Benign fibroid tumor. What are fibroids, their symptoms and treatment

Uterine fibroids have reached the greatest distribution among gynecological diseases. The disease is a benign tumor and is considered a precancerous process.

Malignancy (transition to cancer) of fibroids is very rare, however, the pathology requires increased attention from medical personnel.

Cancer alertness are subject to:

proliferating uterine fibroids;
an increase in myomatous nodes in menopause;
bleeding or spotting during menopause.

Leiomyosarcoma of the uterus

Uterine sarcoma is a non-epithelial malignant tumor of the uterus that most often develops from fast-growing, or proliferating, fibroids.

Uterine sarcoma is rare, about 2-6% of uterine neoplasms and 1% of tumors of the reproductive organs.

The most common is leiomyosarcoma, which develops from the muscular tissue of the uterus and can be reborn from leiomyoma.

The tumor can affect women of any age, but is most common during menopause.

The pathogenesis of the disease is associated with hyperestrogenism as one of the main factors in the development of uterine fibroids.

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Features of uterine sarcoma

The main feature of uterine leiomyosarcoma is the absence of a clinical picture of the disease in the early stages of development or the appearance of symptoms characteristic of uterine fibroids.

Of the main signs that may indicate the presence of a uterine sarcoma in a patient, it should be distinguished:

sharp and rapid growth of uterine fibroids;
growth of the uterus during menopause;
spotting or bleeding during menopause;
pain in the lower abdomen, a feeling of pressure or fullness.

A tumor of the uterus can give distant metastases, mainly of a hematogenous nature, to the liver and lungs, even with a small size.

Diagnostics

Diagnosis of uterine leiomyosarcoma in the early stages is difficult, due to the absence of atypical cells in separate diagnostic curettage of the uterus, biopsy or cytological examination.

Often the diagnosis is made after the removal of the uterus for fibroids after the results of histological examination.

During the operation, malignancy of fibroids can be suspected if the uterus has a heterogeneous consistency, discoloration, hemorrhages and necrosis.

Treatment

Treatment of uterine sarcoma is carried out by an oncologist.

The main method is extirpation of the uterus with appendages; in some cases, the upper third of the vagina is removed.

After the operation, the patient is prescribed chemotherapy and radiation therapy.

Clinical examination is carried out 1 time in 3 months for 3 years with mandatory consultations of an oncogynecologist. A woman is registered with a gynecologist for life.

treating
doctors

Our center employs the most experienced and qualified staff in the region

Attentive
and experienced staff

Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and Aesthetic Medicine, Candidate of Medical Sciences, Doctor of the Highest Category, Associate Professor of the Department of Restorative Medicine and Biomedical Technologies, A.I. Evdokimova, Member of the Board of the ASEG Association of Specialists in Aesthetic Gynecology.

Graduated from the Moscow Medical Academy named after I.M. Sechenov, has a diploma with honors, passed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA them. THEM. Sechenov.
Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
From 2009 to 2017 she worked at the Medical and Rehabilitation Center of the Ministry of Health of the Russian Federation
Since 2017, she has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine, JSC Medsi Group of Companies
She defended her dissertation for the degree of candidate of medical sciences on the topic: "Opportunistic bacterial infections and pregnancy"

Myshenkova Svetlana Alexandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

In 2001 she graduated from the Moscow State University of Medicine and Dentistry (MGMSU)
In 2003 she completed a course in obstetrics and gynecology at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
He has a certificate in endoscopic surgery, a certificate in ultrasound diagnostics of pathology of pregnancy, fetus, newborn, in ultrasound diagnostics in gynecology, a certificate in laser medicine. He successfully applies all the knowledge gained during theoretical classes in his daily practice.
She has published more than 40 works on the treatment of uterine fibroids, including in the journals Medical Bulletin, Problems of Reproduction. He is a co-author of guidelines for students and doctors.

Kolgaeva Dagmara Isaevna

Head of Pelvic Floor Surgery. Member of the Scientific Committee of the Association for Aesthetic Gynecology.

Graduated from the First Moscow State Medical University. THEM. Sechenov, has a diploma with honors
Passed clinical residency in the specialty "obstetrics and gynecology" on the basis of the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
She has certificates: an obstetrician-gynecologist, a specialist in laser medicine, a specialist in intimate contouring
The dissertation work is devoted to the surgical treatment of genital prolapse complicated by enterocele.
The sphere of practical interests of Kolgaeva Dagmara Isaevna includes:
conservative and surgical methods for the treatment of prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

Graduated from the Ryazan State Medical University named after Academician I.P. Pavlova with a degree in General Medicine
Passed clinical residency in the specialty "obstetrics and gynecology" at the Department of Clinic of Obstetrics and Gynecology. V.F. Snegirev MMA them. THEM. Sechenov
He owns a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access
The sphere of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic surgery for uterine myoma (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

Graduated from the First Moscow State Medical University. THEM. Sechenov.
Passed clinical residency in the specialty "obstetrics and gynecology" on the basis of the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
She is a certified obstetrician-gynecologist.
Possesses the skills of surgical treatment of gynecological diseases on an outpatient basis.
He is a regular participant in scientific and practical conferences on obstetrics and gynecology.
The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnosis and treatment of intrauterine pathology, pathology of the cervix

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, oncogynecologist

In 2013 he graduated from the First Moscow State Medical University. THEM. Sechenov.
From 2013 to 2015, he underwent clinical residency in the specialty "Obstetrics and Gynecology" on the basis of the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
In 2016, he underwent professional retraining on the basis of GBUZ MO MONIKI them. M.F. Vladimirsky, majoring in Oncology.
From 2015 to 2017, he worked at the Medical and Rehabilitation Center of the Ministry of Health of the Russian Federation.
Since 2017, she has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine, JSC Medsi Group of Companies

Mishukova Elena Igorevna

Obstetrician-gynecologist

Dr. Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. Passed clinical internship and residency in obstetrics and gynecology at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
Mishukova Elena Igorevna owns a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingo-oophoritis, etc.
Mishukova Elena Igorevna is an annual participant of Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

Graduated from the Moscow Medical Academy. THEM. Sechenov with a degree in General Medicine. Passed clinical residency in the specialty "obstetrics and gynecology" on the basis of the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
The dissertation work is devoted to the topic of organ-preserving treatment of adenomyosis by FUS-ablation. He has a certificate of an obstetrician-gynecologist, a certificate in ultrasound diagnostics. He owns a full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingo-oophoritis, etc.
Author of a number of publications, co-author of a methodological guide for physicians on organ-preserving treatment of adenomyosis by FUS-ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Ultrasound doctor.

