The X-Files Continued from Page 62 include a hysterectomy or hormonal therapy. As women age, they are more likely to have uterine fibroids, especially from their thirties and forties until menopause. About 80 per cent of women have uterine fi- broids by the time they reach age 50. Most have mild or no symptoms. But fibroids can cause serious problems that need treatment. The cause of uterine fi broids is not known. But after fi broids develop, the hor- mones estrogen and progesterone appear to infl uence their growth. pause, when hormone levels decline, fi broids often shrink or disappear. After meno- In very rare cases, malignant growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb. PATHOLOGY AND HISTOLOGY Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and whorled. The size varies, from microscopic to lesions of considerable size. Typically, lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall. Leiomyomas are estrogen sensi- tive and have estrogen receptors. They may enlarge rapidly during pregnancy due to increased estrogen levels. Fibroids tend to regress following menopause because of lowered levels of estrogen. Hormonal therapy is based on this concept. SYMPTOMS The symptoms depend on the size, location, number, and the pathological findings. Fibroids, particularly when small, may be entirely asymptomatic and found incidentally on plain fi lm. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, back ache, urinary frequency or retention, and in some cases, infertility. During pregnancy, they may be the cause of miscarriage, bleeding, premature labour, or interference with the position of the fetus. DIAGNOSIS Often found incidentally on plain fi lm when calcifi ed, diagnosis is usually accom- plished by bimanual examination, better yet by ultrasound. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shad- owing of the ultrasound beam. Magnetic resonance imaging (MRI) can be used to defi ne the depiction of the size and location of the fi broids within the uterus. No imaging modality can clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma; however, the latter is very rare, and there is a tremendous prevalence of the former. For this reason, biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, or should there be questions regarding whether the fi broid is interfering with fertility, a laparoscopy is one option for further information to be gathered regarding the exact size and location of the fibroid. TREATMENT The presence of fi broids does not mean that they need to be treated; this is dependant on the symptomatology and presence of related conditions. The presence of uterine fi broids can cause problems which can be corrected with surgery – hysterectomy (uterine removal) or myomectomy (fi broid removal). Although a myomectomy can- not prevent the recurrence of fi broids at a later date, such surgery is increasingly recommended, especially for women who have not completed bearing children, or who express an explicit desire to retain the uterus. MALIGNANCY Very few lesions are, or become, malignant. Signs that a fi broid may be malignant are rapid growth or growth after menopause. Such lesions are typically a leiomyosarcoma on histology. There is no consensus, among pathologists, regarding the transfor- mation of leiomyoma into a sarcoma. Most pathologists believe that a leiomyosarcoma is a de novo disease. • www.canadianchiropractor.ca SUBSCRIBE TODAY ! $2800 7 ISSUES only (GST $29.40; QST/HST $31.64) • US $35.00 (USD) • Foreign $50.00 (USD) Name: ___________________________ Clinic Name: ______________________ Address: _________________________ City: ____________________________ Prov: ____________________________ P.Code: __________________________ Tel: _____________________________ Fax: ____________________________ e-mail: ___________________________ PLEASE CHECK ONE: Doctor of Chiropractic Chiropractic or Student Educational or Research Inst. Other ______________________ Please Specify TYPE OF PRACTICE Solo Group Chiropractic Integrated Disciplines Other ______________________ Please Specify Not in Practice - Student ARE YOU? (SELECT ONE) Owner ❏ Assistant ❏ PAYMENT: Cheque - Payable to Annex Publishing & Printing Inc. Amex Visa MC Account #: ____________________________ Expiry: ___________________________ Signature: ____________________________ Date: ________________________________ TO SUBSCRIBE: Tel: 866-790-6070 Fax: 877-624-1940 Mail: Canadian Chiropractor c/o Annex Publishing & Printing Inc. P.O. Box 530 Simcoe, Ontario N3Y 4N5 e-mail: [email protected] www.canadianchiropractor.ca GST#867172652RT0001 1208CC CANADIAN CHIROPRACTOR | DECEMBER 2008 • 41 Other ______________________ ❏ Please Specify Associate ❏ Employee ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏
Chiropractic + Naturopathic Doctor December 08: Page 41
