Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation"

Transcription

1 Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation Clinical Policy Number: Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date: August 19, 2015 Next Review Date: August 2016 Policy contains: Power morcellation. Leiomyosarcoma. Hysterectomy. Uterine fibroids. ABOUT THIS POLICY: AmeriHealth Caritas Pennsylvania has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas Pennsylvania clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peerreviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of medically necessary, and the specific facts of the particular situation are considered by AmeriHealth Caritas Pennsylvania when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas Pennsylvania clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas Pennsylvania clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas Pennsylvania will update its clinical policies as necessary. AmeriHealth Caritas Pennsylvania clinical policies are not guarantees of payment. Coverage policy AmeriHealth Caritas Pennsylvania considers the use of laparoscopic power morcellation to be investigational and, therefore, not medically necessary. Limitations: None. NOTE: The following CPT code is not included in the Pennsylvania Medicaid fee schedule: C Morcellator Alternative covered services Surgical hysterectomy and myomectomy. Laparoscopic hysterectomy and myomectomy without morcellation. Laparotomy using a smaller incision (minilaparotomy). Deliberate blocking of the uterine artery (catheter-based uterine artery embolization). 1

2 High-intensity focused ultrasound. Drug therapy. Background Uterine sarcomas are a rare form of uterine cancer, accounting for 3 percent to 5 percent of all uterine cancers diagnosed in the US. They arise in the myometrium or connective tissue of the uterus. Uterine sarcomas are highly aggressive, with five-year overall survival rates ranging between 17 percent and 55 percent. Leomyosarcomas are a rare form of soft tissue cancer that is often dormant, but often fatal after diagnosis. They can be found in multiple sites, often in the uterus and gastrointestinal system. Laparoscopic power morcellation is a minimally invasive technique used to treat uterine fibroids, compared to removing the uterus or removing uterine fibroids. Morcellation devices generally cut tissue into smaller fragments to facilitate removal of tissue through small incisions. Recent clinical information suggests laparoscopic power morcellation poses a risk of spreading unsuspected cancerous tissue such as uterine sarcomas to travel beyond the uterus. On April 17, 2014, the U.S. Food and Drug Administration (FDA) withdrew approval of laparoscopic power morcellators because of this risk of spreading cancer. Although many women develop uterine fibroids in their lifetime, most cause no symptoms. Some cases result in heavy or prolonged menstrual bleeding, pelvic pressure or pain, or frequent urination. It is estimated that one in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma. Since no reliable method exists to predict whether a woman s uterine fibroid may have sarcoma, and with the risk of spreading possible cancerous tissue within the abdomen and pelvis, laparoscopic power morcellation is discouraged by the FDA. On July 30, 2014, a morcellation device manufacturer instituted a recall on all its morcellation devices, citing uncertainty in the risk-benefit assessment associated with the use of power morcellators. Methods Searches: AmeriHealth Caritas Pennsylvania searched PubMed and the databases of: UK National Health Services Centre for Reviews and Dissemination. Agency for Healthcare Research and Quality s National Guideline Clearinghouse and other evidencebased practice centers. The Centers for Medicare & Medicaid Services (CMS). We conducted searches on August 11, Search terms were: Leiomyosarcoma, morcellation and uterine fibroids. Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies. Guidelines based on systematic reviews. 2

3 Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes sometimes referred to as efficiency studies which also rank near the top of evidence hierarchies. Findings Although many women develop uterine fibroids in their lifetime, most cause no symptoms. Some cases result in heavy or prolonged menstrual bleeding, pelvic pressure or pain, or frequent urination. It is estimated that 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma. Recent clinical information suggests laparoscopic power morcellation poses a risk of spreading unsuspected cancerous tissue such as uterine sarcomas to travel beyond the uterus. On April 17, 2014, the U.S. Food and Drug Administration (FDA) withdrew approval of laparoscopic power morcellators because of this risk of spreading cancer. On July 30, 2014, a morcellation device manufacturer instituted a recall on all its morcellation devices, citing uncertainty in the risk-benefit assessment associated with the use of power morcellators. Subsequent analyses showed that power morcellation used on women with uterine fibroids who had undetected tumors was associated with an increased risk of the tumor spreading throughout the abdomen, and increased risk of subsequent death. Because uterine sarcomas are often difficult to detect pre-operatively, reviews concluded that uterine morcellation is contraindicated in women with fibroids and suspected cancer; abdominal hysterectomy should be performed instead. More research is needed in understanding the risk and deciding when morcellation is indicated. Summary of clinical evidence: Citation Felix (2013) Shibley (2014) Content, Methods, Recommendations Key points: Etiology of Uterine Sarcomas Significant risk factors for uterine sarcoma included obesity and history of diabetes. Older age at menarche was inversely associated with uterine sarcoma risk. BMI was significantly, but less strongly related to uterine sarcomas compared with EECs or MMMTs. Key points: Safety Techniques Regarding Morcellation Inflation of a morcellation bag creates an artificial pneumoperitoneum, possibly creating a safe environment for the morcellation procedures. Glossary Medically necessary A service or benefit is medically necessary if it is compensable under the Medicaid program and if it meets any one of the following standards: The service or benefit will, or is reasonably expected to, prevent the onset of an illness, condition or disability. 3