Gushchina Marina Yuryevna graduated from the Saratov State Medical University. V. I. Razumovsky, has a diploma with honors. She was awarded a diploma from the Saratov Regional Duma for excellent academic and scientific achievements, and was recognized as the best graduate of the SSMU. V. I. Razumovsky.
She completed a clinical internship in the specialty "obstetrics and gynecology" at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
He has a certificate of an obstetrician-gynecologist; doctor of ultrasound diagnostics, specialist in the field of laser medicine, colposcopy, endocrinological gynecology. She repeatedly took advanced training courses in "Reproductive Medicine and Surgery", "Ultrasound Diagnostics in Obstetrics and Gynecology".
The dissertation work is devoted to new approaches to differential diagnosis and tactics of managing patients with chronic cervicitis and early stages of HPV-associated diseases.
He owns a full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, hysterosalpingography), and in a hospital setting (hysteroscopy, cervical biopsy, conization of the cervix, etc.)
Gushchina Marina Yurievna has more than 20 scientific publications, is a regular participant in scientific and practical conferences, congresses and congresses on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, pediatric and adolescent gynecologist

Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. Passed clinical residency in the specialty "obstetrics and gynecology" on the basis of the Department of Obstetrics and Gynecology No. 1 of the Medical Faculty of the First Moscow State Medical University. THEM. Sechenov.
He has a certificate of an obstetrician-gynecologist, an ultrasound diagnostician, a specialist in laser medicine, pediatric and adolescent gynecology.
He owns a full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, cervical biopsy), and in a hospital setting (hysteroscopy, cervical biopsy, conization of the cervix, etc.)
Passed clinical residency in the specialty "Obstetrics and Gynecology" on the basis of the Department of the Federal State Budgetary Educational Institution of Additional Professional Education "Institute for Advanced Studies of the Federal Medical and Biological Agency".
He has certificates: an obstetrician-gynecologist, a specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Doctor of ultrasound diagnostics, obstetrician-gynecologist, candidate of medical sciences

Graduated from the Ivanovo State Medical Academy with a degree in general medicine.
She completed an internship at the Tambov Regional Clinical Hospital with a degree in obstetrics and gynecology
He has a certificate of an obstetrician-gynecologist; doctor of ultrasound diagnostics; a specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
Repeatedly took advanced training courses in the specialty "Obstetrics and Gynecology", "Ultrasound Diagnostics in Obstetrics and Gynecology", "Fundamentals of Endoscopy in Gynecology"
He owns the full range of surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal accesses.

According to the classification, uterine fibroids belong to benign neoplasms of the female reproductive system and have nothing to do with malignant processes. Therefore, to the question “uterine fibroids is cancer or not”, provided that there are no signs of malignancy and the diagnosis is not in doubt at the moment, one can give an unequivocal answer “no”.

Services table

Service name	Price
Promotion! Initial consultation with a reproductologist and ultrasound	0 rub.
Repeated consultation of a reproductive specialist	1 900 rub.
Primary consultation of a reproductive specialist, Ph.D. Osina E.A.	10 000 rub.
Hysteroscopy	RUB 22,550
Ultrasound gynecological expert	3 080 rub.
Therapeutic and diagnostic laparoscopy (1 category of complexity)	65 500 rub.
Therapeutic and diagnostic laparoscopy (2nd category of complexity)	RUB 82,200
Program "Health of women after 40"	RUB 31,770

A completely different question is the progression of this nosological form, because many people say that uterine fibroids can develop into cancer.

Can uterine fibroids turn into cancer?

Uterine fibroids is a fairly common disease of the female reproductive system, the quantitative indicator of which is growing every day. The prevalence of this nosological form covers even a young age, which previously was rather an exception to the rule. Hearing for the first time about such a pathological condition, women are initially in a state of some kind of shock, since not all patients know the difference between a benign and a malignant process. Having learned about its benign characteristics, some patients “exhale” and begin to take this issue less responsibly. However, other women begin to ask doctors very correct questions: “uterine fibroids develop into cancer?”, “Can uterine fibroids turn into cancer?”.

In order to understand this issue, it is necessary to understand how to distinguish fibroids from uterine cancer.

In the diagnosis of the type of newly diagnosed formation of the pelvic organs, there are indirect signs of a benign or malignant process, as well as reliable ones.

The doctor who examines this patient, with bimanual palpation, can determine the nodular formation with his hands, according to the characteristics of its surface, in some cases, oncological pathology can be suspected: this is the roughness of the surface of the node, needle-like protrusions, heterogeneity of the consistency of the formation. However, if such signs are not observed, then this does not relieve oncological alertness.

When conducting an ultrasound examination, the doctor can also presumably tell by ultrasound data if there are signs of malignancy: heterogeneity of the contours and structure of the formation, the presence of cavities in it, signs of necrosis or metastasis, effusion in the abdominal cavity.

When performing magnetic resonance imaging or MRI, the nuances of this neoplasm are also clearly visible.

When performing laparoscopy or laparotomy, visual signs of an oncological process can be detected. But it is worth saying that none of the above methods gives an accurate answer to the question of benign or malignant uterine fibroids, the symptoms also will not give a reliable answer.

The only way that will give an accurate answer to the questions posed is only a histological examination of the material obtained during the diagnostic or therapeutic surgical intervention.

Does uterine fibroids turn into cancer?

Unfortunately it is so. Any neoplasm, like any at some point, but healthy, tissue in the future can be a substrate for an oncological disease. Not a single doctor or scientist will give a woman a guarantee that the myomatous lesion of the uterus will not be converted into a malignant process. Since there are a lot of theories of the origin of oncological pathology, no one can accurately deny the possibility of malignancy. That is, uterine fibroids, of course, can acquire the properties of a malignant process.

The only way to somehow reduce the possibility of degeneration of an already existing, but benign neoplasm, is to draw up risk groups for morbidity, as well as the implementation of preventive measures and measures to prevent such a formidable complication.

Uterine fibroids: degeneration into cancer and how to avoid it?

It is necessary to change the way of life: it is necessary to completely abandon smoking and taking alcoholic beverages, to adjust the mode of work and rest. Remove foods high in carcinogens from the diet, increase the proportion of vegetables and fruits with a high content of antioxidants;

The recommended measure is also to reduce body weight with its excess. This requires the above correction of the menu, as well as fairly moderate physical activity.
With increased physical activity and the presence of a myomatous node on the leg, its torsion and malnutrition of the node can occur, and later its necrosis. blood flow in the pelvic organs also increases, which also negatively affects the development of fibroids in the direction of its rapid increase.

A very important point, and at the same time, a big mistake of women is the self-treatment of this pathology in the form of the use of physiotherapy. Any thermal effect on the uterus can improve blood circulation in the pelvic organs, thereby causing a rapid progression of the pathological process. This may be a triggering factor for the degeneration of the tumor into a malignant form.

Termination of pregnancy when it occurs in the form of abortion also provokes the degeneration of the tumor. Abortion is a powerful hormonal stress for the body, as well as the method of its implementation, for example, curettage of the uterine cavity can be a provoking factor in such malignancy of the myomatous formation.

No one can say for sure whether uterine fibroids will degenerate into cancer or not, therefore, when making such a diagnosis, you should immediately seek medical help in order to start conservative or surgical treatment on time, depending on the clinical situation, the size of the tumor, and the age of the woman. Indeed, all over the world, doctors have come to the conclusion that it is necessary to introduce preventive medicine to the masses in order to prevent diseases, and not engage in lengthy and expensive treatment.

The interstitial is formed in the center of the myometrium and is usually medium or large in size.
Submucous, grows towards the inside of the uterine cavity
Subserous - the tumor is completely or partially located on the surface of the uterine wall.
Intraligamentary is formed between ligaments or inside muscle tissue.
Retroperitoneal - the tumor grows from the lower part of the uterine body outward into the retroperitoneal space, the rarest variant.

