Uterine fibroids

Pathology

Uterine myomas, also called leiomyomas or fibroids, are benign tumors that develop in the smooth muscle of the uterus. They are characterized by hyperdevelopment of smooth muscle cells and connective tissue of the uterus.

Their incidence varies between 20-25% and 40% in women of childbearing age, with differences related to factors such as ethnicity and family history.

The possibility of a benign uterine myoma mimicking a uterine sarcoma is extremely rare, estimated to be around 0.03%. Uterine sarcoma is a rare malignancy that accounts for about 7% of all uterine malignancies.

In most cases, with the arrival of menopause and the consequent reduction in hormone levels, uterine myomas tend to shrink in size, resulting in alleviation or disappearance of symptoms.

The Candiolo Institute is involved in the diagnosis and treatment of this disease, with a focus on two key aspects: understanding whether there is a risk that the disease may evolve into malignancy and recognizing atypical forms early, which require early intervention.

Types

Fibroids can have different localizations in the uterus:

• “Subserous” myoma, develops outside the uterus;
• “submucosal” myoma, develops within the uterine cavity;
• “intramural” myoma; develops within the uterine muscle (myometrium).

Symptoms

In some cases uterine myomas are asymptomatic. In others, depending on their size, number and location, symptoms may manifest with:

• Abdominal, sacral or lumbar pain;
• abdominal bloating;
• sense of pelvic weight;
• constipation;
• urination disorders.

It should also be pointed out that some uterine fibroids, some submucosal ones, can cause severe genital bleeding as well as infertility.

Risk factors

Risk factors for uterine myomas include:

• Age: most common between the ages of 40 and 50;
• Familiarity: increased risk if the mother had fibroids;
• ethnicity: more frequent in African American women;
• Obesity: high body mass index increases risk;
• Early menarche: onset of menstruation before age 10;
• nulliparity: absence of pregnancy;
• Alcohol: excessive consumption may increase risk;
• Diet: high consumption of red meat and high-fat dairy products;
• Chronic stress: may contribute to the development of myomas.

Diagnosis and examination

Uterine myomas are often discovered incidentally during a routine gynecologic examination .

For an accurate diagnosis they are critical:

• Detailed medical history, collecting the patient’s symptoms and needs;
• Gynecological objective examination;
• Pelvic ultrasonography, transvaginal and transabdominal, which allows localization of myomas and evaluation of their ultrasonographic characteristics.

In some cases it may be useful to perform adiagnostic hysteroscopy, a minimally invasive, rapid examination that can be performed without anesthesia and allows direct observation of the uterine cavity.

If clinical or ultrasonographic features are not typical and malignant degeneration is suspected, the specialist may request further investigation by Nuclear Magnetic Resonance Imaging (MRI).

Myomas must be distinguished from other conditions, such asadenomyosis(endometriosis of the uterus) or other uterine masses, including sarcomas, which are otherwise very rare; the definite diagnosis of sarcomas is usually made by histologic analysis after surgery.

Therapies

In cases of small asymptomatic myomas, periodic clinical and instrumental monitoring to control their size and characteristics is sufficient.

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

Interdisciplinary Group

Every cancer requires, in all phases of disease management, a multidisciplinary approach that at the Candiolo Institute is guaranteed by a team of different specialists, belonging to the various clinical and surgical departments of the Institute: this team is called GIC (Interdisciplinary Care Group). The GIC ensures that each patient is taken care of throughout the diagnostic-therapeutic process, including prescribing and booking examinations and communicating with the patient and his or her family members. The GIC defines and shares a personalized care pathway for each patient, based not only on the type and stage of the tumor, but also on the patient’s own characteristics. The goal is to ensure that he or she has the best outcome both oncologically and functionally and the maintenance of a good quality of life.The Group also works closely with researchers at the Institute to ensure that patients have rapid access to the latest research-produced innovations in screening, diagnosis and treatment.

Regarding uterine myomas , the referral GIC is the GINECOLOGICAL TUMORS GIC.

Clinical divisions

The diagnostic-therapeutic pathway for uterine fibroids at Candiolo involves several clinical divisions, including:

• Ovarian Cancer Center
• Gynecologic oncology
• Anesthesia and resuscitation
• Nuclear medicine
• Radiotherapy
• Radiodiagnostics
• Pathologic anatomy

Clinical studies

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

The main ones involve clinical research and ultrasound diagnosis, early detection of uterine sarcomas and their differentiation from myomas. Pharmacological and hormone therapy studies are also underway.

Why choose us

At the Candiolo IRCCS Institute, each patient is followed according to highly specialized standards, thanks to the synergistic work of a dedicated Interdisciplinary Care Group (ICG) .