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The uterine fibroma is a benign tumor of the female genital tract; it is also called myoma, fibromyoma or leionioma, and is considered the most common tumor of the uterus.
In uterine fibroid, the structure of the uterus is altered and the fibrous cells are more abundant than the muscular ones.
Incidence
The uterine fibroma originates from the smooth muscle cells of the myometrium (hence "myoma"): medical statistics show an incidence of cancer in 15-30% of women aged between 30 and 50, but it seems that the incidence rate is underestimated.
After the age of 50, which coincides for many women with menopause, uterine fibroids tend to regress or even disappear; the fibroid at the uterus of pregnant women, on the other hand, tends to expand, while remaining a benign form. If the contraceptive pill inhibited the growth of uterine fibroids, a hormone-based replacement therapy during menopause could favor its development.
Generality
In most cases, the fibroid to the uterus has a rather slow evolution, while rapid growth is a less frequent phenomenon.
The size of the fibroids can be very different not only from subject to subject, but also, in the same woman, based on the affected area: uterine fibroids could measure a few millimeters, a few centimeters or, in some more severe cases, expand to cover the entire uterus. Furthermore, uterine fibroids can be multiple, or grow individually.
Classification
Benign uterine tumors can be classified into four categories:
- Submucosa: they flow towards the inner part of the cavity of the uterus, towards the endometrium.
- Subroserose: when they only affect the surface. The tumor appears as a protuberance wrapped by the peritoneum, and could be pedunculated.
- Infralegamentario: the fibroma is interposed between the two sheets of the uterine ligament.
- Intramural: if the neoplasm occurs in the internal muscular wall, which undergoes a deformation.
Uterine tubes and the cervix are two targets rarely affected by fibroids; in fact, 95% of the fibroids has the uterine body as a preferential locus.
Symptoms and warnings
To learn more: Symptoms Uterine fibromas
Most uterine fibroids are asymptomatic, which means that women do not complain of symptoms of any kind (see article: uterine myoma, symptoms). In other cases, however, affected women may notice the tumor due to excessive intrauterine losses (hypermenorrhea): menstruation is abundant and the cycle lasts longer. Given the abundant and prolonged blood loss, there are also cases of anemia. A particular type of uterine fibroid, the pedunculated fibroma, involves pain caused by the twisted course of the tumor.
Another alarm bell is represented by the sensation of abdominal swelling associated with an abnormal heaviness located in the lower abdomen; still, discomfort, constipation and pain on urination could be factors related to the manifestation of the fibroid to the uterus.
Diagnosis
A gynecological check is absolutely essential to keep under control not only the uterine fibroids, but also all the various pathologies that can affect the female genital apparatus. It is no coincidence that periodic checkups are recommended, to be carried out at least once a year.
Pelvic ultrasound (external examination) is useful to clarify the location, volume and number of fibroids in the uterus; Trans vaginal ultrasound (performed by the vaginal probe) better defines the morphology of the fibroid. This latter technique is not recommended for large-caliber fibroids, as the probe cannot reach all areas of the uterus, "hidden" by the fibroid.
The endoscopic techniques that visualize the inside of the cavity of the uterus are called hysteroscopies .
Magnetic resonance imaging is another diagnostic technique, the best in assessing the possible involvement of vaginal stroma cells and myometrium.
If the doctor assumes that the fibroid may also have developed into the colon and rectum, the patient will undergo a rectosigmoidoscopy.
Instead, CT is indicated to verify the possible invasion of neoplastic cells in the lymph nodes.
Therapy
To learn more: Myomectomy
Based on the age of the woman, the type of fibroid, histology, its location and the state of growth, the gynecologist chooses the most suitable therapy for the patient:
- Myomectomy : surgical removal of uterine fibroid
- Hysterectomy : removal of the organ (preferable solution for menopausal women and for large fibroids, at an advanced stage)
- Embolization: involves blocking blood circulation in the uterus
- Drug therapy (eg contraceptive pill) in women of childbearing age
Surgery can be performed in laparoscopy (a traditional surgical procedure that involves removing the tumor through an opening in the abdomen); also hysteroscopy, already analyzed as a neoplastic detection technique, can be exploited for low-level surgical procedures, able to completely eliminate the fibroid from the uterus.