Cervical, isthmus, corporal tumor.

It can grow or completely disappear during menopause, is able to maintain its size for a long time or increase rapidly, it can clinically occur both with symptoms and asymptomatically.

Although myoma is a benign tumor and extremely rarely can hide a malignant nature, it can bring a lot of inconvenience and health problems to a woman. Observation requires even small-sized fibroids in order to timely catch the trend towards the development of complications.

Complications of myomas:

Pain and heaviness in the lower abdomen, large nodes can lead to the development of varicose veins in the small pelvis. Discomfort may increase after physical exertion, during and after sexual intercourse.
Violation of the work of adjacent organs. Nodes up to 3 cm, even if there are several, do not lead to serious changes. But large ones (more than 5 cm in diameter), when the node is located in front and in contact with the bladder, provoke frequent urge to go to the toilet, a feeling of incomplete emptying. If the node is close to the rectum, it causes constipation, the development of hemorrhoids, inflammation of the rectum and surrounding tissues.
Abundant menstruation and anemia. Regular such blood loss can cause severe anemia, which may require a blood transfusion.
Infertility and miscarriage. Large nodes can cause fetal malformations if pregnancy does occur. Pregnancy also has a greater risk of complications: premature outflow of water, placental abruption, growth retardation and fetal development.
Depression and sexual dysfunction.
Myoma can cause emergency operations.
Accompanying illnesses. Fibroids are primarily hormonal disorders at the level of the whole organism, therefore it is a “frequent friend” of mastopathy, endometrial hyperplasia and polyps, and cystic changes in the ovaries.

Cancer is a malignant tumor of epithelial tissue. In the case of the uterus, it occurs when it develops from the cells of the endometrium, the inner layer of the uterus. Because fibroids increase the risk of developing endometrial pathology, then the likelihood of cancer of the uterine body increases. That's why fibroma can indirectly cause cancer of the uterine body.

The danger of sarcoma of the uterus lies in the fact that in all its indicators it behaves like a normal benign uterine myoma. It can occur at any age - even during pregnancy, but more often in menopause. It is not always possible to identify uterine sarcoma in a timely manner, even with careful observation by a doctor.

There is no pattern in which fibroid is more prone to degeneration into a malignant tumor Neither size nor location matters.

Sarcoma of the uterus can be asymptomatic and manifest itself only in the later stages. It is possible to detect a tumor in time only in 1/3 of women.. Particular care should be taken in the following cases:

rapid growth of nodes;
increase after menopause;
sudden detection of a large node, including during pregnancy;
the development of fibroids in the stump of the cervix, if an operation was previously performed to remove the organ;

Pain, heaviness in the lower abdomen, heavy menstruation, with clots, disruption of the work of adjacent organs.

Condition diagnostics include: gynecological examination, ultrasound, hysteroscopy or diagnostic curettage.

Examination by a gynecologist

Radical treatment of fibroids- removal of nodes along with the uterus. However, at the same time, the woman loses her reproductive function, the intervention itself is also fraught with long-term complications. All other methods are temporary, even the removal of all nodes with a preserved uterus leads to the appearance of new tumor foci. The algorithm for treating fibroids is as follows:

observation by a gynecologist once a year and obligatory ultrasound to track the growth dynamics of nodes;
conservative treatment (combined contraceptives, agonists of gonadotropin-releasing hormone and antigonadotropins, gestagens);
surgical removal as indicated.

Surgical intervention can be done in different sizes- removal of only nodes, a complex with the uterus and cervix, if necessary, with appendages. The following operation options are possible:

Laparoscopic intervention - removal of fibroids through small incisions on the anterior abdominal wall and performing all actions with the help of manipulators.
Hysteroscopy is the removal of neoplasms in the uterine cavity by introducing a special apparatus with manipulators into the organ.
Abdominal surgery is a classic version with a transverse or longitudinal incision on the anterior abdominal wall.

Transcervical conservative myomectomy

Read more in our article on whether fibroids can turn into cancer.

Read in this article

Types and features of uterine fibroids

Uterine fibroids are formed in the muscular layer of the organ. The tumor can be single and multiple, this is affected by the number of nodes. According to the nature of growth, five types of formations are distinguished:

Interstitial (intermuscular, intramural). It is formed in the center of the myometrium, as a rule, has medium or large sizes.
Submucosal (submucous). Grows towards the inside of the uterine cavity
Subserous (subperitoneal). The tumor is completely or partially located on the surface of the uterine wall.
Intraligamentary (interligamentous). It is formed between ligaments or inside muscle tissue.
Retroperitoneal. The tumor grows from the lower body of the uterus outward into the retroperitoneal space, the rarest variant of fibroids.

Myoma is also divided into types according to localization:

Neck tumor. It is located on the cervix, which often leads to impaired blood flow.
Isthmus (isthmic) formation. It is a connective and muscle tissue that is randomly intertwined, preventing the germination of blood vessels. Located between the cervix and body of the uterus. Such a formation causes sharp pains over the pubic area, making it difficult to urinate.
Corporal tumor. Formed in the body of the uterus. Symptoms depend on the location of the tumor.

Single fibroids can become multiple over time. According to the degree of growth, the tumor can be small (up to 20 mm), medium (from 20 to 60 mm), large (more than 60 mm). Small and medium forms are often simply observed. Large formations are removed surgically.

Signs and symptoms

The first signs of the disease usually appear when the tumor has reached a fairly large size. The main clinical symptoms include:

Cramping sharp or pulling pain in the abdomen. With a rapid increase in the tumor, pain becomes more pronounced, permanent. Large formations lead to a constant feeling of heaviness in the lower abdomen.
Prolonged, irregular, profuse menstruation, acyclic bleeding. Due to the large blood loss, anemia develops, headaches, fatigue, and weakness appear.
Abdominal enlargement, which is not associated with significant weight gain - but this is only in the case of large fibroids.
Infertility and miscarriage.

Uterine fibroids can grow or disappear completely during menopause, are able to maintain their size for a long time or grow rapidly, and can clinically occur both with symptoms and asymptomatically.

What is the danger of fibroids for women's health

Despite the fact that fibroids are a benign tumor and can rarely hide a malignant tumor, it can bring a lot of inconvenience and health problems to a woman. Observation requires even small-sized fibroids in order to timely catch the trend towards the development of complications.

The main "dangers" and troubles of fibroids can be hidden in the following:

Pain and heaviness in the lower abdomen. The presence of uterine fibroids is accompanied by compression of other organs and nerve endings in the pelvis. Large nodes can lead to a violation of the outflow of blood from the lower body, thus provoking the development of varicose veins in the small pelvis. All this brings a woman a constant feeling of heaviness, pain in the lower abdomen. Discomfort may increase after physical exertion, during and after sexual intercourse.
Violation of the work of adjacent organs. Nodes up to 3 cm, even if there are several, do not lead to serious changes. But large ones (more than 5 cm in diameter) can squeeze neighboring organs, disrupting their work. For example, when the node is located in front and in contact with the bladder, women note frequent urges to the toilet, a feeling of incomplete emptying.
If the node is close to the rectum, it can provoke constipation, the development of hemorrhoids, proctitis and paraproctitis (inflammation of the rectum and surrounding tissues).

