About a month ago I met with a gynecologist to talk about the results from the Oct. scan. It’s bad enough that it took them 4 months to find the time to talk to me about the results, but it’s worse that the girl seemed to have read my chart 2 seconds before I walked in the door. Worse yet she recommended something I think would have been detrimental: “tratamiento hormonal” until I reach menopausal age (I’m 38 now). This would consist of Decopeptyl to chemically induce menopause and then later add-back hormones. She was all ready to just give me one simple injection right away to just erase all my hormones.
I’ve already taken that once, and it says right on the paper that comes with it that it should not be taken for more than 5 months and only once in a life time. Of course at the time, as I was sitting in the office, I didn’t remember to tell her that. What I did tell her was that I’d already taken it and had a rough time. That nobody cared about the rough time I was having – in 2001 somebody actually told me that I was not suffering but just uncomfortable. That later I was given progesterone and had an even worse time with that. That the depo-progevera caused the abdominal tumors (I know there is no proof of cause and effect). So I’ve lost confidence in not so much the treatment, but in its administration.
Why should somebody like me who weighs 45kg get the same dosage as somebody who weighs double? Who would monitor the side effects, how often, and how fast would they be able to counteract them?
What could she say to make me feel confident that they were really doing their best to take care of me? Nothing. Her idea of giving me information was just to say that with add-back it’s not so bad and that if she were in my place she would do it. She kept going on and on about endometriosis and how lucky I am not to have that, because that IS painful. In the end I just wound up crying like a baby right there in the office. Feeling so impotent and powerless. You go there scared, weak, confused looking for help, for information, but then have to defend yourself tooth and nail.
Anyway, in the end I didn’t take it and told her that I might be convinced with more information. Her idea of more information was to hand write a prescription for decopeptyl that I could get at the pharmacy or through my regular doctor if I wanted it for free. So I’ve been looking for more information and I am just more convinced that I did the right thing. Maybe I will find something new that will change my mind, but I haven’t found it yet and the hospital sure isn’t helping.
Here is some of the information I found about GnRh agonists, confirming that it shouldn’t be taken long-term.
http://www.greenjournal.org/cgi/reprint/99/5/709.pdf
“Prolonged GnRH Agonist and Add-Back Therapy for Symptomatic Endometriosis: Long-term Follow-up” 2002.
But now, I am not even sure if decopeptyl is a gnrh agonist or something else.
Still, if it is a choice between operation or injections, I would take the operation. The operation is not so systemic and really really rough. It took me about a year to recover from the last one. But the injections gave me side effects that may not go away ever. Maybe I will be the first one in history to discover yet another horrible side effect. No thanks.
Tomorrow I can pick up the MRI results from the digestive doctor to take to the tumor doctor on Wed. She said that it didn’t look like there were any signs of malignancy. If there are, then my whole world will crash.
Hace un mes vi un ginecólogo para hablar de los resultados de la exploración de oct.. Es bastante malo que les tardo 4 meses para encontrar un momento para hablar con mí sobre los resultados, pero es peor que la muchacha se parecía haber leído mi historia solo 2 segundos antes de que entré en la puerta. Peor que todo, ella recomendó algo que pienso sera perjudicial: "tratamiento hormonal" hasta que alcanzo la edad de menopausia (ahora tengo 38). Esto consistiría en Decopeptyl para inducir menopausia y después reponen hormonas, se llama “add-back”. Ella era lista para darme una inyección enseguida para borrar todas mis hormonas. Ya he tomado eso una vez, y dice en el papel que viene con él, que no debe ser tomada por más de 5 meses y solamente una vez en la vida.
Por supuesto en ese momento, en la oficina, no se me ocurrió decirle eso. Lo que le dije era que lo había tomado, y lo pase mal. Que nadie se importaba - en 2001 alguien de hecho me dijo que no sufriera sino que estaba incómodo. Que me dieron la progesterona y lo pase incluso peor con eso. Encima el depo-progevera causó los tumores abdominales (sé que no hay prueba de causa y efecto). He perdido confianza no tanto en el tratamiento, pero en su administración.
