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“WHAT IS THE ANSWER TO MY UTERINE FIBROID QUESTION?” A PATIENT ASKS HER INTERVENTIONAL RADIOLOGIST AND GYNECOLOGIST
After UAE how much do the uterine fibroids
decrease? Average
overall uterine reduction is 50% at 3 months, reduction continuing as much
as a year (if not longer).
Individual fibroids decrease by about 65%, if not more, at 3 months. What happens with part of the uterine fibroids that don’t decrease? If a fibroid
doesn’t decrease it’s because it is either already infarcted before the
embolization, as happens occasionally, or wasn’t sufficiently embolized. In the rare instance of
insufficient embolization the fibroid may continue to grow.
If a fibroid wasn’t sufficiently embolized
do you repeat UAE? If
so, how soon after the first UAE?
In the rare occasions where I have
had to repeat an arteriogram and UAE, I have waited 3-6 months after the
procedure before a repeat.
What questions should I ask an
Interventional Radiologist concerning the Uterine Artery Embolization
procedure? One should
ask about the physician’s training and experience with embolization
procedures in general and UAE in particular. It would be helpful to ask if
the doctor’s experience fulfills the published training standards for UAE.
In my opinion, if the physician has not fulfilled these training criteria
the woman should look elsewhere. The other important issue is to be sure
that the IR takes the responsibility to care for the UAE patient after the
procedure is completed. If the IR expects the patient to go back to her
gynecologist for after care and follow-up, then he or she has (in my
opinion) not made the commitment to properly treat and care for these
patients.
Bloating is a fairly common symptom for a number of problems including fibroids, irritable bowel syndrome, temporary GI distress and ovarian cancer. I usually tell women that if bloating persists for more than 2 weeks, they should see a doctor. But, even then, it is usually nothing serious. Testing for ovarian cancer, at present, is not very accurate - blood tests or ultrasound can miss early cancers or be falsely positive and make everyone unnecessarily worried. The good news is that there will be a new blood test coming out this year (2004) that has, in early testing, been extremely accurate. The test, called proteiomics (it will have other commercial names when it is made available) matches proteins in the blood to proteins known to occur with ovarian cancer. So, finally, we may have an answer to early detection of this terrible disease. – William Parker, M.D. Pap smears can screen for cervical cancers, which are not generally hereditary. So that doesn't bother me as far as UAE. As far as ovarian cancer, she needs to go over her risk of cancer with a gyn oncologist or her own gyn. The risk is increased, but she needs to look at the entire family. – Paul Indman, M.D.
If a woman has uterine fibroids and cancer
of the uterus what is the best procedure for that patient? Hysterectomy
performed by a gynecologic oncologist, who specializes in this kind of
problem. What is an Abdominal Radical Trachelectomy? The abdominal radical trachelectomy is a new procedure for women with early cervical cancer. Most of the cervix is removed with surrounding lymph nodes, but the body of the uterus is left in place, so fertility can be preserved. This is a relatively new procedure and not many gynecologic oncologists are performing it yet. - William Parker, M.D. What is considered a "fast growing fibroid"? There is no fixed definition of 'fast-growing' for fibroids. There is also no data to support the concept that a 'fast-growing' fibroid is more likely to be a cancer than any other kind of fibroid. A research project comparing the incidence of sarcoma in fibroids labeled 'fast-growing' and those not so labeled found the same low incidence of sarcoma in both groups.
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