Cellular growth and proliferation are influence by many factors within the cells environment. New growth also called Neoplasm is characterized by uncontrolled cellular growth that fails to conform to the normal pattern of growth for a particular tissue. That is why the study of uncontrolled cellular growth of female reproductive organs are focus. We are looking into UTERINE FIBROID.
What is uterine fibroid?
Fibroids are firm, compact tumors (which are mostly non-cancerous) that are made of smooth muscle cells and fibrous connective tissue which develop in the uterus. Most women have fibroids, but not all are detected. These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. Man and the surrounding environment share the
same basic structural unit. Normal cellular growth and proliferation
(Multiplication) is dependent on a healthy internal and external exchange of
nutrient and waste
Normal or Healthy Uterus:
Below is a labelled picture of a healthy uterus without fibroid.
Uterus with Fibroids:
Below is a labelled picture of an unhealthy uterus i.e. with fibroids.
TYPES OF FIBROID
e. Fibroid in stalu Nacendi
f. Fibroid in Broad ligament:
i. Intramunal fibroid
ii. Suberosal fibroid
iii. Submucosal fibroid (Pedunculated lesion)
They are located within the wall of the uterus and are the most common type. Unless large they are asymptomatic. It begins as small modules in the muscular wall of the uterus. With time it may expand inward causing distortion and elongation of the uterine cavity.
They are located underneath the mucosal surface of the womb and can become very large. They can also grow out in a papillary manner to become peduculated fibroid. This pedunculated growth can detach from the uterus to become a parasitic myorma the uterine muscle will be contracting to expel it. There are such cases people are said to have delivered fibroid. A pedunculated lesion within the cavity is termed an intracavitory fibroid and can pass through the cervix.
They are located in the wall of the cervix, further growth of the uterine fibroid may develop secondary changes such as hemorrhage bleeding.
Nacrosis: Death of a portion of the issue.
Calcification: To become hard or make something hard by adding calcium salt.
Cystic changes: A growth containing liquid that forms in an organ.
AETIOLOGY – CAUSES OF FIIBROID
What are the causes of fibroid?
Exact aetiology is not clearly understood but the current working hypothesis is that genetic predisposition, prenatal hormonal exposure as in pregnancy and abortion. African descant nulliparity – childlessness. Diabetic elevation of Blood sugar: cardiovascular disease-like high blood pressure defeat of muscular wall as in atherosclar rotic injury i.e. a gradual loss of elasticity in the wall of arteries due to thickening and calcium to the uterine blood vessel and the resulting inflammatory state may play a role.
SIGNS AND SYMPTOMS OF FIBROID
These depend on the location of the lesion (damage to the skin or any part of the body and its size).
Signs and Syptoms include:
- Abnormal gynecologic Hemorrhage
- Heavy or painful menstruation
- Abdominal discomfort or bloating pelvic cramp before the date of the period
- Painful defecation
- Urinary frequency or retention infertility
- Painful intercourse depending on location
- Premature labour
- Malpresentation of foetal part
DIAGNOSIS OF FIBROID
1. Sonography will depict the fibroid as focal masses with a heterogeneous texture which usually cause shadow of the ultrasound beam. Ultrasound can determine location and dimension but it cannot clearly distinguish between ordinary or cancerous type.
2. Hysterosal pingorgraphy: with the aid of a laparascope we can visualize and evaluate the lesions that affect the uterine cavity.
3. Abdominal palpation: These can be felt with examining finger (especially under fasting).
4. Digital examination: with aseptic procedure, the fibroid can be touch by examining finger.
TREATMENT OF FIBROID
Health education remains one of the most important areas of health care. It must be designed to inform and educate public about treatable forms of cancer, so that fear will not inhibit people from seeking early medicine assistance. Fear remains the large single obstacle that complicates and compromise early detection effort, though it is difficult to convince people to participate in screening programs. If adequate health talk is given, most fibroid do not require treatment unless they are causing symptoms. After menopause most fibroid shrink and it is unusual for fibroid to cause problem. Symptomatic uterine fibroid, the type that can causes discomfort can be treated by medication.
- Among the chemotherapies, we have:
- Progestin: It is highly effective in limiting menstrual blood flow and improving other symptoms, side-effect are typically moderate because progestin is release in low concentration locally
- Danazol is an effective treatment to shrink fibroid and control symptoms. Its us is limited by unpleasant side effect. It has to be taken with caution.
