Emory Report

September 5, 2000

 Volume 53, No. 2

New simpler treatment found for uterine tumors

By Lillian Kim

One in four U.S. women develops fibroids, tumors of the uterus that almost always are noncancerous and may not cause any health problems. For many women, however, fibroids can cause lower back pain, excessive bleeding during periods, a sensation of pressure, painful intercourse and bowel and urinary problems.

Women with symptomatic fibroids have few treatment options. They can take the drug Lupron-but only for six months. They can elect to have a hysterectomy, in which the uterus is surgically removed, or a myomectomy, in which the fibroid itself is surgically removed. Or they can undergo uterine fibroid embolization (UFE), a minimally invasive procedure that aims to shrink the tumors.

"A lot of women want alternatives to surgery," said Mark Silverstein, an Emory interventional radiologist who specializes in fibroid embolization.

The procedure, which has been in practice for about five years, is based on a simple principle: Starve the tumors of the blood they need to grow, and they will shrink. This involves blocking the blood flow to the tumor by injecting tiny particles of polyvinyl alcohol (PVA) into the blood vessels feeding it.

The procedure's primary advantage is that it is minimally invasive; UFE typically is performed under local anesthesia and conscious sedation. A small puncture is made in the groin to access one or both femoral arteries. Guided by X-ray, the radiologist threads a catheter through the femoral artery and into the uterine artery, then injects PVA particles to embolize, or block, the vessels directly feeding the fibroid. The fibroids eventually shrink to roughly half their original size.

Angela Brown, a patient of Silverstein's, said her fibroids once were so large that her uterus swelled to the size of a 16-week pregnancy. She bled heavily during her menstrual periods, plunging her hemoglobin level dangerously low.

The fibroids also caused her leg and back pain and pressed against her bladder, forcing her to wake every two hours during the night to urinate. She was so drained of energy that she couldn't play with her children.

Since undergoing UFE in April, her symptoms have reversed. Her uterus has shrunk, her periods have become less severe and her pain has been relieved.

"My kids say, 'Mommy's back,'" Brown says. "We walk, we ride bikes. Now I sleep at night."

For Brown, the short recovery time for UFE was a major plus. Most patients can be discharged within 24 hours and can return to their normal activity level after one or two weeks. The most common post-operative complaint is pain, which can be controlled with medication. By contrast, women undergoing hysterectomy usually require at least four to six weeks to recover.

Another significant advantage of fibroid embolization is that it may not eliminate a woman's ability to bear children. But because the procedure is relatively new, no one yet knows the UFE's long-term effects on fertility.

"Women who have had this procedure have gotten pregnant," said Silverstein, assistant professor of radiology. "But we don't know whether they are the exception or the rule."

UFE has a success rate of roughly 80­90 percent but may not work for all women. Those whose fibroids fail to shrink sufficiently to relieve symptoms may later need to undergo a hysterectomy.

Some women do prefer to go ahead and have the uterus removed, according to Silverstein.

"Some women prefer surgery," he said. "It's a matter of patient preference, what they feel is best for them."

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