4 The service or benefit will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability. The service or benefit will assist the member in achieving or maintaining maximum functional capacity in performing daily activities, taking into account both the functional capacity of the member and those functional capacities that are appropriate for members of the same age. Uterine fibroids Noncancerous growths that develop from the muscular tissue of the uterus. References Professional society guidelines/others: Ethicon, Inc. Medical device market withdrawal: morcellation devices including generators and disposables. July 30, United States Food and Drug Administration. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication. April 17, Peer-reviewed references: Bognani G, Cliby WA, Aletti, GD. Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis. Gynecol Oncol. 2015;137(1): Felix AS, Cook LS, Gaudet MM, et al. The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer. 2013: 108: Graebe K, Garcia-Soto A, Aziz M, et al. Incidental power morcellation of malignancy: a retrospective cohort study. Gynecol Oncol. 2015;136(2): Hayes, Inc. Hayes Medical Technology Report. Unsuspected Uterine Cancer in Women Undergoing Hysterectomy with Power Morcellation. Lansdale, PA: Hayes, Inc.; July, Shibley T, Nezhat CH, Taylor B. Safety techniques regarding morcellation. International Medical News Group. June 2014: p.14. Singh SS, Scott S, Bougie O, et al. Technical update on tissue morcellation during gynaecologic surgery: its uses, complications, and risks of unsuspected malignancy. J Obstet Gynaecol Can. 2015;37(1): Wright JD, Tergas AI, Burke WM, et al. Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation. JAMA. Published online July 22, doi: /jama Clinical trials: 4

5 Searched clinicaltrials.gov on August 11, 2015, using the terms Leiomyosarcoma, morcellation and uterine fibroids. Intracorporeal Versus Extracorporeal Morcellation: Clinical Efficacy and Safety Outcomes (IEME). NCT A Modified Technique for Laparoscopic Subtotal Hysterectomy NCT CMS National Coverage Determinations (NCDs): There is no national coverage determination related to this policy. Local Coverage Determinations (LCDs): There are no local coverage determinations related to this policy. Commonly submitted codes: Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill accordingly. CPT Code Description Comment Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g for less Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g for less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 grams Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 grams;; with removal of tube(s) and/or ovary(s Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas ICD-9 Code Description Comment 179 Malignant neoplasm, sarcoma, uterus Leiomyosarcoma, uterus Uterine Fibroid ICD-10 Code Description Comment C49.9 Malignant neoplasm of connective and soft tissue, unspecified C55 Malignant neoplasm of uterus, part unspecified D25.0 Submucous leiomyoma of uterus D25.1 Intramural leiomyoma of uterus D25.2 Subserosal leiomyoma of uterus D25.9 Leiomyoma of uterus, unspecified 5

6 HCPCS Level II C1782 Morcellator Description Comment 6

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery The Condition: Uterine Fibroid (Fibroid Tumor) A uterine fibroid is a benign (non-cancerous) tumor that grows in the uterine

More information

Clinical Policy Title: Home uterine activity monitoring

Clinical Policy Title: Home uterine activity monitoring Clinical Policy Title: Home uterine activity monitoring Clinical Policy Number: 12.01.01 Effective Date: August 19, 2015 Initial Review Date: July 17, 2013 Most Recent Review Date: July 15, 2015 Next Review

More information

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery

Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery The Condition: Uterine Fibroid (Fibroid Tumor) A uterine fibroid is a benign (non-cancerous) tumor that grows in the uterine

More information

Considering Surgery for Uterine Fibroids? Learn about minimally invasive da Vinci Surgery

Considering Surgery for Uterine Fibroids? Learn about minimally invasive da Vinci Surgery Considering Surgery for Uterine Fibroids? Learn about minimally invasive da Vinci Surgery The Condition: Uterine Fibroids A uterine fibroid is a benign (non-cancerous) tumor that can grow inside and outside

