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Uterine Fibroids

Pathology

Uterine myomas, also known as leiomyomas or fibroids, are benign tumors that arise from the smooth muscle tissue of the uterus. They are characterized by the proliferation of smooth muscle cells and associated connective tissue.

Their prevalence ranges from approximately 20 to 25 percent up to 40 percent of women of reproductive age, with variation related to factors such as ethnicity and family history.

The possibility of a benign uterine myoma mimicking a uterine sarcoma is extremely rare, estimated at around 0.03 percent. Uterine sarcomas are uncommon malignant tumors, accounting for approximately 7 percent of all uterine malignancies.

In most cases, fibroids tend to decrease in size after menopause due to the reduction in hormonal stimulation, often leading to an improvement or resolution of symptoms.

The Candiolo Cancer Institute is involved in the diagnosis and treatment of uterine fibroids, with a particular focus on identifying potential atypical forms and excluding malignant transformation, ensuring early and appropriate intervention when needed.

Types

Fibroids can be classified according to their location within the uterus:

  • Subserosal fibroids: develop on the outer surface of the uterus
  • Submucosal fibroids: develop within the uterine cavity
  • Intramural fibroids: develop within the uterine wall (myometrium)

Symptoms

In some cases, uterine fibroids are asymptomatic. When present, symptoms vary depending on size, number, and location, and may include:

  • Abdominal, sacral, or lumbar pain
  • Abdominal bloating
  • Pelvic heaviness or pressure
  • Constipation
  • Urinary symptoms

Some fibroids, particularly submucosal types, may also cause abnormal uterine bleeding and, in certain cases, infertility.

Risk Factors

Risk factors associated with uterine fibroids include:

  • Age, most commonly between 40 and 50 years
  • Family history, particularly maternal history of fibroids
  • Ethnicity, with higher prevalence in African American women
  • Obesity, with increased risk associated with higher body mass index
  • Early menarche, defined as onset of menstruation before age 10
  • Nulliparity, meaning no prior pregnancies
  • Alcohol consumption, particularly in excessive amounts
  • Diet, with high intake of red meat and high-fat dairy products
  • Chronic stress, which may contribute as a modifying factor

Diagnosis and Examination

Uterine fibroids are often incidentally detected during routine gynecologic examination .

Accurate diagnosis relies on:

  • Detailed medical history, including symptom assessment
  • Gynecological examination
  • Pelvic ultrasound, both transvaginal and transabdominal, to localize fibroids and assess their characteristics

In selected cases, diagnostic hysteroscopy may be useful. This is a minimally invasive procedure that can be performed without anesthesia and allows direct visualization of the uterine cavity.

When imaging or clinical features are atypical and malignancy is suspected, further evaluation with magnetic resonance imaging (MRI) may be indicated.

Fibroids must be differentiated from other conditions such as adenomyosis (endometriosis of the uterus) or other uterine masses, including sarcomas, which are rare. Definitive diagnosis of sarcomas is usually established through histological examination after surgical removal.

Therapies

In cases of small, asymptomatic fibroids, regular clinical and imaging follow-up is sufficient to monitor size and characteristics over time.

When fibroids become symptomatic or reach significant size, treatment options include:

Surgical Therapy

Surgical treatment is indicated in more complex cases or when medical therapy is insufficient.

It consists of removal of the fibroid (myomectomy) and can be performed hysteroscopically, laparoscopically, or, more rarely, via laparotomy, depending on the location, size, and number of fibroids, as well as the patient’s age and reproductive plans.

In patients who have completed childbearing, prophylactic uterine and adnexal removal may be considered (hysterectomy with salpingectomy or adnexectomy). This procedure can be performed either laparoscopically or via laparotomy, depending on the patient’s clinical history and uterine size.

In selected cases, uterine artery embolization may be performed. This is a minimally invasive radiological procedure in which the uterine arteries are selectively occluded using embolic agents under radiological guidance, leading to ischemia and subsequent shrinkage of fibroids.

Drug Therapy

Medical therapy is mainly used to correct anemia caused by heavy menstrual bleeding and to prepare the patient for possible surgical treatment.

Pharmacological options for uterine fibroids include:

  • Combined hormonal contraceptives (COCs):
    • Available as oral, vaginal, or transdermal formulations;
    • Help regulate the menstrual cycle and reduce heavy bleeding.
  • Estro-progestins:
    • Combinations of estrogen and progestin;
    • Administered orally, vaginally, or transdermally;
    • Used to control menstrual symptoms and excessive bleeding.
  • Progestins:
    • Available in oral, intrauterine (slow-release device), or subcutaneous formulations;
    • Can reduce menstrual bleeding and pelvic pain.
  • GnRH analogues:
    • Inhibit pituitary gonadotropic activity;
    • Temporarily suppress ovarian hormone production, inducing a reversible hypoestrogenic state similar to menopause;
    • Primarily used to reduce fibroid size before surgery or to control severe symptoms.

Multi Disciplinary Team

Every cancer requires a multidisciplinary approach at all stages of disease management. At the Candiolo Cancer Institute, this is provided by a team of specialists from various clinical and surgical departments, known as the GIC, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.

For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient’s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.

The Group also collaborates closely with the Institute’s researchers to provide patients with rapid access to the latest innovations in screening, diagnosis, and treatment.

Regarding uterine myomas, the relevant referral GIC is the Gynecological Tumors GIC.

Clinical Divisions

The diagnostic and therapeutic pathway for uterine fibroids at the Candiolo Cancer Institute involves several clinical divisions, including:

Research and Innovation

Researchers at the Candiolo Cancer Institute are actively involved in several national and international projects focused on gynecological diseases.

Current research activities primarily include clinical studies and advances in ultrasound diagnostics, with particular emphasis on the early detection of uterine sarcomas and their differentiation from uterine myomas. Additional ongoing studies focus on pharmacological and hormonal therapies aimed at improving disease management and patient outcomes.

Why Choose Us

At Candiolo Cancer Institute, every patient with esophageal cancer is treated in a highly specialized manner, thanks to the synergistic work of the dedicated Interdisciplinary Care Group (GIC) .

Clinical Experience and Tailored Approach

Due to the high number of cases treated each year, the Candiolo Cancer Institute is a national reference center. This extensive experience allows us to manage even the most complex cases, always using a personalized approach, tailored to the clinical and individual profile of each patient.

Imaging Technologies and Advanced Diagnostics

Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that enable precise assessment of disease extent.

Additionally, the Institute provides advanced laboratory investigations, including molecular and genomic analyses, which are essential for identifying the biological characteristics of the cancer and guiding therapeutic decisions.

Minimally Invasive Surgical Techniques and Multidisciplinarity

When appropriate, surgery is performed using minimally invasive techniques (laparoscopic or thoracoscopic), which minimize operative trauma, promote faster recovery, and enhance postoperative quality of life. All treatment decisions are made within the GIC (MDT), ensuring a coordinated and integrated approach.

Clinical Research and Access to Trials

As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focus on scientific research. Patients can be considered for participation in active clinical trials, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.

Care and Support Every Step of the Way

The Multi Disciplinary Team (GIC or MDT) supports the patient at every stage, from diagnosis to treatment and follow-up, addressing nutritional needs, psychological well-being, and reintegration into daily life. The scheduling of checkups, visits, and treatments is organized to ensure continuity and peace of mind, always prioritizing the human dimension of care.