¿Por qué debe alguien como yo que pese 45kg tomar la misma dosificación que alguien que pesa el doble? ¿Quién supervisaría los efectos secundarios, con que frecuencia, y cuanto tardaran en contrariarlos? ¿Qué podría ella decirme para darme la sensación que realmente hacían su mejor para cuidarme? Nada. Su idea de darme información era simplemente decir que eso con el “add-back” no es tan malo y si ella estuviera en mi lugar que ella lo haría. Hablaba mucho de endometriosis y el suerte que tengo de no tener eso, porque eso ES dolorosa. Al final acabe llorando como un bebé allí en la oficina. Sientes tan impotente. Vas allí asustada, débil, y confusa, en busca de ayuda, de información, pero tienes que defenderse.
De todas formas, al final no lo tomé y le dicho que puede ser que me convencen con más información. Su idea de más información era darme una receta para el decopeptyl que podría conseguir en una farmacia o a través de mi doctor regular si lo quiero gratis.
Así que estoy buscando más información y estoy aun mas convencido de que hice la cosa correcta para mi. Quizá encontraré algo nuevo que cambiará mi idea, pero no la he encontrado todavía y el hospital no está ayudando con información.
Aquí está algo de la información que encontré (en ingles) sobre los agonistas de GnRh.
Pero ahora, no soy incluso seguro si el decopeptyl es un agonista gnrh.
No obstante, si tengo que elegir entre una operación o inyecciones, tomaría la operación. La operación no es tan sistémica y es realmente duro. Me tarde un año para recuperarse del último. Pero las inyecciones me dieron efectos secundarios que quizás tendrán para siempre. Quizás yo será la primera persona en la historia para descubrir otro efecto secundario horrible. No gracias. Puedo recoger mañana los resultados del MRI del doctor digestivo para llevar al doctor de los tumores miércoles. Ella me dijo que no tenían un aspecto maligno. Si tienen, entonces mi mundo entero se estrellará.
What is LPD?
"...the enigmatic disorder known as disseminated peritoneal leiomyomatosis. DPL is very rare condition in which "fibroid" tumorlets numbering from a handful to hundreds are scattered about the peritoneal surfaces and omentum in the abdominal cavity. The way that we think about DPL changed after [Quade] laboratory published about paper showing that DPL tumorlets are "metastatic" from a single tumor clone. Despite this uniclonal origin, in most cases, DPL behaves as a clinically benign process, with many cases presenting incidentally and the rest of cases presenting because of symptoms related to the mass effect of these many tumorlets. In a very small number of cases, DPL seems to "transform" into leiomyosarcoma, another uniclonal, but malignant smooth muscle tumor. Consequently, for most patients, chemotherapy has little effect and the side effects cause more harm than benefit. DPL, like uterine fibroids (benign smooth muscle tumors that we diagnose as leiomyomas), is composed of benign smooth muscle tumor cells that are hormonally sensitive, and reducing the level of estrogen and progesterone by GnRH agonists (e.g., Lupron) and oopherectomy seems to help, but these obviously leave the patient in a postmenopausal state, which has important implications for bone, heart, and reproductive health. A few cases of hormone-secreting ovarian tumors have been associated with DPL as well. If mass effect symptoms are present, debulking surgery helps as long as the procedure is through and that the microscopic tumorlets don't grow back.
...patients with DPL should see a gynecologic oncologist (a doctor trained in the surgical management of tumors of the female genital tract), preferably one who practice in a university setting as they will be more likely to have managed a case or two. Unfortunately, there is no one out there that has taken care of large numbers of DPL patients. In New York, I would consider going to the Memorial-Sloane Kettering Cancer Center. Here at [Brigham and Women’s Hospital ], I would recommend seeing Dr. Mike Muto or Dr. Ross Berkowitz (or another member of their group)."
"Leiomyomatosis peritonealis disseminata (LPD), also known as diffuse peritoneal leiomyomatosis, is a rare disease in which multiple smooth muscle or smooth muscle-like nodules develop subperitoneally in any part of the abdominal cavity [1].