Hydronephrosis developed as a result of a violation of the outflow of urine through the ureter

Abundant menstruation and anemia. Myoma can disrupt the normal anatomical structure of the body of the uterus, which leads to a change in the structure of its internal cavity and the ability to contract. This leads to profuse menstruation, often with clots. Regular such blood loss can cause severe anemia, which may require a blood transfusion. Especially often heavy menstruation is accompanied by submucosal nodes.
Infertility and miscarriage. In addition to the fact that fibroids can become an obstacle to the penetration of spermatozoa to the egg and implantation of the fetal egg to the endometrium, large nodes can cause fetal malformations if pregnancy does occur. Impressions of the skull and chest bones, other anomalies in the development of the skeleton may develop.

This happens due to the fact that the nodes are not extensible in nature, and the baby has to adapt to the shape of the uterine cavity that is. In addition, gestation against the background of uterine fibroids also has a greater risk of complications. This is premature outflow of water, placental abruption, growth retardation and fetal development. Women with fibroids are more likely to have a caesarean section, in which case the existing nodes can be removed at the same time.

Depression and sexual dysfunction. A constant feeling of discomfort, heaviness, limitation of physical activity (for example, aerobics, long cycling, warming up and other procedures are prohibited) can lead to depressive states.
Acute surgical pathology. Myoma can cause emergency operations. For example, with necrosis of a myomatous node, it is necessary to remove it, often in combination with the uterus, or when a myomatous node is born, with its submucosal location.

Torsion of the fibroid stem leads to necrosis of the myomatous node

Accompanying illnesses. Myoma is not a limited lesion of the body of the uterus. First of all, these are hormonal disorders at the level of the whole organism. Therefore, fibroids are a "frequent friend" of mastopathy, endometrial hyperplasia and polyps, and cystic changes in the ovaries.

Can uterine fibroids develop into cancer and what

Cancer is a malignant tumor of epithelial tissue. In the case of the uterus, it develops from endometrial cells, the inner layer of the uterus. Since uterine fibroids increase the risk of developing endometrial pathology, the likelihood of cancer of the uterine body increases. Therefore, fibroma can indirectly cause cancer of the uterine body.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Since it is often difficult for a simple layman to distinguish between types of tumor tissues, another type is also taken for "cancer" - sarcoma. It arises from the muscular, connective, fibrous tissue of the body of the uterus. The danger of uterine sarcoma lies in the fact that in all its indicators it behaves like a normal benign uterine myoma.

It can occur at any age - even during pregnancy, but more often in menopause. It is not always possible to identify uterine sarcoma in a timely manner, even with careful observation by a doctor.

There is no pattern in which fibroid is more susceptible to degeneration into a malignant tumor - neither size nor location plays a role. Most often, uterine sarcoma occurs in the following groups of women:

late onset of menstruation and late delivery;
a large number of artificial interruptions of pregnancy;
late menopause - after 55 years;
radiotherapy to the pelvic area for other diseases;
malignant diseases of the genital organs in close relatives in history.

Transformation of fibroids into cancer

Also, inflammatory processes in the pelvis, injuries, constant stress, bad habits, obesity and metabolic disorders play a role. However, the starting points for the beginning of the degeneration of fibroids into sarcomas are unknown. Most likely, the reason lies in genomic and gene disorders, mutations.

Watch this video about the danger of uterine fibroids:

Signs of rebirth

Sarcoma of the uterus can be asymptomatic and manifest itself only in the later stages. There are no methods of early diagnosis, therefore, it is possible to detect a tumor in time only in 1/3 of women. This is the danger of a tumor. Particular care should be taken in the following cases:

rapid growth of nodes - for six or more weeks of pregnancy for 6-12 months (for example, there was a fibroid for 5 weeks, it became ten in six months);
the growth of myomatous nodes after the onset of menopause;
sudden detection of a large node, including during pregnancy, if the woman was regularly observed by a doctor;
the development of fibroids in the stump of the cervix, if an operation was previously performed to remove the uterus;
sudden weight loss, weakness, lethargy, anemia, prolonged subfebrile body temperature in the presence of uterine fibroids.

However, sarcoma can hide under the usual symptoms of fibroids:

pain, heaviness in the lower abdomen;
profuse menses, with clots;
violation of the work of adjacent organs.

Condition Diagnostics

To detect signs of fibroid degeneration into sarcoma, the following methods are used:

Gynecological examination. Allows you to track the size of the uterus, its soreness, the state of the surrounding tissues (in malignant tumors, they become dense, soldered to each other).
Ultrasonography. You can track the growth of nodes in dynamics, identify suspicious signs of malignancy.
Hysteroscopy or diagnostic. Helps to identify the pathology of the endometrium and cancer of the body of the uterus. It is possible to detect a sarcoma in this way only when it grows inside the cavity (like a submucosal fibroid), as well as when it progresses and grows into the endometrial tissue.

observation by a gynecologist once a year and a mandatory ultrasound examination to track the dynamics of the growth of nodes;
conservative treatment - to slow down the growth of nodes, for the treatment of complications, and also as preoperative preparation;
surgical removal according to indications - these are nodes more than 6 cm in diameter, anemia against the background of multiple fibroids and bleeding, necrosis of the node, dysfunction of the pelvic organs, and others.

Conservative treatment usually involves hormonal treatment. The options are:

Combined oral contraceptives, according to the morphotype of a woman, reduce the foci of the disease, and also dull the symptoms of the pathology.
Gonadotropin-releasing hormone agonists and antigonadotropins are used as preoperative therapy for fibroids, as they reduce the size of myomatous areas. These are Buserelin, Diferelin, Zoladex, etc.
Gestagens - restore hormonal levels. These are Duphaston, Utrozhestan and others.

Surgical intervention can be performed in different volumes - removal of only nodes, a complex with the uterus and cervix, if necessary - with appendages. Everything is determined by the clinical situation. It is never necessary to remove the uterus! The following operation options are possible:

Laparoscopic intervention - removal of fibroids through small incisions on the anterior abdominal wall and performing all actions with the help of manipulators.
Hysteroscopy - removal of neoplasms in the uterine cavity by inserting a special apparatus with manipulators into the uterus.
Abdominal surgery is a classic variant with a transverse or longitudinal incision on the anterior abdominal wall.

There are also new trends in the treatment of myomatosis. For example, the technique of uterine artery embolization, FUS-ablation of nodes. However, all these methods have not found wide application due to the high cost of the necessary equipment for implementation, a relatively low percentage of efficiency in some cases.

Detection and histological confirmation of uterine sarcoma is an indication for extirpation of the uterus with appendages at any age, sometimes the scope of intervention can be expanded (for example, removal of the omentum, lymph nodes, etc.). If necessary, radiation therapy and hormonal therapy are performed, especially with tumor recurrence or the appearance of metastases.

Almost half of the women treated for uterine sarcoma develop distant tumor foci - more often in the lungs, lymph nodes, mesentery of the small and large intestines. However, from the moment of diagnosis to the detection of metastases, sometimes 5 or more years pass - that is, the tumor progresses, but slowly.

Fibroids are naturally benign. However, similar symptoms can hide uterine sarcoma, which is not always easy to identify on time. Regular monitoring and implementation of all recommendations increases the chances of maintaining a woman's reproductive health.

