How common is leiomyosarcoma?

Leiomyosarcoma is a rare and aggressive form of cancer; malignant tumors develop from smooth muscle tissue, sometimes in the uterus. OB/GYN specialist Lauren Streicher, MD, discusses this condition and how the morcellation procedure is related.

Transcript

00:00

My experience is very typical. If you talk to most busy gynecologists, they will tell you that they see one, maybe two cases of a leiomyosarcoma during their entire career.

00:16

This is one of the very controversial areas because there's a lot of numbers out there. Sometimes you'll hear something as high as 1 out of 350

00:23

or as low as 1 out of 10,000. And the truth is probably somewhere in between. Now a number of like 1 out of 350, let's think about that.

00:31

That really defies logic because we know that fibroids are incredibly, incredibly common. And in fact, probably about 80% of women have fibroids.

00:40

Most of them don't even know it. And typically, if a patient comes to see me who has fibroids, I tell her, if they're not bothering you,

00:47

don't do anything about it. Or if someone has fibroids that are bothersome, we might offer a uterus-sparing option

00:55

such as myomectomy or fibroid embolization. Well, if 1 out of 350 of those women

01:01

had leiomyosarcoma, first of all, a lot of women would be dying, we would hear about it all the time,

01:08

and quite frankly, no gynecologist would recommend to a patient that they hang on to their uterus. We would tell every woman with fibroids you must have

01:15

a hysterectomy if there's a 1-out-of-350 chance. So the reality is that the numbers are much lower than that.

01:23

A new study is going to be published in the "New England Journal of Medicine" which puts the number at about 1 out of 7,500, which is a lot more accurate.

01:32

Even if I talk about my personal experience, over the last 15 to 20 years, I've treated probably about 40,000 women with fibroids.

01:41

Between myself and my partners, we've performed morcellation about 1,000 times. I have seen exactly one case of leiomyosarcoma,

01:50

and that was in a patient that was diagnosed prior to surgery. My experience is very typical. If you talk to most busy gynecologists,

01:57

they will tell you that they see one, maybe two cases of leiomyosarcoma during their entire career.

02:03

So it's a rare cancer, but believe me, every surgeon that takes care of women with fibroids is highly motivated to make dissemination

02:12

of this cancer even rarer. A lot of people have said that the morcellator is dangerous. And the truth is, it's not the morcellator that's dangerous,

02:20

it's leiomyosarcoma that's dangerous. This is a very serious cancer. And even if someone has a traditional big open incision

02:29

where the uterus is removed intact, only 40% of those women are alive five years later. And that's because in most cases,

02:37

the cells have already been disseminated prior to surgery. So while a lot of people are saying it's the morcellation that's causing the problem, number

02:46

one, morcellation does not cause cancer, it's already there. And number two, while absolutely I agree that morcellation can spread a cancer, in most cases,

02:57

the cancer has already been spread. So we need to do the best job we can to identify women who might be at risk for having a cancer,

03:05

and they should not have morcellation. And then because we can't identify every woman, we need to do a better job of making it safe.

03:12

And right now, our best option is to perform morcellation inside an enclosed bag so that in the event that there

03:20

is an undetected cancer, the chance of those cancerous cells being released and seeding other areas of the body

03:29

will essentially be eliminated. [AUDIO LOGO]