These nodules, though histologically benign, cannot be distinguished macroscopically from peritoneal carcinomatosis.
The aetiology is thought to be smooth muscle metaplasia of the subperitoneal mesenchyme [2]. About 100 documented cases were found in the English language literature; LPD patients are mainly females of reproductive age [3], and only rarely have cases affecting men been reported [4,5].
The condition is associated with high levels of exogenous and endogenous female gonadal steroids (e.g. pregnancy, prolonged exposure to oral contraceptives and/or combined hormonal replacement therapy, granulomatous cell tumours of the ovary) [4,6], indicating that oestrogens and progestins play an important role in the pathogenesis of LPD as they do in leiomyomata uteri.
Most LPD cases are clinically benign, and in some instances the lesions may partially or completely regress [5,7]. Alternatively, LPD may progress, recur or (rarely) undergo malignant transformation [8].
LPD is most common in women of reproductive age. More than half of all patients are pregnant or taking oral contraceptives at the time of diagnosis [14].
Quade et al. showed (in 1997) that LPD has molecular-genetic and cytogenetic features suggesting that individual tumourlets are monoclonal, with a pathogenesis similar to leiomyomata uteri. In LPD, the smooth muscle cells are influenced by oestrogens [7,15], and sex steroid receptors have been identified in nearly all cases [16]. LPD can be associated with other oestrogen-dependent diseases including endometriosis, ovarian clear cell carcinoma, endometrial carcinoma [17] and ovarian fibrothecoma [2]. Recently, two cases of development of LPD and ovarian Brenner tumour during tamoxifen [cancer drug] therapy have been reported [18-22].
Although LPD is most common in premenopausal women, cases have been reported in postmenopausal women using [23] or not using [13,24,25] hormone replacement therapy (HRT). The identification of luteinizing hormone (LH) receptors in LPD nodules from a postmenopausal woman suggests that the typical postmenopausal increase in LH levels might affect the pathogenesis of this condition [22].
Recently, familial occurrence of LPD has been described, showing an autosomal dominant model with varying degrees of penetrance [26].
Most patients with LPD present without specific symptoms and many documented cases of LPD have been discovered incidentally during surgery (caesarean section, laparotomy or laparoscopy). Sometimes patients may present with mostly non-specific symptoms, such as irregular, heavy uterine bleeding and pain or a mass in the lower abdomen [27], discomfort, urinary frequency (due to the effect of the mass on the bladder), gastrointestinal bleeding and peritonitis (following erosion of LPD implants in the bowel wall) [7,13,18,28]. Sometimes patients experience symptoms directly related to LPD: urosepsis secondary to obstruction of the ureters, and an acute abdomen due to ovarian torsion [29].
Sonographic and CT findings reported in the literature include non-specific, solid, and complex soft tissue masses that are often large and mimic a leiomyomatous uterus. In some cases, the masses grow in a fashion similar to that of normal uterine parenchyma, whereas others demonstrate heterogeneous enhancement. Diagnosis may be confused with peritoneal carcinomatosis if the masses are present diffusely throughout the abdomen and pelvis. Peritoneal carcinomatosis, however, is often associated with tumour cake, ascites and liver metastases, which have not been reported with LPD [29].
Magnetic Resonance (MR) findings include masses similar in signal intensity to skeletal muscle or uterine parenchyma, and when sarcomatous transformation occurs these are not significantly different from the features of benign implants. If the masses are located in the pelvis adjacent to the iliac vessels, they may be confused with lymphadenopathy [5,14,30-33]. Moreover, some multiple, pedunculated leiomyomas arising from the uterus may mimic LPD implants. Final diagnosis relies on histological examination [34] and immunohistochemical evaluation.
Sometimes, LPD may recur in patients taking HRT [13,24,25] even after hysterectomy and bilateral salpingo-oophorectomy [23], or in patients who have undergone in vitro fertilization [35]. Matthews and Speers reported a patient who died after a fourth recurrence of LPD and distant metastases 10 years after hysterectomy. Each recurrence seems to be more likely to produce morphological evidence of sarcoma [23].