More information

Clinical Policy Title: Air Ambulance Transport

Clinical Policy Title: Air Ambulance Transport Clinical Policy Title: Air Ambulance Transport Clinical Policy Number: 18.02.02 Effective Date: Oct. 1, 2014 Initial Review Date: April 16, 2014 Most Recent Review Date: May 21, 2014 Next Review Date:

More information

Clinical Policy Title: Air Ambulance Transport

Clinical Policy Title: Air Ambulance Transport Clinical Policy Title: Air Ambulance Transport Clinical Policy Number: 18.02.02 Effective Date: Sept. 1, 2014 Initial Review Date: April 16, 2014 Most Recent Review Date: May 21, 2014 Next Review Date:

More information

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery The Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis, Prolapse Many benign (non-cancerous) conditions

More information

Uterine fibroids (Leiomyoma)

Uterine fibroids (Leiomyoma) Uterine fibroids (Leiomyoma) What are uterine fibroids? Uterine fibroids are fairly common benign (not cancer) growths in the uterus. They occur in about 25 50% of all women. Many women who have fibroids

More information

The time to take care of yourself.

The time to take care of yourself. understanding Hysterectomies are the second most common surgery among women in the U.S., behind only C-sections. 1 The time to take care of yourself. Women spend a lot of time taking care of others spouses,

More information

Treating heavy menstrual bleeding caused by fibroids or polyps

Treating heavy menstrual bleeding caused by fibroids or polyps Treating heavy menstrual bleeding caused by fibroids or polyps With today s medical advances the outlook for successful treatment of fibroids and polyps has never been better. You don t have to live with

More information

Hysterectomy. The time to take care of yourself

Hysterectomy. The time to take care of yourself Hysterectomy The time to take care of yourself The time to take care of yourself Women spend a lot of time taking care of others spouses, children, parents. We often overlook our own needs. But when our

More information

Uterine Fibroid Symptoms, Diagnosis and Treatment

Uterine Fibroid Symptoms, Diagnosis and Treatment Fibroids and IR Uterine Fibroid Symptoms, Diagnosis and Treatment Interventional radiologists use MRIs to determine if fibroids can be embolised, detect alternate causes for the symptoms and rule out misdiagnosis,

More information

Fibroids - Management

Fibroids - Management Fibroids - Management Scenario: Diagnosis of fibroids How do I know my patient has fibroids? Fibroids are commonly asymptomatic and may be identified incidentally by examination or investigation for gynaecological

More information

!"#$"%&'()*#+,'(-./0(1234()',5(!**+'%( 367361234(

!#$%&'()*#+,'(-./0(1234()',5(!**+'%( 367361234( THE TUMULTUOUS MARRIAGE OF MORCELLATION AND MIS; CAN OR SHOULD THIS RELATIONSHIP BE SAVED? Julian C. Schink MD Chief of Women s Health Spectrum Health Medical Group Grand Rapids, MI Disclosure! I have

More information

Uterine Fibroids. fibroids or have had Treatments. them in the past, How you can help relieve the pain

Uterine Fibroids. fibroids or have had Treatments. them in the past, How you can help relieve the pain Uterine Fibroids WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Uterine fibroids are benign (not cancer) growths in the uterus. They are the most common type of growth found in a woman s

More information

Interventional Radiology Associates

Interventional Radiology Associates UTERINE ARTERY EMBOLISATION A MINIMALLY INVASIVE TREATMENT OPTION FOR UTERINE FIBROIDS PATIENT GUIDE Q. What are uterine fibroids? A. Fibroids are benign (non-cancerous) growths that develop in the muscle

More information

Fibroid Treatment Options

Fibroid Treatment Options Fibroid Treatment Options A guide for patients ask4ufe.com 1-877-ASK-4-UFE Uterine Fibroids and Their Symptoms Fibroids are noncancerous growths in or on the walls of the uterus (or womb). They can range

More information

Clinical Policy Title: Home phototherapy for hyperbilirubinemia

Clinical Policy Title: Home phototherapy for hyperbilirubinemia Clinical Policy Title: Home phototherapy for hyperbilirubinemia Clinical Policy Number: 11.02.04 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 19,

More information

FIBROIDS. Information Leaflet. Your Health. Our Priority.

FIBROIDS. Information Leaflet. Your Health. Our Priority. FIBROIDS Information Leaflet Your Health. Our Priority. Page 2 of 6 What are fibroids? Fibroids are growths made of bundles of muscle fibre that grow in the muscle wall of the uterus (womb). Fibroids start

More information

Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE

Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE Understanding Your Diagnosis of Endometrial Cancer A STEP-BY-STEP GUIDE Introduction This guide is designed to help you clarify and understand the decisions that need to be made about your care for the

More information

Considering a Hysterectomy?