Useful video

Watch this video about the diagnosis and treatment of uterine fibroids:

Myoma or leiomyoma, uterine fibromyoma is the most common benign tumor in women of late reproductive or premenopausal age, arising from the cells of the myometrium - the muscular layer of the uterus.

The tumor is a tangle of randomly intertwined fibers of the smooth muscles of the myometrium, usually found in the form of a rounded knot or nodes.

Myoma is a hormone-dependent disease, often developing against the background of various conditions that cause an imbalance of hormones, such as polyps, anovulation, endometrial hyperplasia. The most common soil for the appearance of fibroids is an increase in the level of the female sex hormone estrogen, which is produced by the ovaries in women of reproductive age.

That is why fibroids rarely occur in girls before puberty and postmenopausal women, when estrogen production is significantly reduced. An increase in the level of hormones in the blood of a pregnant woman often stimulates and accelerates the growth of a tumor, while in postmenopause, small nodes decrease until they disappear completely.

Characteristic features of the tumor

As a benign tumor, leiomyoma has a number of features:

Myoma is the most common tumor in the uterus of women 35-55 years old. Tumors of small sizes, corresponding to pregnancy up to 10 weeks, are able to maintain a stable state for a long time and not increase in size, however, in the presence of provocateurs (inflammation of the appendages and uterus, curettage, prolonged plethora of the pelvic organs) begins to grow rapidly.

Fibroids are capable of not only growth, but also regression, even complete disappearance after menopause. However, in one in ten cases, the tumor continues to grow during several years of the menopausal period, mainly during the course of the disease along with endometrial hyperplasia or proliferative ovarian diseases.

Although fibroids are considered benign, cases of malignancy have been observed. This occurs extremely rarely, in approximately 1-1.5% of patients who have been found to have large nodular fibroids.

Uterine fibroids are characterized by a variety of clinical manifestations. It may be asymptomatic, or it may have pronounced symptoms. All this depends on a lot of factors, including the localization of the tumor (submucosal, subperitoneal, intermuscular and intermediate variants), its size (small, medium, large), as well as the nature of growth.

Classification of fibroids into types

In 95% of cases, fibroids are located in the body of the uterus, in its muscular wall, on the internal mucous membrane or on the outside of the uterus (in the abdominal cavity). And only 1 out of 20 tumors develops on the neck.

Subserous view

Single subserous nodes of small size in most cases do not manifest themselves for a long time. However, as they increase, signs of malnutrition of the tumor may appear, as a result of which the risk of pedicle torsion increases.

In this case, the patient may experience discomfort, periodic sharp or pulling pains in the lower abdomen. The pain can radiate to the lumbar region, perineum and leg. Torsion of the leg of the myomatous node or the development of necrosis is often accompanied by severe pain, worsening of the general condition of the patient, irritation of the peritoneum and general clinical signs of the so-called "acute abdomen".

Interstitial-subserous appearance

Intermediate nodes of this type are less susceptible to destructive processes that occur as a result of malnutrition of the tumor. They do not manifest themselves for a long time, so they can reach huge sizes. The rapid growth of the node is usually accompanied by a feeling of discomfort and heaviness in the lower part, an increase in the abdomen.

The pain is associated with stretching of the uterine wall, as well as the pressure of a large node on the nerve endings of the pelvic organs. Malnutrition of the node is almost always accompanied by acute pain. If a large node is reached, pressure on neighboring organs is possible, up to a violation of their functions.

The pressure of the node on the bladder may be accompanied by frequent urge to urinate, incomplete emptying of the bladder and, as a result, the development of infections in the urinary tract. The node located on the back wall puts pressure on the rectum, disrupts defecation.

Large lateral nodes can compress the ureters, obstruct the outflow of urine on one side and contribute to the occurrence of hydroureter and hydronephrosis. Myomatous nodes of the subserous type rarely violate the menstrual function, however, multiple nodes can lead to a violation of the contractility of the myometrium.

Nodular view of uterine fibroids

Nodes that develop in the muscular wall of the uterus lead to its increase, and also often affect the contractility of the myometrium.

At the same time, the duration and profusion of menstruation increase in patients, spotting between menstruation is less common, while there is no direct relationship between the size of the node and uterine bleeding.

In patients with uterine fibroids, against the background of blood loss, anemia may develop, which can also be the result of the accumulation of large volumes of blood in an enlarged uterus.

With the growth of the interstitial myomatous node to a large size (more than 20 weeks of pregnancy), inferior vena cava syndrome may occur, manifested in the observation of shortness of breath and increased heart rate when taking a horizontal position of the body.

In addition, the growth of nodular fibroids may be accompanied by pain in the lower abdomen, heaviness and enlargement of the abdomen, acute urinary retention and the development of hydronephrosis.

submucosal appearance

In this disease, the tumor is localized on the inner lining of the uterus. It can be located on the leg, and also have a wide muscular base. With the development of the node, the patient has abundant and prolonged menstrual and intermenstrual bleeding with clots, often leading to anemia, as well as severe cramping pain in the lower abdomen. During uterine contractions, pedunculated nodes may protrude into the cervical canal and vagina. Submucosal fibroids are often accompanied by miscarriage and infertility.

Juvenile fibroids

The disease often occurs in young nulliparous women. The beginning of the development of nodes of this type often coincides with the period of puberty in girls, the restructuring of the hormonal background and the first menstruation. Precursor cells of a future tumor are born even during the intrauterine development of the fetus and, when the necessary hormonal stimulus appears, they begin to develop.

How big is the tumor

The size of myoma nodes can vary from a few millimeters to tens of centimeters in diameter. This parameter, as well as the localization of the tumor, is always taken into account when making a diagnosis and choosing a method of treatment. In addition, control of the size of the node makes it possible to apply conservative methods of treatment, while maintaining the childbearing function of the patient.

When ultrasound was not available, the size of the fibroids was measured in weeks of pregnancy. With the growth of the node, the size of the uterus also increases, which is quite possible to observe even when viewed on a chair. These convenient "measures" are used to this day, although modern diagnostic methods make it possible to determine the size of myomatous nodes with an accuracy of up to a millimeter.

Small uterine fibroids

The size of the myomatous node is less than 6 weeks of pregnancy. A tumor of this size with an asymptomatic course is subject to conservative treatment. It is removed only in cases of submucosal location, subserous at risk of torsion of the leg, as well as in case of infertility or anemia. Small fibroids may shrink and disappear completely in postmenopausal women.

Medium fibroids

The size of the myomatous node is comparable to the uterus at 6-12 weeks of pregnancy. In this case, conservative treatment is also possible to stop the growth of the tumor, but only in the case of asymptomatic development of the disease and the absence of signs of rapid growth. With fibroids of this size, there is a high risk of infertility and miscarriage. In the case of an external location, the node may disrupt the functions of neighboring organs.

Large fibroid

The term applies to a tumor larger than 12 weeks of gestation. Regardless of the location and type of node, it must be deleted. Among the large knots, there were specimens that reached the size of a mature pregnancy and weighed 3 kg.

Causes of the disease

The tumor begins to develop from a single cell, so it is impossible to detect it in the early stages. The process of growing a microscopic node to a noticeable size takes about five years.

