Routine Scans Key To Detecting Fibroid Malignancies Early

As a nurse who has worked for 18 years at a hospital’s obstetrics and gynaecology (ob-gyn) unit, Nurunneesa (not her real name) should have been well aware of issues related to reproductive health.

About three years ago, the 44-year-old single woman was told that she had a uterine fibroid but she paid little attention to it. Then, several months later, doctors told her she was at risk of developing leiomyosarcoma (LMS), a rare aggressive cancer, which required her to undergo a hysterectomy to have her uterus removed.

Nurunneesa regrets taking her fibroid problem lightly.

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“Usually, women are unaware that they have fibroids in the uterus, only finding out during an ultrasound scan. If left untreated, these growths can disrupt daily life, especially if symptomatic, such as experiencing unusual pain in the lower abdomen.

“Women with fibroids may also experience heavy and prolonged bleeding during menstruation and even become anaemic to the point of needing blood transfusions,” she told Bernama.

She added that in most cases, fibroids are benign tumours but can become malignant in rare instances.

CANCEROUS

Nurunneesa said in her case, when the fibroid was first detected, it was about two centimetres (cm) in size and did not affect her work or health.

“So, I left it unchecked, thinking it was the non-aggressive type. However, unexpectedly, the fibroid grew to 13 cm within six months,” she said, adding her abdomen became distended and she experienced severe pelvic pain and drastic weight loss.

“A specialist then advised me to undergo an open myomectomy to remove the fibroid, which was the size of a four-month-old foetus,” she said.

However, a week after the fibroid was removed, she was advised to undergo a laparoscopic hysterectomy as the biopsy results of the fibroid sample detected LMS cells.

Nurunneesa agreed to the procedure. She is glad she had her uterus removed as it prevented her from developing cancer.

MONITORING

Meanwhile, ob-gyn specialist Dr Nor Liana Nisa Othman said fibroids or leiomyomas are non-cancerous tumours formed from uterine muscle tissue that grows abnormally and becomes solid lumps.

“It is rare for these types of growths to become cancerous. Even if it happens, it’s only in about one percent or one out of 100 people with fibroids. However, the risk of LMS still exists.

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“Doctors may suspect cancer if a previously small fibroid suddenly grows very quickly in a short period,” she told Bernama.

Dr Nor Liana Nisa, who works at a private hospital in Kedah, also explained that most fibroids grow slowly, thus requiring regular monitoring through ultrasound scanning or magnetic resonance imaging (MRI) to ensure there are no drastic changes or abnormal features in the uterus.

“The most high-risk period is during a woman’s reproductive phase, between the ages of 30 and 50, especially if she has never given birth, is overweight or has a family history of fibroids,” she said.

Commenting on women who believe there is no need to have their fibroids screened regularly if they have no symptoms or pain, the specialist said some individuals may be asymptomatic or only experience mild symptoms, advising them to go for regular check-ups to avoid any potential risk.

She added in certain cases, the tumour can grow as large as a watermelon or over 20 cm in size.

“That’s why regular check-ups are very important. The earlier the doctor detects any abnormality, the sooner the patient can receive appropriate treatment. However, don’t be overly worried – not all fibroids require surgery.

“Treatment varies for each patient depending on symptoms, size and location of the fibroid, as well as their age and desire to conceive. However, it’s crucial to monitor the size of the fibroid as the larger it gets, the more complicated and risky it becomes,” she said.

TYPES OF FIBROIDS, TREATMENT

Dr Norhayati Kasim, who is also an ob-gyn specialist, said there are several types of fibroids, namely cervical, intramural, submucosal and subserosal, each diagnosed according to the location of the growth.

Cervical fibroids grow in the cervix while intramural fibroids are located in the uterine wall. Submucosal fibroids grow inside the uterus and subserosal fibroids on the outer wall of the uterus.

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“The risk level depends on the size and location of the fibroid. The larger the tumour, the higher the risk to health, including (developing into) cancer, although this is very rare.

“Large fibroids can damage the uterus and reduce the chances of conceiving. If pregnancy does occur, the risk of miscarriage or premature birth is very high,” she explained.

On the exact cause of fibroids, Dr Norhayati said it is still unclear but often linked to hereditary factors. Other factors include stress and hormonal imbalances, particularly when estrogen and progesterone levels are high or excessive.

“Estrogen acts like a ‘fertilizer’ for fibroids. That’s why I don’t allow patients with fibroids to consume herbal supplements or foods high in phytoestrogens like soy and collagen,” she said, recommending that women seek professional advice before taking any supplement.

Dr Norhayati also said there are now advanced treatments such as microwave ablation and high-intensity focused ultrasound (HIFU) to remove fibroids painlessly.

Microwave ablation is a minimally invasive procedure that uses microwave radiation to generate high heat to destroy fibroid tissue.

“The heat is directed precisely at the fibroid tissue through an antenna-like needle inserted via a small puncture in the skin or uterus (laparoscopic surgery), guided by ultrasound imaging,” she said.

The treated fibroid will then shrink within three to six months. Besides having a low risk of complications, this method causes only minimal pain – a ‘one’ or ‘two’ on a scale of 10. Patients can go home the next day and return to work after three days.

As for HIFU, it is a non-invasive treatment that uses high-intensity ultrasound waves focused on the fibroid area.

“The heat generated destroys the fibroid tissue, causing it to shrink. The advantage of this method is that it’s done as an outpatient procedure and the patient can go home immediately,” she said.

However, Dr Norhayati said the HIFU method does not allow doctors to take a biopsy sample to confirm whether the tumour is cancerous or not.

“This is different from microwave ablation, where doctors can take a tumour sample for lab testing before the procedure to ensure the fibroid is not cancerous.

“If the biopsy report shows (presence of) cancer cells, the patient expresses (the) need to undergo open surgery to remove the fibroid uterus,” she said, adding that currently, only one private hospital in Melaka offers the HIFU treatment.

HIFU, she said, is a technology from China and specialists need to undergo training in that country to operate the machine.

“That’s why the cost of the HIFU procedure is quite high,” she said, adding both HIFU and microwave ablation are unsuitable for fibroids that are too large or numerous. In such cases, the only solution is surgery.