Myometrial tumours

Abstract

The full spectrum of myometrial tumours is comprised of: leiomyoma (the ubiquitous common fibroid); epithelioid smooth muscle tumours; other myometrial tumours such as diffuse uterine leiomyomatosis and intravenous leiomyomatosis; and leiomyosarcoma. Fibroids are the commonest tumour in women during the reproductive years, occurring in an estimated 20–50% of women over the age of 30 years, which contrasts sharply with leiomyosarcoma, the malignant equivalent of leiomyoma, whose incidence is commonly quoted as 0.67/100 000 women. The other tumours are even less common: malignant mesenchymal neoplasms of the uterus account for 3% of malignancies of the uterus and approximately one-third are leiomyosarcoma. This article will therefore concentrate mainly on fibroids, and the other myometrial tumours will be discussed briefly for completeness. The benign fibroid is more common in certain ethnic populations, especially Afro-Caribbeans, and the incidence in all races increases with age. The importance of fibroids lie in their major impact on women's health, being the most common indication for hysterectomy in England, while in the USA by the age of 60 years 30% of women will have had a hysterectomy, of which 60% will have been performed to treat fibroids. Fibroids therefore also have a significant cost implication, the 72 362 hysterectomies performed for fibroids in 1993/1994 cost the NHS an estimated £70 million. While fibroids can cause menorrhagia, pelvic pain/discomfort, and bladder and bowel compression symptoms, at least 50% remain asymptomatic, and it is uncertain whether they impair fertility or cause miscarriage. While hysterectomy and myomectomy are the mainstay treatment modalities, there are uncertainties and controversies about optimal therapy and standard clinical outcome measures. The place of newer treatments such as uterine artery embolisation (UAE) and laparoscopic and vaginal myomectomy has yet to be evaluated.