The onset of microscopic fibroid nodes most often occurs at the age of 30: by that time, women already have time to face gynecological, somatic diseases and neuroendocrine disorders.

All this can cause somatic mutation of individual cells of the reproductive system, which becomes the start of tumor development. The subsequent development of the node requires favorable soil for tumor progression.

It can be created by the following factors:

prolonged improper contraception;
abortions;
inflammation of the appendages and uterus;
endometriosis;
lack of childbirth and lactation;
ultraviolet irradiation;
stress;
formation of cysts and ovarian cysts.

By the age of 35-40, the functional activity of the ovaries begins to decline, the hormonal background changes and the fibroids begin to grow more intensively. Thus, by the age of 40-45, the myomatous node on the uterus just reaches a large size, which becomes the reason for the most frequent operations to remove fibroids in patients of this particular age.

According to modern gynecologists, the cause of fibroids lies in late motherhood and low fertility. The body of a woman is initially set up to bear several pregnancies with short breaks between them.

If pregnancy does not occur for a long time, the body begins to “grow” its own “pregnancy” in the form of fibroids. And the further growth of the node is supported by injuries and diseases of the woman, weak immunity.

The reason for the appearance of myomatous nodes in young women lies in the peculiarities of the biology of their reproductive organs: uterine cells may initially develop incorrectly and the girl is born with cells already prepared for the formation of fibroids.

What are the symptoms of patients

It is known that in the early stages the disease can be asymptomatic, and subserous myoma makes itself felt only when it reaches a significant size. Therefore, the best option for every woman would be a regular visit to the gynecologist and an annual ultrasound examination.

In some cases, the disease manifests itself. In this case, menstrual flow may become more abundant, clots may appear in the blood, the duration of menstruation may increase, slight uterine bleeding may begin in the middle of the menstrual cycle.

Sometimes there is heaviness in the abdomen, a feeling of pressure on the bladder or intestines. Upon reaching the fibroids of medium and large sizes, the abdomen increases, periodic pulling pains pursue. There are problems with carrying a pregnancy or its onset.

In case of heavy bleeding, severe pain radiating to the leg, groin or lower back, weakness, sweating, urge to vomit, you should immediately go to the doctor, as these symptoms may indicate torsion of the fibroid stem, its prolapse, death, rupture, as well as a host of others, life-threatening diseases.

Impact of uterine fibroids on current pregnancy

During pregnancy occurs a rapid change in the hormonal background in the body, due to which the myomatous nodes soften and begin to grow.

Not always a favorable start of pregnancy is compatible with the development of fibroids: the presence of a node in the uterus increases the risk of spontaneous abortion.

In addition, during pregnancy there is a high probability of pinched fibroids, torsion of the legs and disruption of the pelvic organs.

The highest risk of miscarriage is in the presence of a submucosal node and fixation of the placenta on the surface of the fibroids. Subserous myoma of small or medium size has little effect on the course of pregnancy and makes it possible to endure and give birth to a healthy child.

However, whatever the tumor, a pregnant woman should be seen by a doctor at least once every two weeks.

In some cases, when fibroids are detected, the doctor may advise you to terminate the pregnancy. Most often, this question arises due to the diagnosis of a large fibroid, a node in the cervix, as well as accelerated tumor growth.

In nulliparous women after 35, the risk of complications is much higher, especially if the node is located in the wall of the uterus or in its cavity, blood circulation is disturbed

Modern types of disease diagnosis

One of the most informative modern methods for diagnosing leiomyoma is echography. Ultrasound examination in this case is only 92-95% effective. To clarify the location of the nodes, differential diagnosis of tumors of the abdominal space and subserous myomatous nodes, magnetic resonance imaging is used, which gives a three-dimensional image, allows you to more accurately determine the size and localization of nodes compared to ultrasound.

Hydrosonography makes it possible to distinguish the submucosal node from the endometrial polyp, more accurately determine its location and characterize the degree of destruction of the uterus. Hysteroscopy is performed to diagnose the presence of small nodes.

In order to exclude pathological changes in the mucous membrane of the cervical canal and the endometrium of the uterus in patients with myomatous nodes of any size, a separate diagnostic curettage of the inner lining of the uterus is performed with a mandatory histological examination of the taken materials.

If it is impossible to differentiate between tumors of the abdominal cavity and subserous uterine fibroids by non-invasive methods, laparoscopy is indicated.

What treatments are relevant today

The detection of any myomatous node requires immediate treatment, which, depending on the location of the tumor, the stage of its development, the presence or absence of symptoms, can be either surgical or conservative.

Surgery to remove a tumor

Surgical treatment of uterine fibroids is the leading and most effective. Indications for it can be large blood loss during menstruation, the detection of a large tumor (more than 12 weeks of pregnancy), as well as its rapid growth, malnutrition of the node, the presence of other tumors of the reproductive organs, endometriosis, infertility.

Urgently, the operation is performed with severe uterine bleeding, torsion of the legs of the subserous myomatous node, the presence of submucosal nodes. Surgical treatment can be conservative and radical.

Conservative surgical interventions include:

Laparoscopic myomectomy.

Indications for its implementation are small nodes on the leg, subserous, intramural or intermediate tumors no larger than 20 mm in diameter. During the operation, a camera and surgical instruments are inserted into the abdominal cavity through small punctures, tumors are excised and sutures are applied.

The recovery period lasts up to 3 days, there is no noticeable cosmetic effect, no adhesions are formed in the small pelvis. Contraindications to this type of intervention is the presence of more than three myomatous nodes.

Hysteroscopic myomectomy.

It is indicated if it is necessary to remove submucosal nodes. It is carried out vaginally, the least traumatic compared to other methods. Contraindications to its implementation are infectious diseases of the genital tract, suspicion of hyperplasia and adenocarcinoma of the endometrium.

Laparotomy with myectomy.

It is prescribed in cases where access to myomatous nodes is difficult by hysteroscopy or laparoscopy. In some cases, during the operation, the expediency of preserving the uterus is decided.

After any conservative treatment, relapses are possible. The only way to permanently get rid of fibroids is to perform a hysterectomy or complete removal of the nodes along with the uterus and appendages. A radical solution to the problem is offered to women of postmenopausal age, as well as in cases where the above methods have not yielded results.

Treatment of uterine fibroids without surgery

Conservative therapy of fibroids is carried out in order to stop the development and reduce the size of the tumor. In this case, steroid drugs are prescribed that suppress the production of hormones, inhibit the growth of tumors and contribute to their speedy disappearance.

However, drug treatment does not always give the expected effect, therefore, if there is no need for surgical treatment, it is possible to supplement the drug treatment, for example, folk, or replace it with more modern procedures, such as uterine artery embolization or FUS ablation of fibroids.

Embolization

The essence of the method is to prevent the transport of nutrients to the tumor in order to reduce it and possibly disappear. The procedure is painless and does not require anesthesia, tissue damage.

Through the femoral artery, the surgeon inserts a catheter into the uterine artery and launches a special substance that blocks the access of blood to the myomatous node.

At the same time, the remaining parts of the myometrium continue to function. During the first three months, there is a decrease in the node by approximately 40%, six months - up to 65%. This method allows you to save the body and prepare the body for the onset and normal pregnancy.