Malignant transformation of LPD is uncommon and only ten cases have been documented in the English literature [8,29]. Of these, only three occurred in postmenopausal women (so seven cases of malignant transformation in premenopausal women)[29,36]. The interval between initial detection of LPD and the development of sarcoma varies from synchronous diagnosis to 8 years.
In most reports of malignant LPD, no history of oestrogen exposure was found. Bekkers hypothesized that LPD without exogenous or increased endogenous oestrogen exposure, and without expression of ER/PR by tumour cells, may represent a different entity carrying a higher risk of malignant transformation [3].
On the basis of these observations, we can affirm that no established guidelines exist regarding the management of LPD. However, therapy needs to be individualised according to the patient's age, hormonal and reproductive status and symptomatology. Different drugs (gonadotropin realising hormone agonist (GnRH agonist), megestrol acetate, danazol) have been considered in some cases but with poor results. If intestinal and bladder mass effect symptoms are prominent, a surgical approach is indicated [37]."
BMC Cancer. 2006; 6: 127.
Published online 2006 May 10. doi: 10.1186/1471-2407-6-127.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1481579
...patients with DPL should see a gynecologic oncologist (a doctor trained in the surgical management of tumors of the female genital tract), preferably one who practice in a university setting as they will be more likely to have managed a case or two. Unfortunately, there is no one out there that has taken care of large numbers of DPL patients. In New York, I would consider going to the Memorial-Sloane Kettering Cancer Center. Here at [Brigham and Women’s Hospital ], I would recommend seeing Dr. Mike Muto or Dr. Ross Berkowitz (or another member of their group)."
"Leiomyomatosis peritonealis disseminata (LPD), also known as diffuse peritoneal leiomyomatosis, is a rare disease in which multiple smooth muscle or smooth muscle-like nodules develop subperitoneally in any part of the abdominal cavity [1].
These nodules, though histologically benign, cannot be distinguished macroscopically from peritoneal carcinomatosis.
The aetiology is thought to be smooth muscle metaplasia of the subperitoneal mesenchyme [2]. About 100 documented cases were found in the English language literature; LPD patients are mainly females of reproductive age [3], and only rarely have cases affecting men been reported [4,5].
The condition is associated with high levels of exogenous and endogenous female gonadal steroids (e.g. pregnancy, prolonged exposure to oral contraceptives and/or combined hormonal replacement therapy, granulomatous cell tumours of the ovary) [4,6], indicating that oestrogens and progestins play an important role in the pathogenesis of LPD as they do in leiomyomata uteri.
Most LPD cases are clinically benign, and in some instances the lesions may partially or completely regress [5,7]. Alternatively, LPD may progress, recur or (rarely) undergo malignant transformation [8].
LPD is most common in women of reproductive age. More than half of all patients are pregnant or taking oral contraceptives at the time of diagnosis [14].
Quade et al. showed (in 1997) that LPD has molecular-genetic and cytogenetic features suggesting that individual tumourlets are monoclonal, with a pathogenesis similar to leiomyomata uteri. In LPD, the smooth muscle cells are influenced by oestrogens [7,15], and sex steroid receptors have been identified in nearly all cases [16]. LPD can be associated with other oestrogen-dependent diseases including endometriosis, ovarian clear cell carcinoma, endometrial carcinoma [17] and ovarian fibrothecoma [2]. Recently, two cases of development of LPD and ovarian Brenner tumour during tamoxifen [cancer drug] therapy have been reported [18-22].
Although LPD is most common in premenopausal women, cases have been reported in postmenopausal women using [23] or not using [13,24,25] hormone replacement therapy (HRT). The identification of luteinizing hormone (LH) receptors in LPD nodules from a postmenopausal woman suggests that the typical postmenopausal increase in LH levels might affect the pathogenesis of this condition [22].
Recently, familial occurrence of LPD has been described, showing an autosomal dominant model with varying degrees of penetrance [26].
