Scalpel-free surgery?
Cutting-edge treatment for uterine fibroids

Most of us are familiar with ultrasound imaging as a diagnostic tool used to show pictures of what's inside our bodies. Now, ultrasound is being used as a treatment for uterine fibroids.

A fibroid is a benign tumour that grows within the muscle of the uterus. While fibroid growths are rarely cancerous, they can cause many uncomfortable symptoms. Most common are heavy menstrual bleeding and a feeling of pressure in the pelvis as the fibroids grow larger and take up more room within the uterus. The latter can cause frequent urination, constipation, distended abdomen, abdominal pain, lower back pain, and pain during intercourse.

Traditional treatments for fibroids are: surgical removal of the fibroid, drugs to shrink the fibroid for removal, or a surgical procedure which blocks or reduces the blood flow to the fibroid which destroys the fibroid before it's removed (uterine fibroid embolization). As with most surgeries, fibroid removal results in pain while the wound heals and recuperation time is required. After undergoing a hysterectomy, for example, the patient typically needs 4 to 6 weeks of recovery time. The drugs prescribed to shrink fibroids bring on temporary menopause, which can cause not only menopause symptoms (hot flashes, night sweats, mood swings, etc.), but also bone loss.

Wouldn't a non-surgical or drug-free treatment be wonderful? It's not wishful thinking. A technique utilizing high-energy ultrasound waves is currently being tested with positive results. Traditional ultrasound imaging uses cool, low-energy ultrasound waves to move through fluid and soft tissues while the waves are reflected back when they hit solid structures (e.g. a gallstone) to provide pictures of internal organs. High-energy MRI-guided focused ultrasound, on the other hand, uses ultrasound beams that are directed at diseased tissue, and the intense heat is used to destroy the targeted tissue. The MRI scanner is used to guide and monitor the treatment.

Dr. David Gianfelice has been studying this technology for 10 years, first in Montreal, the original Canadian test site, and now at Toronto General Hospital (TGH) which is the only Canadian test and research site. Since it doesn't make sense to treat fibroids that are less than 2 cm, and fibroids beyond 15 cm may not respond as well to the treatment, Dr. Gianfelice and his team have been studying this treatment on fibroids that are 8-10 cm. The patient comes into the hospital for treatment that lasts 2 ½-3 hours and she can return to work the next day. So far they have tested the treatment on 12 patients. Although testing has been on only a small subpopulation of women who have fibroids, the results are positive. In fact, in the United States, this treatment has already been approved by the Food and Drug Administration. Hopefully in 4-6 years, Canadian women will be able to access this treatment by paying for it in the same way as for laser eye surgery. It is estimated it will probably be another 5-10 years before the procedure is covered by the healthcare system in Canada.

Dr. Gianfelice has also been using high-energy MRI-guided focused ultrasound on breast cancer tumours. Since breast cancer tissue is outside the body and easily accessible, the treatment has great potential. The goal is to replace lumpectomies currently used to remove breast cancer tumours with the non-invasive method. Although patients will still require chemotherapy and/or radiation, the surgical element will be eliminated. TGH has already tested 25 patients and a Japanese colleague of Dr. Gianfelice has treated 30 patients. Both studies have had good results. As well, the American College of Radiology is testing 200 patients at 10 sites.

In Boston, the treatment is being tested on brain tumours. Brain tumours can often be inoperable due to their proximity to critical tissue (such as the brain stem). Therefore, a non-invasive treatment that accesses the tumour through a closed skull would be fantastic. Although it's only a research protocol and just in the start-up phase, the potential is exciting.

In addition, TGH is now testing the treatment on bone cancer patients. When tumours are found in the bones, chemotherapy and radiation are ineffective; there is no cure for bone cancer. Plus, these patients suffer intense pain. The TGH tests have been successful in lessening their pain. And there are no side effects. Although it's palliative care, the patients' quality of life is improved greatly. In the future, the treatment could be combined with chemotherapy and radiation to treat and destroy bone cancer tumours to achieve local control. That may mean, for example, a patient could live 24 months instead of 12 months, and with much less pain.

MRI-guided focused ultrasound treatment promises to provide relief and hope to so many. Indeed, it has the potential to save lives. Don't be surprised if what is currently considered cutting-edge becomes the treatment norm.