FUS ablation of fibroids

This method involves the impact on the tumor with focused ultrasound, its heating in order to cause necrosis of the node. The procedure does not require the penetration of instruments into the body cavity and direct contact with the myoma: the impact occurs through the abdominal wall. It is performed on an outpatient basis, does not require anesthesia. The effectiveness of the method is questioned, because most patients experience relapses.

Methods of treatment from traditional medicine

The effectiveness of alternative treatment of fibroids has not been proven. However, why not try some of the remedies for yourself, especially since the method involves eating plant materials.

When bleeding, 2 handfuls of carrot tops are brewed with 1 liter of boiling water and infused for 50-60 minutes. Take half a glass before meals until the bleeding stops.

Prepare a mixture of strawberry leaves, St. 2 tbsp. l. the mixture is poured with a liter of boiling water and insisted overnight. Take twice a day before meals for 0.5 tbsp. for a long time with breaks of 10 days every 2 months.

Prepare an infusion of 2 tbsp. l. series, 1 tbsp. l. tops of flowering yarrow, 1 tbsp. l. motherwort herbs and 0.5 liters of boiling water. Leave for exactly one hour and strain. Take twice a day before meals for ½ tbsp.

Consequences after removal of uterine fibroids

Uterine fibroids are classified as benign tumors. The malignancy of the nodes occurs with the same probability as the appearance of oncological foci on the body of a healthy uterus. After removal of fibroids, the prognosis for life is favorable, moreover, most women in the future can become pregnant and give birth to healthy children. However, in the case of conservative treatment with preservation of the body of the uterus, relapses are possible.

In some cases, increased tumor growth, its spread, as well as numerous nodes may require radical treatment with the removal of the uterine body and the exclusion of reproductive function. Even the smallest nodes, the treatment of which was not started on time, can lead to similar consequences (primary and secondary infertility).

Therefore, the main prevention of the development of large fibroids and loss of reproductive function is a regular visit to the gynecologist, an annual gynecological ultrasound, as well as timely and urgent treatment of even the smallest detected myomatous node.

How did I become a doctor? Quite a difficult question ... If you think about it - there was no choice. I was born in the family of a resuscitator, and every day at dinner I heard my father's story about how his day went. As a child, it all seemed fantastic, beyond reality.

Myoma is a benign tumor of the uterus that grows from the muscular layer. The disease is accompanied by the appearance of chronic pelvic pain, intermenstrual discharge and other cycle disorders. The nodes are found mainly in women over 35 years old, and every woman is primarily concerned about one thing: can fibromyoma turn into cancer? By and large, the whole tactics of diagnosing, treating and monitoring a patient with an identified pathology depends on the answer to this question.

The first thing every woman should remember is that uterine fibroids are not cancer, but under certain conditions, a malignant tumor may develop in the tissues of the reproductive organ. Knowing how and why oncology occurs, you can notice the first signs of an insidious disease in time, start treatment and prevent the development of deadly complications.

Difficulties of terminology: is there cancer?

It is important to understand that fibroids can never turn into cancer simply because it is physically impossible. Cancer is a malignant tumor arising from the epithelial tissue of various organs. At a certain moment, there is a failure in the structure of cells, and they begin to divide uncontrollably, filling the surrounding space with themselves and metastasizing through the blood and lymphatic vessels. Rare variants of cancer grow only deep into the tissues, destroying them to the very foundation, but do not give metastases.

Sarcoma is a malignant tumor of the muscular layer of the uterus, which can occur both against the background of fibroids and independently of it.

Supporters of this theory have identified several reasons why fibroids degenerate into cancer:

Lifestyle: addiction to smoking and alcohol in the presence of a benign tumor;
Visiting the sauna, bath and solarium;
Irrational nutrition and vitamin deficiency;
Excess weight as a factor in metabolic disorders and estrogen accumulation;
Significant physical activity that increases blood flow in the pelvic organs;
Injuries of the uterus during childbirth or during therapeutic and diagnostic interventions;
Irrational intake of hormonal drugs.

Proponents of the theory of the transformation of fibroids into a malignant tumor are sure that visiting a sauna, a bath is one of the reasons for the degeneration of a neoplasm.

In recent years, many studies have been carried out on this topic, and most gynecologists are inclined to think that fibroids are not capable of becoming a cancerous focus. A benign tumor of the uterus does not turn into a sarcoma under any circumstances. Against this background, recommendations for quitting smoking, a ban on physical activity and visiting the sauna do not make sense. But it is important to understand that unequivocal evidence of this version has not been received, which means that oncological vigilance regarding fibroids remains.

Proponents of the second theory point out that uterine sarcoma is an independent disease. A malignant tumor may occur with or without fibroids. The presence of one pathology does not exclude the occurrence of another. That is why, when a fibroid is detected, the first thing to do is to think about whether it is cancer, and undergo a complete diagnosis by a gynecologist.

Only a complete diagnosis will help to accurately determine the type of tumor, its location, size, and degree of damage.

On a note

Sarcoma can occur directly in the myomatous nodes, but this does not mean that the myoma itself has degenerated into a malignant tumor.

How to recognize the disease in time

Even if the gynecologist accepts as an axiom the fact that fibroids are not oncology, and it does not develop into a malignant tumor, he must still carefully examine the woman and conduct the necessary diagnostic tests. The clinical picture of sarcoma is very similar to the manifestations of fibroids, and at the initial stages of the development of the disease, it is quite difficult to identify a dangerous neoplasm.

Sarcoma of the uterus refers to the "silent" tumors. The disease is asymptomatic, and only with time characteristic signs appear:

Drawing pain in the lower abdomen, radiating to the lower back. Depending on the location of the tumor, the pain may go to the thigh or perineum;
Increased volume and duration of menstrual bleeding;
Acyclic spotting from the genital tract;
Uterine bleeding;
Signs of compression of adjacent organs: constipation, feeling of incomplete emptying of the intestine, increased urination.

One of the characteristic signs of uterine sarcoma are abundant and prolonged periods.

All these symptoms are very similar to the manifestations of uterine fibroids, and in the early stages, without special diagnosis of the disease, it is easy to confuse. , we wrote in one of our articles.

In favor of sarcoma, the following manifestations of the disease can speak:

Rapid node growth (more than 4 weeks per year);
The appearance of foci in the appendages (metastases of a malignant tumor);
Frequently recurring uterine bleeding, especially during menopause and against the background of a rapid increase in the size of the uterus.

It is important to know

Among all the symptoms of fibroids, the growth of the node and the appearance of acyclic bleeding in menopause deserve close attention. According to the observations of doctors, in 80% of cases this is not a true increase in the tumor, but the development of a malignant neoplasm. After examination, in a large number of women over the age of 55, not only sarcoma is found, but also ovarian cancer, as well as other oncological processes of the reproductive organs.

The following symptoms indicate the development of sarcoma:

Unmotivated weight loss;
Severe weakness, fatigue and other signs of tumor intoxication;
Prolonged slight increase in body temperature;
Anemia;
Ascites (accumulation of fluid in the abdominal cavity);
Enlargement of regional lymph nodes.

Sudden weight loss may indicate the development of cancer in the uterine cavity.