Considering a Hysterectomy? Considering a Hysterectomy? Learn more about virtually scarless surgery using da Vinci Single-Site technology { {Symptoms & Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis,

More information

Fibroids. Types of Fibroids

Fibroids. Types of Fibroids Fibroids Uterine Fibroids, or uterine myomas affect more than 30% of women. The terms fibroid and myoma are used interchangeably. Most fibroids do not cause symptoms, and do not require treatment, but

More information

Uterus myomatosus. 10-May-15. Clinical presentation. Incidence. Causes? 3 out of 4 women. Growth rate vary. Most common solid pelvic tumor in women

Uterus myomatosus. 10-May-15. Clinical presentation. Incidence. Causes? 3 out of 4 women. Growth rate vary. Most common solid pelvic tumor in women Uterus myomatosus A.J. Henriquez March 14, 2015 Uterus myomatosus Definition, incidence, clinical presentation and diagnosis. New FIGO classification for uterine leiomyomas Brief description on treatment

More information

Case scenario. Abnormal Bleeding. Managing Abnormal Bleeding and Uterine Fibroids in a Primary Care Setting

Case scenario. Abnormal Bleeding. Managing Abnormal Bleeding and Uterine Fibroids in a Primary Care Setting Managing Abnormal Bleeding and Uterine Fibroids in a Primary Care Setting Buvana Reddy MD HealthPartners OB/GYN Department Case scenario 45yo female s/p tubal ligation who presents with a history of heavy

More information

Clinical Policy Title: Fecal DNA for colorectal cancer detection

Clinical Policy Title: Fecal DNA for colorectal cancer detection Clinical Policy Title: Fecal DNA for colorectal cancer detection Clinical Policy Number: 08.01.04 Effective Date: October 1, 2014 Initial Review Date: June 18, 2014 Most Recent Review Date: June 17, 2015

More information

Frequently Asked Questions about Fibroids

Frequently Asked Questions about Fibroids Frequently Asked Questions about Fibroids How do I know if I have fibroids? Symptoms Include: Heavy bleeding (which can be heavy enough to cause low blood count) or painful periods, feeling of fullness

More information

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

Uterine Fibroid Embolization. A Patient s Guide to a Minimally Invasive Fibroid Treatment

Uterine Fibroid Embolization. A Patient s Guide to a Minimally Invasive Fibroid Treatment Uterine Fibroid Embolization A Patient s Guide to a Minimally Invasive Fibroid Treatment About Uterine Fibroid Embolization (UFE) UFE blocks the blood supply to fibroids, causing them to shrink. It is

More information

Fibroids and polyps What you should know. MyoSure tissue removal could be the answer.

Fibroids and polyps What you should know. MyoSure tissue removal could be the answer. Fibroids and polyps What you should know MyoSure tissue removal could be the answer. What are fibroids and polyps? Fibroids Fibroids are non-cancerous tissue growths in the muscle walls of the uterus.

More information

Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy

Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy Cancer Antigen 125 (CA-125) Testing Corporate Medical Policy File name: Cancer Antigen 125 (CA-125A) Testing File Code: UM.DIAG.05 Origination: 02/2011 Last Review: 02/2014 (ICD-10 remediation only) Next

More information

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Number: 17.01.02 Effective Date: April 1, 2015 Initial Review Date: January 21,

More information

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery The Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis, Prolapse Many benign (non-cancerous) conditions

More information

da Vinci Myomectomy Changing the Experience of Surgery Are you a candidate for the latest treatment option for uterine fibroids?

da Vinci Myomectomy Changing the Experience of Surgery Are you a candidate for the latest treatment option for uterine fibroids? da Vinci Myomectomy Changing the Experience of Surgery Are you a candidate for the latest treatment option for uterine fibroids? Your doctor may be able to offer you a new, minimally invasive surgical

More information

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition The Condition(s): Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis and/or Prolapse

More information

Summa Health System. A Woman s Guide to Hysterectomy

Summa Health System. A Woman s Guide to Hysterectomy Summa Health System A Woman s Guide to Hysterectomy Hysterectomy A hysterectomy is a surgical procedure to remove a woman s uterus (womb). The uterus is the organ which shelters and nourishes a baby during

