Information for Patients

 Treating Uterine Fibroid Tumors Without Surgery

Many young to middle-aged women suffer from the effects of uterine fibroid tumors.  These are benign tumors of the uterine muscle layer which are relatively common, especially in African-American females.  Frequently, these benign tumors are quite small and patients do not know that they have them.  However, a subset of patients develop symptoms from these tumors which can get quite large and, in fact, the uterus can enlarge as much as a 12 to 18 week pregnancy.  Symptoms caused by uterine fibroids include heavy menstrual bleeding which can even lead to anemia (too little red blood cells in the body due to excessive menstrual bleeding), and pressure effects from the size of the tumors pressing on the rectum or bladder causing urine leakage or difficulty urinating or pain or difficulties with bowel movements.  The uterus can grow so large as to be noticeable and some women desire treatment of these tumors due to the swelling in the lower abdomen that they may cause.

Previously, these tumors were treated surgically with removal of the uterus.  This is an open surgery which has some risks associated with it and has several weeks of recovery time for the patient.  Obviously, further child bearing is not possible after this surgery.  To reduce the extent of surgery for fibroids, some surgeons will remove just the fibroid tumors (myomectomy) or a partial hysterectomy (leaving some of the uterus behind).  However, there is a significant rate of recurrence where the fibroids will actually grow back after the surgery.

A new form of therapy for uterine fibroids is called uterine fibroid embolization (UFE).  In this technique, the arteries to the uterus are selected with a small catheter which is placed from the artery in the groin and small particles are injected into this artery to occlude the blood supply to the uterine tumors.  Interventional radiologists have been embolizing the uterine arteries for many years to control the bleeding from various tumors of the uterus and cervix.  It was noted after these procedures that uterine fibroids also shrank and thus, we started using this procedure to treat benign fibroids alone.  Several thousands of these procedures have been performed worldwide.  The success rate is over 80%, meaning that heavy menstruation or symptoms from pressure of the tumors and swelling in the abdomen will become much better or go away after the procedure.  More importantly, the procedure is generally done in one day and patients stay in the hospital overnight and leave the next morning.  The procedure leaves no permanent scars and there is only a band-aid over the groin after the embolization is complete.  Side effects are generally limited to one or two days and consist of some pain and cramping.  This may be fairly uncomfortable immediately after the procedure and thus the patients are usually admitted overnight to receive IV antibiotics and pain medications until this discomfort subsides.  There is a small chance of forming a bruise or painful swelling at the site of catheterization.  There is a chance of infection of the tumors after the blood supply is occluded.  These infections may be severe enough to require a hysterectomy.  These risks are estimated at less than 5%.  A few deaths have been reported after the performance of UFE.  However, the incidence of death after UFE is much less than after open surgery.  Women being evaluated for UFE usually have an ultrasound done of the uterus to evaluate the uterus and the ovaries.  Uterine cancer can sometimes cause excessive bleeding during and between periods.  Therefore, your doctor may want to perform an endometrial biopsy before the procedure.  This is done in the office setting during a pelvic exam.  For more information, patients can go to the Society of Cardiovascular and Interventional Radiology website (www.scvir.org) where there is more patient information and a listing of doctors in areas throughout the United States that perform this procedure. 

 Treatment of Cancer Without Surgery

Patients with cancer are best treated with surgical removal of the tumor.  This offers the best hope for cure.  However, cancer invariably spreads to lymph nodes and to other organs and many people who have cancer have metastatic disease or tumor that has spread to other lymph nodes and organs.  In general, such patients are treated with non-surgical techniques like radiation therapy and chemotherapy, where certain types of drugs or radiation beams are used to kill the tumor that has spread to other parts of the body.  There are several techniques used in interventional radiology that can treat tumor which has spread to limited portions of the body more effectively and with fewer side effects. 

If a patient has a tumor which is less than 5cm in diameter (less than the size of a grapefruit), they may not be candidates to have surgical resection because the risks are too great in having surgery.  These tumors can be treated in a variety of ways without resorting to surgery.  One way is radiofrequency ablation (RFA).  The way this works is that a needle (this is a special needle which unfolds into the shape of an umbrella) is placed into the tumor.  Radiofrequency waves are passed through the needle and this causes heating of the tumor which destroys tumor cells within a certain radius.  Radiofrequency ablation is performed just about anywhere in the body where a needle can be placed.  It is guided into the tumor using one of several imaging techniques including cat scans, ultrasound, or a standard x-ray machine.  Most of the work with RFA has involved tumors in the liver, but tumors in the bones and lung and breast have also been treated using this technique.  Since the needle produces heat to destroy tumor, this procedure can be painful and it is only done with deep sedation or sometimes with general anesthesia.  If the tumors are in the abdomen and they cannot be punctured using standard imaging techniques, the tumor can still be ablated or killed using minimally invasive surgical techniques like laparoscopy where a small probe with a video camera in inserted into the abdomen and the procedure is done through this small hole using a camera and multiple needles.  Since the procedure is done with a needle, the risks are similar to a biopsy procedure and include a small risk of bleeding and infection and damage to the organs around where the needle is placed.  As RFA has not been performed for very long, the long-term effects on tumor are not well known, but patients with few tumors that are small (fewer than five tumors that are less than 5cm in diameter) seem to respond well to this therapy.  More importantly, if the tumors come back or do not die completely, this treatment can be repeated.  The discomfort associated with this procedure generally lasts for only a few hours to a day after the procedure and there are no long-term or delayed side effects such as those associated with radiation therapy or chemotherapy, which include loss of hair, nausea and vomiting, and radiation damage to the organs near the treated cancer. 

Another non-surgical therapy for cancer involves methods of blocking blood flow to the tumors.  Tumors, like normal organs in the body, require oxygen and nutrients to survive.  These are delivered by the arteries supplying blood.  In embolization therapy, the arteries feeding a tumor are blocked off using small particles which permanently occlude blood flow to the tumor.  This form of therapy is good for certain types of tumors, namely primary liver cancer, liver metastases, and some lung tumors and head and neck tumors.  Frequently, chemotherapy is given along with the small particles to increase the