Most patients with LPD present without specific symptoms and many documented cases of LPD have been discovered incidentally during surgery (caesarean section, laparotomy or laparoscopy). Sometimes patients may present with mostly non-specific symptoms, such as irregular, heavy uterine bleeding and pain or a mass in the lower abdomen [27], discomfort, urinary frequency (due to the effect of the mass on the bladder), gastrointestinal bleeding and peritonitis (following erosion of LPD implants in the bowel wall) [7,13,18,28]. Sometimes patients experience symptoms directly related to LPD: urosepsis secondary to obstruction of the ureters, and an acute abdomen due to ovarian torsion [29].
Sonographic and CT findings reported in the literature include non-specific, solid, and complex soft tissue masses that are often large and mimic a leiomyomatous uterus. In some cases, the masses grow in a fashion similar to that of normal uterine parenchyma, whereas others demonstrate heterogeneous enhancement. Diagnosis may be confused with peritoneal carcinomatosis if the masses are present diffusely throughout the abdomen and pelvis. Peritoneal carcinomatosis, however, is often associated with tumour cake, ascites and liver metastases, which have not been reported with LPD [29].
Magnetic Resonance (MR) findings include masses similar in signal intensity to skeletal muscle or uterine parenchyma, and when sarcomatous transformation occurs these are not significantly different from the features of benign implants. If the masses are located in the pelvis adjacent to the iliac vessels, they may be confused with lymphadenopathy [5,14,30-33]. Moreover, some multiple, pedunculated leiomyomas arising from the uterus may mimic LPD implants. Final diagnosis relies on histological examination [34] and immunohistochemical evaluation.
Sometimes, LPD may recur in patients taking HRT [13,24,25] even after hysterectomy and bilateral salpingo-oophorectomy [23], or in patients who have undergone in vitro fertilization [35]. Matthews and Speers reported a patient who died after a fourth recurrence of LPD and distant metastases 10 years after hysterectomy. Each recurrence seems to be more likely to produce morphological evidence of sarcoma [23].
Malignant transformation of LPD is uncommon and only ten cases have been documented in the English literature [8,29]. Of these, only three occurred in postmenopausal women (so seven cases of malignant transformation in premenopausal women)[29,36]. The interval between initial detection of LPD and the development of sarcoma varies from synchronous diagnosis to 8 years.
In most reports of malignant LPD, no history of oestrogen exposure was found. Bekkers hypothesized that LPD without exogenous or increased endogenous oestrogen exposure, and without expression of ER/PR by tumour cells, may represent a different entity carrying a higher risk of malignant transformation [3].
On the basis of these observations, we can affirm that no established guidelines exist regarding the management of LPD. However, therapy needs to be individualised according to the patient's age, hormonal and reproductive status and symptomatology. Different drugs (gonadotropin realising hormone agonist (GnRH agonist), megestrol acetate, danazol) have been considered in some cases but with poor results. If intestinal and bladder mass effect symptoms are prominent, a surgical approach is indicated [37]."
BMC Cancer. 2006; 6: 127.
Published online 2006 May 10. doi: 10.1186/1471-2407-6-127.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1481579
Telling LPD Articles
LPD Articles and Case Studies
- (2008) Anastrozole for LPD in a postmenopausal woman
- LPD induced by GnRH Agonist
- Progesterone receptor activity in leiomyomatosis peritonealis disseminata.
- Malignant Degeneration in Leiomyomatosis Peritonealis Disseminata
- Disseminated Peritoneal Leiomyomatosis Presenting as Severe Hypochromic Microcytic Anemia (2004)
- Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies.(2007)
- Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy.(2006)
- Recurrent leiomyomatosis peritonealis disseminata after hysterectomy and bilateral salpingo-oophorectomy during combined hormone replacement therapy.
- Leiomyomatosis peritonealis disseminata with malignant change in a post-menopausal woman.
- A Case of Leimyomatosis Peritonealis Disseminata Combined with Advanced Gastric Cancer [in a man]
- 2007, Aug. Computed tomography of pancreatic implantation with malignant transformation of leiomyomatosis peritonealis disseminata in a man.
