WOMENS-HEALTH Messages for March, 1998: Re: Fibroids and Cancer Question

Re: Fibroids and Cancer Question

From: J.Glenn Bradley MD (anonymous@obgyn.net)
Tue, 31 Mar 1998 18:46:32 -0600 (CST)

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At Tue, 31 Mar 1998, EMM. wrote: >
>I'm the person who (confused in Phoenix)
>asked about my upcoming TAH next week. I got
>all my tests in and my endo biopsy came back normal.
>I asked my doctor some questions (sent her a fax
>and follow up phone call) and she would not
>anser them, told me I had too many questions.
>The only thing she would say is I need a
>hysterectomy because:
>-- my 12 yr old asymptomatic
> fibroid started growing in the last year
> (note this is based on her one "feel" comparing it
> to what was described by the u/s)
>-- I had mild dysplasia in 1991 with no recurrence.
>-- CA-125 of 80 (which I understand is normal in presence
> of big fibroid.)
>
>She then refused to treat me any further (this is fine with me, I will
>not be operated on by someone who won't answer
>simple questions.) She recommended I see an oncologist.
>
>I understand that fibroids rarely turn cancerous. Is it
>not standard procedure if doing a myomectomy to biopsy
>the fibroid, then do a hysterectomy (quite understandably)
>if it is cancerous? Am I missing something here?

Dear Confused: Intra-operative analysis for possible malignancy is a common procedure for some tumors (eg.breast) but fibroid evaluation is not really reliable. The specimen has to be fixed in what is called "permanent sections" in order for the pathologist to actually count the number of abnormal cells per high powered field seen under the microscope. The diagnosis of a malignant fibroid is made only when certain criteria are met; the necessary slide preparation usually takes a couple of days, whereas a frozen section takes minutes. I have only seen 3 malignant fibroids in a busy 27 year career.Preoperative uterine biopsies are totally unreliable. The only clinical indication is a relatively rapid growth of the fibroid, and 99.9% of these are benign. Almost all malignant fibroids (rare as they are), are probably malignant from the start. It would be extremely unusual IMHO, for a patient to have stable fibroids for years and experience malignant degeneration.

Dr.B

Next message: Dana: "Re: To Dr. Marchbein"
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In reply to: anonymous: "Fibroids and Cancer Question"
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