The problem is that these symptoms occur in the later stages, when the tumor metastasizes. Treatment at this stage does not always bring the desired effect. That is why it is important to distinguish benign fibroids from malignant sarcomas in time and start treatment. The earlier the tumor is detected, the better the prognosis of the disease.

Diagnostic algorithm for suspected uterine sarcoma

It does not matter what position the gynecologist takes regarding benign formation. If the doctor has the slightest suspicion that a dangerous tumor is hiding under the guise of fibroids, he must conduct a complete examination and make an accurate diagnosis. In this case, it is not critical whether the myoma degenerated into cancer or a malignant neoplasm arose without previous pathology of the myometrium.

Examination scheme for the detection of sarcoma:

Mandatory, but not too informative research in this case. The doctor must examine the woman on the chair, but all he will determine is the presence of a formation in the uterus. In favor of sarcoma, its immovability, cyanosis of the mucous membrane of the cervix speaks, however, these signs are not very accurate and cannot be the basis for making a diagnosis.

During a gynecological examination, the doctor can determine the presence of a tumor, but not differentiate it.

On a note

If sarcoma is suspected, the gynecologist performs a rectovaginal examination to assess the condition of the tissues of the vagina and rectum. This method allows you to determine the size and localization of the node, as well as to identify metastases of a malignant tumor.

Laboratory research

To find out that fibroids are benign, the following tests help:

General blood analysis. Both with myoma and sarcoma, anemia can be observed as a result of blood loss. In a malignant tumor, an increase in ESR is often recorded;
Test for tumor markers: CA-125 (norm up to 35 U / ml). The growth of this indicator testifies in favor of uterine sarcoma.

For your information

CA-125 can also be elevated in some other diseases, so it is not a clear sign of a malignant tumor of the uterus. Nevertheless, gynecologists say that it is necessary to take an analysis for a tumor marker, since its growth provides grounds for further targeted examination.

Increased levels of the CA-125 tumor marker may indicate malignant tissue degeneration.

Of practical importance is the identification of genetic oncomarkers - special substances that indicate a person's predisposition to a particular type of cancer. In the case of sarcoma, the identification of such indicators is important:

MSH6;
MSH2;
MLH1;
RASSF1.

The same markers are also detected with a tendency to cervical dysplasia and endometrial cancer.

Doppler ultrasound

With an ultrasound examination, the doctor sees a volumetric formation in the walls of the uterus, but cannot make an accurate diagnosis based on these data. Sonographic signs of fibroids and sarcomas are very similar, and on ultrasound, a malignant tumor looks almost the same as a benign formation. About that, you can read in a separate article on this topic. In favor of sarcoma, the following signs can speak:

Rapid growth of the node in dynamics (according to previous measurements during ultrasound);
Changes in the structure of the tumor and the appearance of foci of heterogeneous echogenicity (this symptom may also indicate the development of necrosis of benign fibroids).

An ultrasound helps the specialist determine if there is a tumor in the uterus.

Significant assistance in the diagnosis is provided by dopplerography. When assessing blood flow in the uterine vessels, the following signs indicate the development of sarcoma:

Severe vascularization of the formation (a large number of blood vessels);
The occurrence of irregular and randomly scattered signals from the vessels;
Registration of low-resistant blood flow in the tumor;
The index of resistance of the uterine arteries is less than 0.4;
The appearance of pathologically dilated vessels that feed the node.

Such features of blood flow are due to the fact that a malignant tumor produces its own vessels and creates a large number of arteriovenous anastomoses.

Endometrial aspiration biopsy

Not the most informative method, since it does not allow to identify a sarcoma located exclusively in the thickness of the muscle layer. However, atypical cells are often found in the biopsy, which gives rise to further examination. With the help of aspiration biopsy, comorbidities (cancer or endometrial hyperplasia) can also be detected.

Endoscopy allows:

See the node located in the uterine cavity or close to the endometrium;
Assess the structure of the mucous membrane and the visible part of the tumor;
Perform targeted biopsy of the neoplasm.

Diagnostic hysteroscopy allows you to examine the uterine cavity using a hysteroscope - a thin optical instrument.

Histological examination

"Gold standard" in the diagnosis of uterine fibroids . Histology is the only way to make an accurate diagnosis. All other tests, including ultrasound, do not give full confidence that there is a sarcoma in the tissues of the uterus. Only after examining the tumor itself, you can be sure to find out its nature and decide on the tactics of treatment.

Methods for obtaining material for histology:

After (provided that the tumor grows to the mucous membrane);
With aspiration biopsy of the endometrium;
During hysteroscopy;
During the removal of the node by open or laparoscopic access.

In the latter case, we are talking about urgent intraoperative histological examination. The doctor removes the knot, and the nurse immediately takes the material to the laboratory. After 15-20 minutes, the answer comes, and now the doctor knows exactly what he is dealing with. If a sarcoma is detected, the scope of the operation expands up to the removal of the uterus and neighboring organs.

Immunohistochemical study

The material for testing is a remote node or biopsy. The method is based on the detection of specific antigens characteristic of a particular tumor. To date, immunohistochemistry is an expensive but effective method for the differential diagnosis of fibroids and sarcomas.

Immunohistochemical study is one of the most reliable ways to detect malignant cells.

Tactics in detecting a malignant tumor of the uterus

Organ-preserving operations for sarcoma are practically not performed. The detection of a malignant tumor is a reason for the radical removal of the uterus. The volume of the operation will depend on the localization of the node, the stage of development of the disease and the presence of metastases. In some situations, supravaginal amputation is sufficient, in others, extirpation is indicated (removal of the uterus along with the cervix). Extended intervention with excision of lymph nodes, peritoneal sheets, removal of the ovaries and fallopian tubes may also be required.

Radiation and chemotherapy for uterine sarcoma are used as auxiliary methods and serve to destroy tumor foci in the pelvic cavity, as well as to suppress metastases. Radiation therapy in this situation can be performed both before surgery and after tumor removal.

The prognosis for sarcoma depends on the stage at which the disease was detected and what treatment was carried out. The average five-year survival rate is:

Stage I - 47%;
II stage - 44%;
Stage III - 20-40%;
Stage IV - 10%.

Radiotherapy is an auxiliary treatment for uterine sarcoma. Its purpose is to suppress the activity of malignant cells.

Instead of a conclusion

Summing up, several important points should be highlighted:

Myoma and sarcoma are not the same thing;
Uterine fibroids is not an oncological pathology;
Sarcoma can occur both in myomatous nodes and in intact tissues of the uterus;
The average age of patients with sarcoma is 45-55 years. That is why certain concerns are caused by the growth of fibroids in menopause, because this symptom may indicate the development of a malignant tumor;
There are similarities and differences in the clinical picture of fibroids and sarcomas, and it is almost impossible to distinguish one disease from another in the early stages;
The only method that can accurately determine a malignant tumor of the uterus is a histological examination;
Even if we take for granted the fact that fibroids degenerate into cancer, this does not happen too often - in 2% of cases.

With regard to uterine fibroids, oncological alertness remains, and this is fully justified. Without special tests, the doctor cannot unambiguously say which tumor is in the uterus. It is better to play it safe and undergo the necessary examination than to start the disease. However, this does not mean that all women with suspected sarcoma should have their uterus removed just in case. The final decision on the choice of a particular treatment strategy should be made after receiving the results of histological examination.