Q: I had a laparoscopic hysterectomy five years ago, and no one ever mentioned that if my fibroids contained cancer cells the procedure could have spread cancer throughout my body. Why didn’t they warn me?
— Frieda R., St. Louis
A: That’s true, and you and thousands of other women have dodged a bullet. That wasn’t the case for 41-year-old Dr. Amy Reed. When she had a hysterectomy, she never suspected the minimally invasive procedure (power or electric laparoscopic hysterectomy morcellation) could make her far sicker than the discomfort she was experiencing from uterine fibroids. But the power tool that minced up the fibroids — a morcellator — spewed cancer cells (hidden inside the fibroids) throughout her abdominal cavity. Less than a week after the procedure, she was diagnosed with stage IV leiomyosarcoma — a particularly difficult form of uterine cancer. She and her husband started a campaign to let docs know that this was a dangerous technique and they should stop doing it. Her effort, along with several important studies in JAMA, finally got the Food and Drug Administration’s attention. In April 2014 they issued an advisory: “Based on currently available information, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.”
How did they not know before? Surgical techniques, unlike medical devices and drugs, don’t go through the FDA’s approval process. So problems might not become widely recognized until thousands of procedures have been done. And most medical professionals have been taught that cancer-containing fibroids are very rare, but researchers have recently found they’re nine times more common than generally expected.
Doctors are working on ways to contain fibroid tissue as it is morcellated inside the body so that cancerous cells are not spread, but for now it appears that laparoscopic or abdominal surgery that extracts the fibroids whole is the safe alternative.
Q: A friend of mine who used to be a bit heavy (he’s 65) has lost a lot of weight, and he proudly told me he’s finally eating the right amount of calories from very healthy foods. (His wife rolled her eyes.) Well, he sure isn’t eating very much food. Could he have an eating disorder at his age, and why haven’t his doctors done anything about it?
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