More information

Uterine Fibroids Information for Patients

Uterine Fibroids Information for Patients Uterine Fibroids Information for Patients Disclaimer This is general information developed by The Ottawa Hospital. It is not intended to replace the advice of a qualified healthcare provider. Please consult

More information

Laparoscopic Assisted Vaginal Hysterectomy

Laparoscopic Assisted Vaginal Hysterectomy Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at ChiaYi 嘉 義 長 庚 紀 念 醫 院 婦 產 科 Clinical Guideline Laparoscopic Assisted Vaginal Hysterectomy By Dr. CJ Tseng Laparoscopic assisted

More information

Considering Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition

Considering Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition Considering Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition Conditions Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis,

More information

Fibroid Relief Speaker s Kit. Core Message p. 2. Publicity for Speaking Session p. 2. Organizing a Speaking Session p. 2

Fibroid Relief Speaker s Kit. Core Message p. 2. Publicity for Speaking Session p. 2. Organizing a Speaking Session p. 2 Fibroid Relief Speaker s Kit Table of Contents Helpful Information Core Message p. 2 Publicity for Speaking Session p. 2 Organizing a Speaking Session p. 2 Tips for Public Speaking p. 3 Speaker Feedback

More information

Clinical Policy Title: Fecal DNA for colorectal cancer detection

Clinical Policy Title: Fecal DNA for colorectal cancer detection Clinical Policy Title: Fecal DNA for colorectal cancer detection Clinical Policy Number: 08.01.04 Effective Date: October 1, 2014 Initial Review Date: June 18, 2014 Most Recent Review Date: June 17, 2015

More information

From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors

From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors Uterine Fibroid Tumors A woman s fibroisis condition usually associated with estrogen dominance. Uterine

More information

Considering Surgery for Uterine Fibroids? Learn why da Vinci Surgery may be the best treatment for women who want to preserve their uterus

Considering Surgery for Uterine Fibroids? Learn why da Vinci Surgery may be the best treatment for women who want to preserve their uterus Considering Surgery for Uterine s? Learn why da Vinci Surgery may be the best treatment for women who want to preserve their uterus The Treatment: Myomectomy Myomectomy is a common alternative to hysterectomy

More information

About the Uterus. Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include:

About the Uterus. Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include: Hysterectomy removal of the uterus is a way of treating problems that affect the uterus. Many conditions can be cured with hysterectomy. Because it is major surgery, your doctor may suggest trying other

More information

Uterine Fibroid Embolization (UFE) A Patient s Guide to a Minimally Invasive Fibroid Treatment. ask4ufe.com 877-ASK4UFE

Uterine Fibroid Embolization (UFE) A Patient s Guide to a Minimally Invasive Fibroid Treatment. ask4ufe.com 877-ASK4UFE Uterine Fibroid Embolization (UFE) A Patient s Guide to a Minimally Invasive Fibroid Treatment ask4ufe.com 877-ASK4UFE UFE is performed by an interventional radiologist (IR), a doctor who uses X-rays and

More information

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery

Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery Considering Hysterectomy? Learn about minimally invasive da Vinci Surgery The Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis, Prolapse Many benign (non-cancerous) conditions

More information

Considering a Hysterectomy?

Considering a Hysterectomy? Considering a Hysterectomy? Learn more about virtually scarless surgery using da Vinci Single-Site technology { {Symptoms & Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Pelvic Prolapse

More information

Clinical Policy Title: Air Ambulance Transport

Clinical Policy Title: Air Ambulance Transport Clinical Policy Title: Air Ambulance Transport Clinical Policy Number: 18.02.02 Effective Date: September 1, 2014 Initial Review Date: April 16, 2014 Most Recent Review Date: May 20, 2015 Next Review Date:

More information

AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE UTERINE FIBROIDS A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient

More information

Brad J. Cohen, MD, MBA 2477 Route 516, Suite 103, Old Bridge, New Jersey Office Fax SURGICAL CONSENT

Brad J. Cohen, MD, MBA 2477 Route 516, Suite 103, Old Bridge, New Jersey Office Fax SURGICAL CONSENT Brad J. Cohen, MD, MBA 2477 Route 516, Suite 103, Old Bridge, New Jersey Office 732-679-6900 Fax 732-679-7900 SURGICAL CONSENT You have elected to have Dr. Brad J. Cohen perform a minimally invasive laparoscopic

More information

Fibroid Program. Inova Alexandria Hospital

Fibroid Program. Inova Alexandria Hospital Fibroid Program Inova Alexandria Hospital Uterine Fibroids The Inova Alexandria Hospital Fibroid Program is a multi-disciplinary program that offers comprehensive fibroid care for women in our community.

