is a simple idea that has been used for years for other medical problems, such as stopping hemorrhaging after childbirth. French physicians began applying the technique to fibroids in the mid-1990s. Since 1996, about 4,000 embolizations have been done in the United States.

Doctors make a nick in the groin the size of a pencil tip and insert dye to map the blood flow in the abdomen. Then they thread a catheter into the two arteries that feed the uterus and inject particles about the size of a grain of sand. The particles float near the fibroids, blocking the blood supply.

"It's a very safe and effective procedure," said Dr. Robin Boyd-Kranis, assistant professor of radiology at University of Maryland who performs the procedure at Mercy Medical Center. "I think it's ideal for the patient who is done child-bearing and doesn't want to have a hysterectomy."

Studies show that, on average, the largest fibroid is reduced by 43 percent after three months, 62 percent after one year and about 80 percent after two years.

"I noticed a big difference within a month," said Debbie Bailey, 46, of Salisbury. She had several fibroids, including one that was 6 inches long. A normal uterus is about the size of a fist; hers had grown to 2 liters, the size of a larger soft drink container. The fibroids felt hard in her belly and caused discomfort. She had to go to the bathroom every hour and a half.

In fall 1998, her gynecologist pushed her to get a hysterectomy. Bailey sought out a second gynecologist, who agreed. Neither mentioned the new alternative. She finally scheduled the operation, but four days before, she canceled it.

"I don't have any real attachment to my uterus, but I do have opposition to pain and a big incision across my abdomen, and not being able to drive for four weeks," said Bailey. So, she got on the Internet and discovered uterine fibroid embolization, also called uterine artery embolization.

Bailey and several other patients said that gynecologists did not tell them about the alternative. Because much of the research on fibroid embolization has been published in radiology journals, rather than those for ob-gyns, doctors said some gynecologists might not know about it.

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