- Dostinex is a moderate and well tolerated dose. It has been shown to shrink fibroid effectively
- Gonatropin: It cause temporary regression of fibroid by decreasing estrogen level. This type if being taken before fibroid operation to shrink both the fibroid and the uterus before surgery. Maximum usage is 6 months or less. In many cases of fibroid regrow after cessation of treatment. However significant benefit may persist for much longer in some cases. Other add pack regular are tibolone Raloxifene.
- Ulupristal Acetate is a synthetic selective progestone receptor modulation which has been tested in small randomized trial with good result for treatment of fibroid.
- Asoprisnil is currently tested with very promising result as a possible use for the treatment of fibroid. The hope is that it will provide the advantages of progesterone antagonist as without their side effect.
- UTERINE ARTERY EMBOLIZATION (UAE)
This method blocks both uterine arteries through the use of guidance imaging thus reducing blood supply to the fibroid. This intervention is not usually recommended when fertility should be preserved. When the fibroid is denied of adequate blood supply it prevents further growth, they bleeding and possibly shrinks them 86% of beneficiaries recommend these devices to their friend.
- RADIO FREQUENCY ABLATION
Is one of the newest minimally invasive treatments for fibroids the fibroid is shrunk by inserting a needle-like device into the fibroid through the abdomen and heating it with radio frequency (RF) electrical energy to cause necrosis of cells i.e. causing death of a portion of the tissue.
This is removal of one or multiple fibroid mainly for women who want to retain their uterus. These procedures are of these types:
i. Hysteroscopy: This method is use whereby an instrument called resect scope are inserted, via the birth canal that can use a high frequency electrical energy to cut the tissue.
ii. Laparoscopic: This is done through a small incision near the navel using laparoscope to remove fibroid.
iii. Laparotomic: Also known as abdominal myomectomy is the most invasive surgical procedure to remove fibroid
If the bleeding becomes embarrassing, total hysterectomy is done and this is classified removal of the uterus ovary and the fallopian tube.
- MAGNETIC RESONANCE GUIDED FOCUS ULTRASOUND (MRGFUS)
This is a non-invasion intervention requiring no incision that uses high intensity ultrasound wave with the aid of MAGNETIC PERONANCE IMAGING (MRI) which guided and monitor the treatment. It is outpatient procedure, it takes one of three hours depending on the size of the fibroid. This procedures has been found to be effectively reasonable and comparable to alternation treatment as discussed earlier.
EPIDEMIOLOGY OF FIBROID
Epidemiology is the study of the distribution of diseases in population. It includes the attack rate (that is incident 1:20) and the number affected at any one time. we are meant to understand that as of 2010 about 235 million women are affected with uterine fibroid 40%may be diagnosed but only 15% will require treatment. It then means that many may have fibroid unnoticed. It is the most common pelvic tumor in women. Fibroids depend on Estrogen and progesterone to grow.
Check your food supplement drugs if these hormone were one of the additives and take precaution. Fibroid are more common in obese women. It is occasionally noted among our teenagers many at times this may lead them into early marriage. It is also noted that fibroid are clinically apparent approximately 25% of reproductive aged women and those who were lured into surgery when there should be no need for it.
In US 80% of Africa American women develop uterine fibroid by their late 40s according to the National institute of Environmental Health Science. Also African women developed fibroid at a younger age. It grows more quickly and more likely to cause symptoms. This lead to higher rates of surgery. Boston University School of medicine researchers found that women fed on high protein and vitamins do not have the risk of developing fibroid too early.
(Judgment about how something is likely to develop in the future - forecast)
Myomectomy is the cheapest operation but has a poor programs, fibroid lead to malignancy. At times, it metastasized that is, it can spread to other vital organs e.g. lungs, lymph nodes especially when it grows too large. Death occurs after surgery due to severe bleeding.
Diet: Avoid much carbohydrate and fatty food. Go for high protein and vitamin.
Caution: Do not rush into surgical intervention, seek for medical advice early. There is gross hormone imbalance after surgery.
SCRIPTURAL SOLUTIONS TO FIBROID
Romans 8:17 says, believers should not think, it strange if they experience ill-health or any constructional imbalance trouble are calamity do not necessarily mean that God has deserted us or that he has stopped loving us. Paul assures us that in all these adversities we will overcome and be more than conquerors through Christ.
In Exodus 23:25, God connected the removal of sickness from among his people with their whole hearted devotion to him and their separation from ungodly influence among them. Deut. 23:28, we will not cast our young. Many miscarriages due to fibroid have been arrested in Jesus name.
In Psalm. 103:3, He sent his word and heals them, also delivered them from their destruction. Have you not heard someone testified that after believing Gods spoken word by his prophet they delivered their fibroid through the birth canal? Why not hold unto God, he is God of impossibilities?
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