Morcellation Surgery Causing Cancer Spread: Informed Consent And Medical Malpractice
Steven E. North, Esq.
Shari James, Paralegal
Uterine cancer and the fear of the spread of the disease is a major concern for women. With approximately 500,000 hysterectomies performed a year in the U.S., mostly because of benign fibroid tumors, women now have to consider whether or not the surgical removal of the organ or tumor will cause the spread of cancer or exacerbate their condition.
A somewhat controversial procedure, known as morcellation, utilizes a device - a morcellator - similar to a power tool, to remove large fibroids and even the uterus by "grinding up" the tissue so that the resulting smaller fragments can then be removed through incisions in a minimally invasive surgery procedure.
Physicians who tout the morcellation procedure over the conventional open abdominal surgery maintain that this surgery is minimally invasive with smaller scars, quicker recovery and shorter hospital stays. They discount the theory that their surgery has a significant potential of spreading cancer.
An article in The New York Times, February 7, 2014, "Uterine Surgical Technique Is Linked to Abnormal Growths and Cancer Spread" and a December 18, 2013 article in The Wall Street Journal, "Doctors Eye Cancer Risk in Procedure" discuss the controversy in the medical community regarding morcellation. Some contend that the procedure "may lead to dissemination of malignant tissue thereby causing metastatic disease." The grinding of growths, such as fibroids, which might be thought to be benign, may in fact contain occult cancer cells which are only discovered when the post-operative pathology is performed. It is maintained by some that such surgery will disseminate the cancer throughout the body rather than contain the disease which would be the case if the specimen had been removed in one piece by conventional surgery. And others say that spread of even benign tissue may cause multiple growths to develop in the abdomen.
An article submitted to the New England Journal of Medicine by four Boston-area doctors, maintains that there is a significant number of women with undetected cancer within the fibroids, and the morcellation procedure in some cases is "tripling the odds of death within five years." With an estimated 20-40% of women over the age of 35 developing fibroids, though usually benign, the chance of spreading cancer is relatively high. Two articles published on February 6, 2014 in The Journal of the American Medical Association discuss the problem.
Like any other medical procedure, patients have a right to know their surgical options and to make their own informed choice as to whether or not they wish to proceed with the procedure. They are entitled to be informed of all the significant considerations associated with the proposed surgery. And if potential surgery is thought to cause the spread of cancer rather than protect against it, the patient should be informed of that.
Informed consent plays a major role in providing care to a patient. There should be verbal communication between the healthcare provider and the patient before the patient chooses to undergo a particular treatment. A written consent form is not a substitute for the required discussion between doctor and patient. The patient must be made to understand the potential benefits of the procedure, the reasonable risks and complications involved, and alternatives as well as the health risk associated with foregoing the procedure.
A medical malpractice claim based upon lack of informed consent, where a physician fails to disclose the appropriate information to a patient, especially when an alternative method of treatment is available may sometimes be hard to prove but can lead to substantial recoveries.