More information

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition The Condition(s): Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis and/or Prolapse

More information

Research Results for Uterine Fibroid Embolization vs. Myomectomy Satellite Feed TRT: 12:42

Research Results for Uterine Fibroid Embolization vs. Myomectomy Satellite Feed TRT: 12:42 10201 Lee Highway Suite 500 Fairfax, Virginia 22030 703.691.1805 703.691.1855 fax Research Results for Uterine Fibroid Embolization vs. Myomectomy Satellite Feed TRT: 12:42 www.sirweb.org info@sirweb.org

More information

Understanding Uterine Fibroids

Understanding Uterine Fibroids RCN Conference May 2014 Understanding Uterine Fibroids Dianne Crowe Advanced Gynaecology Nurse Specialist Northumbria Healthcare Trust Objectives What are fibroids? What causes fibroids? What symptoms

More information

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for a benign gynecologic condition The Condition(s): Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis and/or Prolapse

More information

Role of Robotic Surgery in Obese Women with Endometrial Cancer

Role of Robotic Surgery in Obese Women with Endometrial Cancer Role of Robotic Surgery in Obese Women with Endometrial Cancer Anil Tailor Consultant Gynaecological Oncologist Royal Surrey County Hospital Guildford, Surrey, UK St Peters Hospital Chertsey, Surrey, UK

More information

uncommon approaches to a common problem

uncommon approaches to a common problem uncommon approaches to a common problem Adam M. Griffin, M.D. Medical Director Clinical Assistant Professor Buffalo Infertility & IVF Associates What are Uterine Fibroids? Benign growths that occur in

More information

FIBROIDS PATIENT INFORMATION

FIBROIDS PATIENT INFORMATION Introduction Fibroids are benign (non-cancerous) tumours of the womb. They are also known as myomas or fibromyomas. They are growths of smooth muscle and fibrous tissue. The size of fibroids can vary from

More information

The authors are Dr. Pietro Gambadauro and Professor Antonio Pellicer.

The authors are Dr. Pietro Gambadauro and Professor Antonio Pellicer. Welcome to chapter 8. The following chapter is called Fibroids and Infertility. The authors are Dr. Pietro Gambadauro and Professor Antonio Pellicer. ALT: Please use the navigation bar at the bottom of

More information

2016 Hysterectomy Reimbursement Fact Sheet

2016 Hysterectomy Reimbursement Fact Sheet 2016 Hysterectomy Reimbursement Fact Sheet The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ethicon concerning

More information

UTERINE FIBROIDS. What you need to know about symptoms, diagnosis and treatment

UTERINE FIBROIDS. What you need to know about symptoms, diagnosis and treatment UTERINE FIBROIDS What you need to know about symptoms, diagnosis and treatment Index Index What are Uterine Fibroids?...4 Different Types of Fibroids...5 Symptoms of Fibroids...6 Diagnosis of Fibroids...6

More information

Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer

Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer Camran Nezhat,, MD, FACOG, FACS Stanford University Medical Center Center for Special Minimally Invasive

More information

Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery

Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery Considering Endometriosis Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Endometriosis Endometriosis is a condition in which the tissue that lines your uterus (the endometrium)

More information

UTERINE CANCER FACTSHEET. What is uterine cancer?

UTERINE CANCER FACTSHEET. What is uterine cancer? UTERINE CANCER FACTSHEET What is uterine cancer? The uterus or womb is the hollow, muscular organ in which the baby develops during pregnancy. Uterine cancer is the fourth most common female cancer in

More information

SUBSEROSAL FIBROIDS TREATMENT

SUBSEROSAL FIBROIDS TREATMENT INTRODUCTION Uterine fibroids, also known as leiomyomas, are the most common pelvic mass found in women. Fibroids are benign tumors that arise from the uterine muscular tissue (myometrium). They occur

More information

Coding for multiple surgical procedures By Emily H. Hill, PA

Coding for multiple surgical procedures By Emily H. Hill, PA Coding for multiple surgical procedures By Emily H. Hill, PA Many times, more than one surgical procedure is performed during the same encounter. When that occurs, a modifier(s) is required to explain

More information

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Number: 17.01.02 Effective Date: April 1, 2015 Initial Review Date: January 21,

More information

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery

Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

Fibroids: Can t live with em, can t zap em or can you?

Fibroids: Can t live with em, can t zap em or can you? Fibroids: Can t live with em, can t zap em or can you? M. Jonathon Solnik, M.D., FACOG FACS Assistant Clinical Professor Director, Minimally i Invasive Gynecologic Surgery Acting Director, Division Urogynecology

More information

Hysterectomy. What is a hysterectomy? Why is hysterectomy done? Are there alternatives to hysterectomy?