- 2006, BMC Cancer,LPD Case Study (English)
- Peritoneal Cancer (including LPD)
- (2008) Anastrozole for LPD in a postmenopausal woman
Related Articles
- Inflammation and breast cancer. Balancing immune response: crosstalk between adaptive and innate immune cells during breast cancer progression, Aug. 2007
- estrogen receptor modulators and aromatase inhibitors against Benign Metastasizing Leiomyomas, The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 7 3183-3188
- Leiomyomatosis peritonealis disseminata occurring in a postmenopausal woman (1995,1996).
- Restoration of human chorionic gonadotropin response in human myometrial smooth muscle cells by treatment with follicle-stimulating hormone (FSH): evidence for the presence of FSH receptors in human myometrium. European Journal of Endocrinology, Vol 134, Issue 2, 225-231,
- Leiomyomatosis-Like Lymphangioleiomyomatosis of the Colon in a Female with Tuberous Sclerosis
- Dermatofibroma is a clonal proliferative disease
- Epstein-Barr Virus-associated Leiomyomatosis and Posttransplant Lymphoproliferative Disorder in a Child (2003)
- GnRH Agonist Explained, (blog with comments)
- Hormones Explained: LH, FSH, Estrogen etc.
- Leiomyomatosis-Like Lymphangioleiomyomatosis of the Colon in a Female with Tuberous Sclerosis
- CT Scans (LPD vs. other Neoplasms)
- Colon Leiomyomatosis [in a male]
- Smooth muscle tumors associated with X-linked Alport syndrome: carrier detection in females.
- clues to the pathogenesis of fibroids
- Localization of a gene (MCUL1) for multiple cutaneous leiomyomata and uterine fibroids to chromosome 1q42.3-q43.
- Treatments for Uterine Fibroids [also LPD?]
- 2007, Jun. Extra-uterine pelvic leiomyoma: diagnosis and practical management
- 2002, Prolonged GnRH Agonist and Add-Back Therapy
- Hormone-Dependent Tumor
Alternative and Complimentary Treatments. Hmmm...
- Calcium D Glucarate (by American Cancer Society)
- Calcium D-Glucarate (Spanish)
- 2007, Aug. Lycopene and other carotenoids inhibit estrogenic activity of 17beta-estradiol and genistein in cancer cells.
- 2007, Aug. Lycopene activity against chemically induced DNA damage in Chinese hamster ovary cells.
- 2007, Jul. What the FDA says about Lycopene
- Somebody I Know Cured His Cancer
- Chinese Herbal Therapy for Uterine Fibroids [and LPD?]
- Juicing Against Cancer (but not benign tumors like fibroids) - what about LPD?
- Calcium D Glucarate (by American Cancer Society)
- Calcium D-Glucarate (Spanish)
- Calcium D Glucarate (by American Cancer Society)
- Calcium D-Glucarate (Spanish)
Spanish Articles
- 2007. Miércoles 1 Agosto 2007. Cirugia Espanola. Volumen 82 - Número 02 p. 125 - 127 (Spanish). No Link.
- 2005, Leiomiomatosis Peritoneal Diseminada (Spanish)
- 2004, LPD (Spanish)
- 2004, Leiomioma disecante cotiledoneo de utero. Presentación de un caso y revisión de la literatura. (Spanish) Not exactly about LPD but related.
- 2004, (Spanish) Leiomiosarcoma bien diferenciado de ovario. [Not LPD but related]
- 2001, Cirugia Espanola, LPD Case Study (Spanish)
- 1998, Leiomiomatosis peritoneal diseminada. Presentación de un caso y revisión de la literatura (Spanish)
- 1998, Leiomiomatosis peritoneal diseminada. Presentación de un caso y revisión de la literatura (Spanish)
- 1997, LEIOMIOMATOSIS PERITONEAL DISEMINADA (DISSEMINATED PERITONEAL LEIOMYOMATOSIS )
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