Managing Uterine Tumors: Options and Considerations for Women

Uterine fibroids

Hello Doctor, I am really confused because there is no one around me with a similar issue.
I am 36 years old and have been taking 21-day birth control pills since I was 28.
At the beginning of this year, I noticed that my menstrual blood flow has become very light, with dark brown spotting before and after, requiring only panty liners.
The flow is slightly heavier and brighter red for just one day, needing only a regular sanitary pad.
I have been seeing a traditional Chinese medicine doctor for nearly two years, taking herbs to regulate my cycle, but there has been no improvement.
Last year, I had blood tests done at a small clinic, which showed everything was normal.
Since I am not trying to conceive, I was told that aggressive treatment was not necessary.

Today, I had a pelvic ultrasound at a medical center, and the doctor found a 4-5 cm mass on the left side.
I have been scheduled for blood tests, and the doctor mentioned that the results can only provide a rough estimate of whether the mass is benign or malignant.
To definitively determine this, the mass would need to be surgically removed and sent for pathology.
I have an appointment for a self-paid high-resolution color ultrasound on the morning of the 12th next month, followed by a follow-up consultation in the afternoon.
My concern is how to proceed if the results lean towards benign or malignant.
Should I go ahead and remove the mass and send it for testing regardless of the results? If it turns out to be malignant, would it be better to remove my uterus as well? However, this would mean undergoing a second surgery if it is indeed malignant.
Alternatively, if the results are leaning towards malignancy, should I just remove the uterus directly? But if it turns out to be benign, I would have unnecessarily lost my uterus.
I do not plan to have children anymore, but I am still young.

Given that the mass is 4 to 5 cm, what would be the best course of action? What are the potential side effects of a hysterectomy? How many days would I need to stay in the hospital for either the mass removal or hysterectomy? What post-operative care should I be aware of? I really cannot wait until next month to discuss this with my doctor, and I thought it would be helpful to get advice from another professional.
Thank you.

Li Qiuqiu, 30~39 year old female. Ask Date: 2022/11/16

Dr. Lin Lixuan reply Obstetrics and Gynecology

In general, any tumor in the body requires excision and pathological examination (pathology report) to determine whether it is benign or malignant; imaging studies and blood cancer markers are merely indicators for physicians to assess the likelihood of the tumor being benign or malignant (but they do not provide a definitive diagnosis).
Additionally, many types of cancer, if diagnosed as carcinoma in situ (stage 0) or stage I, may allow for the preservation of the uterus without the need for a total hysterectomy.
If there is a desire for fertility, patients can directly inform their attending physician to evaluate whether treatment can be performed with uterine preservation.
The length of hospital stay and postoperative care should be discussed with the attending physician after confirming the surgical approach.
It is advisable that if there is a strong desire to preserve the uterus for future fertility or to facilitate postoperative care and recovery, patients should clearly communicate this to their attending physician.
Through effective communication between the physician and the patient, a mutually acceptable treatment option can be chosen.

Reply Date: 2022/11/16

More Info

Managing uterine tumors can be a complex and emotional journey, especially for women who are still in their reproductive years. Based on your situation, it seems you have been diagnosed with a 4-5 cm tumor in your uterus, and you are understandably anxious about the implications of this finding. Let's break down the options and considerations you should keep in mind as you navigate this process.

Understanding the Diagnosis
Firstly, it’s important to clarify that tumors in the uterus can be benign (non-cancerous) or malignant (cancerous). The fact that your doctor has suggested a blood test to assess the likelihood of malignancy indicates that they are taking a cautious approach. However, as you mentioned, the only definitive way to determine whether a tumor is benign or malignant is through histopathological examination after surgical removal.

Surgical Options
1. Myomectomy: If the tumor is determined to be benign, a myomectomy may be performed. This procedure involves the removal of the tumor while preserving the uterus. This option is often preferred for women who wish to retain their fertility, but since you mentioned that you do not plan to have children, this may not be your primary concern.

2. Hysterectomy: If there is a significant concern regarding the tumor being malignant, or if you prefer a more definitive solution, a hysterectomy (removal of the uterus) may be recommended. This procedure eliminates the risk of future tumors and is often considered when there are symptoms like heavy bleeding or pain that significantly affect quality of life.

Weighing the Risks and Benefits
- If you choose to have the tumor removed first: This approach allows for a pathological examination to confirm whether the tumor is benign or malignant. If it turns out to be malignant, a hysterectomy can be performed subsequently. However, this means undergoing two surgeries, which can be physically and emotionally taxing.

- If you opt for a hysterectomy right away: This would eliminate the need for a second surgery if the tumor is found to be malignant. However, it also means that you would lose your uterus, which is a significant decision, especially at your age. While you mentioned that you do not plan to have children, the emotional and psychological impacts of such a decision should not be underestimated.

Post-Surgical Considerations
- Recovery Time: The length of hospital stay and recovery can vary based on the type of surgery performed. A myomectomy may require a shorter hospital stay (1-2 days), while a hysterectomy may necessitate a longer stay (2-4 days) depending on whether it is done laparoscopically or through an open procedure.
- Potential Side Effects: After a hysterectomy, women may experience hormonal changes, especially if the ovaries are removed. This can lead to symptoms of menopause, such as hot flashes, mood swings, and vaginal dryness. If the ovaries are preserved, you may not experience these symptoms immediately, but long-term monitoring is essential.

- Follow-Up Care: Regardless of the surgical option chosen, follow-up appointments will be crucial to monitor your recovery and any potential recurrence of tumors. Regular check-ups and imaging studies may be recommended.

Emotional and Psychological Support
It’s completely normal to feel anxious and overwhelmed by this situation. Consider seeking support from friends, family, or a mental health professional who can help you process your feelings and make informed decisions. Engaging in discussions with your healthcare provider about your concerns and preferences is also vital.

Conclusion
Ultimately, the decision on how to manage your uterine tumor should be made in collaboration with your healthcare provider, taking into account your medical history, current health status, and personal preferences. It’s essential to weigh the risks and benefits of each option carefully and to consider seeking a second opinion if you feel uncertain. Remember, you are not alone in this journey, and there are resources available to support you through this challenging time.

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