Hysterectomy. What is a hysterectomy? Why is hysterectomy done? Are there alternatives to hysterectomy? ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM What is a hysterectomy? Hysterectomy Hysterectomy is

More information

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Abnormal Uterine Bleeding WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has

More information

Clinical Policy Title: Investigational (experimental) health services

Clinical Policy Title: Investigational (experimental) health services Clinical Policy Title: Investigational (experimental) health services Clinical Policy Number: 18.04.03 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: September

More information

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION Case 1:15-cv-01046-ODE Document 1 Filed 04/07/15 Page 1 of 66 UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION EVA C. GALAMBOS and JOHN T. GALAMBOS, v. Plaintiffs, ETHICON, INC.;

More information

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for early stage gynecologic cancer

Facing Hysterectomy? Learn why da Vinci Surgery may be your best treatment option for early stage gynecologic cancer Facing? Learn why may be your best treatment option for early stage gynecologic cancer The Condition: Early Stage Gynecologic Cancer A wide variety of gynecologic cancers can affect a woman s reproductive

More information

OPTIONS FOR MANAGEMENT OF UTERINE FIBROIDS R AJ N AR AY AN M D M C W

OPTIONS FOR MANAGEMENT OF UTERINE FIBROIDS R AJ N AR AY AN M D M C W OPTIONS FOR MANAGEMENT OF UTERINE FIBROIDS R AJ N AR AY AN M D M C W BACKGROUND Fibroids affect * 60% reproductive age women 80% of women during lifetime Fibroids account for 600,000 hysterectomies in

More information

Power Morcellation and Occult Malignancy in Gynecologic Surgery

Power Morcellation and Occult Malignancy in Gynecologic Surgery Power Morcellation and Occult Malignancy in Gynecologic Surgery!"#$%&'()"*%$+,-G May 2014& Executive Summary!"#$%&'"%($))*+,"-&,-&./-$(")".,(&01%.$%/&2*0&("'$&1-3$%& %$($-+&0(%1+,-/&4$(*10$&"5&("-($%-&*4"1+&+2$&%,06&"5&,-+%*7

More information

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Abnormal Uterine Bleeding Dr. Brett Vair, MD FRCSC, Obstetrics & Gynecology 90 th Annual Dalhousie Refresher Course December 2, 2016 Disclosure In the past, I have been a presenter with Bayer Mitigating

More information

Perimenopausal Bleeding and Bleeding After Menopause

Perimenopausal Bleeding and Bleeding After Menopause WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Perimenopausal Bleeding and Bleeding After Menopause During perimenopause, your periods may become less predictable. These changes are common.

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis Endometriosis WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens

More information

International Journal of Basic and Clinical Studies (IJBCS) 2014;3(1): Ingec M and Yilmaz M

International Journal of Basic and Clinical Studies (IJBCS) 2014;3(1): Ingec M and Yilmaz M Multiple Myomectomy During First Trimester of Pregnancy: A Metin Ingec 1 Mehmet Yilmaz 1 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Ataturk University, Erzurum, Turkey. Corresponding

More information

Uterine Fibroids Facts

Uterine Fibroids Facts Uterine Fibroids Facts Heavy/Painful Periods and Pelvic Pain It is normal for women to experience heavy menstrual periods or cramps from time to time. What is not normal is a heavy period that impacts

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

Clinical Policy Title: Gene expression profile testing for breast cancer

Clinical Policy Title: Gene expression profile testing for breast cancer Clinical Policy Title: Gene expression profile testing for breast cancer Clinical Policy Number: 02.01.14 Effective Date: December 1, 2013 Initial Review Date: July 17, 2013 Most Recent Review Date: February

More information

Table 7a Corpus Uterus Cancer Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for

Table 7a Corpus Uterus Cancer Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for Corpus Uterus Cancer Figure 7 Definition: The uterus is a hollow organ in the pelvis of females. 1 There are three parts: the top is called the fundus, the middle is called the corpus, and the bottom part

More information

Considering Surgery for Endometriosis? Learn why da Vinci Surgery may be your best option for treating endometriosis and its symptoms.

Considering Surgery for Endometriosis? Learn why da Vinci Surgery may be your best option for treating endometriosis and its symptoms. Considering Surgery for Endometriosis? Learn why da Vinci Surgery may be your best option for treating endometriosis and its symptoms. The Condition: Endometriosis Endometriosis is a condition in which

More information

Uterine Fibroids. Fact Sheet. The National Women s Health Network

Uterine Fibroids. Fact Sheet. The National Women s Health Network The National Women s Health Network Uterine Fibroids Fact Sheet What are fibroids? Uterine fibroids are the most common, noncancerous tumors in women of childbearing age. Commonly just called fibroids,

More information

Arterial embolisation of uterine fibroids

Arterial embolisation of uterine fibroids Patient information Arterial embolisation of uterine fibroids This is an information sheet explaining why this procedure is performed, what it entails and the benefits and risks. Should you have any other

More information

Global Market for Women s Health Devices to Reach $2.4 Billion by 2021

Global Market for Women s Health Devices to Reach $2.4 Billion by 2021 www.gosreports.com http://www.gosreports.com Global Market for Women s Health Devices to Reach $2.4 Billion by 2021 The global market for women s health devices is forecast to grow from an estimated $1.8

More information

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA)

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) Merat Esfahani, MD Medical Oncologist, Hematologist Cancer Liaison Physician SwedishAmerican Regional Cancer Center

More information

Is it time for a new drug development paradigm?

Is it time for a new drug development paradigm? Is it time for a new drug development paradigm? Robert McDonough, M.D. Senior Director, Clinical Policy Research and Development 1 The Aetna Way Our Cause To make quality health care more affordable and

More information

Physician. Patient HYSTERECTOMY HYSTERECTOMY. Treatment Options Risks and Benefits Experience and Skill

Physician. Patient HYSTERECTOMY HYSTERECTOMY. Treatment Options Risks and Benefits Experience and Skill HYSTERECTOMY Physician Treatment Options Risks and Benefits Experience and Skill Patient Personal Preferences Values and Concerns Lifestyle Choices HYSTERECTOMY Shared Decision Making A process of open

More information

A Guide to Hysteroscopy. Patient Education

A Guide to Hysteroscopy. Patient Education A Guide to Hysteroscopy Patient Education QUESTIONS AND ANSWERS ABOUT HYSTEROSCOPY Your doctor has recommended that you have a procedure called a hysteroscopy. Naturally, you may have questions about

More information

Endometriosis. Information and advice. Page 12 Patient Information

Endometriosis. Information and advice. Page 12 Patient Information Endometriosis Information and advice Page 12 Patient Information Contents page What is Endometriosis?... page 3 Symptoms page 5 Treatments.. page 7 Further information and support.. page 9 Contact us page

More information

The main surgical options for treating early stage cervical cancer are:

The main surgical options for treating early stage cervical cancer are: INFORMATION LEAFLET ON TOTAL LAPAROSCOPIC RADICAL HYSTERECTOMY (TLRH) FOR EARLY STAGE CERVICAL CANCER (TREATING EARLY STAGE CERVICAL CANCER BY RADICAL HYSTERECTOMY THROUGH KEYHOLE SURGERY) Aim of the leaflet

More information

Understanding Endometriosis - Information Pack

Understanding Endometriosis - Information Pack What is endometriosis? Endometriosis (pronounced en- doh mee tree oh sis) is the name given to the condition where cells like the ones in the lining of the womb (uterus) are found elsewhere in the body.

More information

Laparoscopy and Hysteroscopy

Laparoscopy and Hysteroscopy AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Laparoscopy and Hysteroscopy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of

More information

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28)

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) Tracking Information Publication Number Manual Section Number 100-3 190.28 Manual Section Title Tumor Antigen by

More information

da Vinci Hysterectomy Changing the Experience of Surgery Are you a candidate for a breakthrough approach to hysterectomy?

da Vinci Hysterectomy Changing the Experience of Surgery Are you a candidate for a breakthrough approach to hysterectomy? da Vinci Hysterectomy Changing the Experience of Surgery Are you a candidate for a breakthrough approach to hysterectomy? Your doctor may be able to offer you a new, minimally invasive surgical procedure.

More information

The 2015 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2014

The 2015 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2014 The 2015 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2014 ECHN strives to provide access to enhanced cancer care and services in a comfortable environment

More information

Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer

Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer 1 Resource impact The guideline on ovarian cancer (NICE clinical guideline 122) is unlikely to have a significant

More information

DA VINCI ROBOTIC HYSTERECTOMY

DA VINCI ROBOTIC HYSTERECTOMY DA VINCI ROBOTIC HYSTERECTOMY Until recently, surgery for most gynecologic conditions was performed using a large abdominal incision. This is because while conventional laparoscopic surgery is effective

More information