What is the Size of a Gynecological Grapefruit?

 

Both the descriptions of their fibroids that women get from their doctors, and the terminology used in medical discussions about treatment decisions concerning fibroids, are typically vague, and often strange; usually expressed in weeks of pregnancy, or in units of fruit, or often even units of sports equipment.   

For example:

I have a cyst the size of a grapefruit on my right ovary.

Dr. Glassner removed 16 fibroids, the biggest of them was the size of a football.  I was told last Friday to schedule a subtotal hysterectomy for fibroids. I'm 45 and have had moderate size ones for a few years now. But it has now grown from a large apple size in July '07 to a "casaba melon" size in just six months,

I was bleeding due to the fibroid tumor. He told me it had grown to the size of a grapefruit. He suggested, when I was ready, to have a hysterectomy

I was diagnosed with “a grossly enlarged uterus” and a fibroid the size of a grapefruit.

Another woman had three tumors in the female organs while pregnant. One was the size of a grapefruit, and two were the size of oranges.

"A common criterion suggests that the size of a three-month pregnancy (equivalent to a grapefruit) is probably the largest your pelvis can accomodate without danger or discomfort.   When a fibroid grows to the size of a four month pregnancy (a cantaloupe), it may start pressing sigificanlty on other organs.   Usually at that point the woman is aware of its presence and may be quite uncomfortable.

"Physcians begin to differ in opinion when the mass reaches the size of a grapefruit.  My position is that anything larger than a cantaloupe, or four month pregancy, should come out.  It is difficult to believe that any woman can be comfortable with a mass the size fo a five month pregancy (or a honeydew melon) in her belly; She may have gotten used to the feeling and be able to put up with it, but it can't be comforable.   Teh more serious issue is that at this size the mass may well be compromising her ureters, the tubes from the bladder to the kidney."   

"Opinion on the size fibroid that must be removed surgically varies from gynecologist to gynecologist.  Some physicians say you should have a hysterectomy if you have a fibroid the size of a two month pregnancy; but since there is plenty of space in teh plevis for a mass the size of a tennis ball or even a small grapefruit, you probably don't have to have surgery for a fibroid this size unles you have significant discomfort.  If your physician tells you that you have a mass the size of a two month pregnancy and that you should have a hysterectomy, you should get a second opinion."

(A Woman's Guide To Menopause And Perimenopause - Google Books Resultby Mary Jane Minkin, Carol V. Wright - 2005 - Health & Fitness - 413 pages)

A normal uterus is about the size of a pear, or an orange. A fibroid uterus, however, will often measure much larger, for example the size of a large grapefruit, a soccer ball, or even a watermelon.

second surgery was due to the excruciating pain and pressure from a fibroid the size of a softball which also involved a vaginal hysterectomy.

It all started years ago with one small and harmless fibroid, or benign tumor, discovered during a regular exam. "Lots of women have fibroids," often the size of grapes, my gynecologist assured me. "Yours is the size of a plum -- no big deal. We'll just watch it over time."   Except that the plum, over time, grew into an orange, then a grapefruit, a cantaloupe, and eventually, a honeydew melon. Last year, my gynecologist took off the (latex) gloves. "Your uterus is now the size of a 16-week pregnancy," she said. "It's time for a hysterectomy."

How do you make intelligent decisions about treatment with descriptions like this?!   One instantly realizes that it simply is not possible to know what measurements an apple, an orange, a grapefruit, or a soccer ball is referring to.    

The lumps of plaster of paris in the middle are incorrect scale models of my uterus and fibroids.   The radiologist's report was vague about what tumors were included in the measurements of the uterus, and the three smaller fibroids were inside the uterus while the largest one is hanging off the top front.   The cracked portion of the uterus on top under the fibroid most likely does not exist, but it was not possible to be sure.   As you can see, the bigger fibroid is sized somewhere between an unobtrusive orange and a more problematic grapefruit, depending on exactly how large are an orange and a grapefruit..   A normal unterus is pear sized and shaped like a pear - well, just a little smaller in both dimensions than this particular pear.

I have images from ultrasounds and a CT scan of these fibroids at my webshots album.   The images of individual fibroids above and below are the correct dimensions, though the smallest ones may be a bit too small, and I will take new photos when I am able to get the rest of the information on the uterus.   The uterus actually looks nothing like the model above; it is pretty much 3-lobed all the way through.   It is also a good deal larger than I'd been led to believe.   My doctor says about a 14 or 15 week pregnancy; maybe if it's a big baby.   I don't believe he actually checked my abdomen, just did a vaginal and hysteroscopic exam.

 

Jan 2008 Ultrasound (Click to view at Webshots) Image hosted by Webshots.com
by villandra

 

Dec 2005 Ultrasound (Click to view at Webshots) Image hosted by Webshots.com
by villandra

 

2004 CT Scan (Click to view at Webshots)

Image hosted by Webshots.com
by villandra

 

Here is a photo of the bigger fibroid among the similar sized fruit.   Notice that depending on one's measurements, that big fibroid could be described as an apple.   When I saw him two years ago, and the big fibroid was two cm smaller in each direction, measuring 6 x 5 x 4.9, my gynecologist told me it was four cm, and that the other two that were visible at that time, one of which was 5 x 5 x 4 cm, were also 4 cm.   And also that I need a total hysterectomy because the fibroids were too big to do anything else, which didn't make a lick of sense.   Now, you have to watch out for these ob/gyn's; they're very what a former housemate would call sideways.    It was quite haughtily explained to me on the fibroid list by the woman who thought I should just take care of my stress, that the doctor did not lie.   It is standard practice to measure the fibroid by it's smallest dimension, and then drop whatever is after the decimal place - and then recommend a total hysterectomy for the third or half sized fibroid the woman is being told she has.   Yup.  Where I'm from, that's called a "deceptive practice", but then I'm from that other planet called Earth

.    

The European Union has made the same observations.   It is in the middle of passing legislation that, while not doing away with the ridiculous terminology, requires doctors who describe tumors in units of fruit to conform to standard definitions of what the units of fruit mean.  

From http://www.therockalltimes.co.uk/2002/02/11/eu-standard.pub.html:

European Union cracks down on measurement of tumors in units of fruit

"People will insist on saying that, for instance, 'when they opened him up, they found a tumour the size of an grapefruit'", noted one expert. "This is said with a cavalier disregard for the actual mean circumference of a grapefruit grown in normal conditions and during a climatically-average season. The figure is, in fact, 11.2cm. Any tumour less than that will have be described as 'slightly smaller than a standard grapefruit'. Growths between 4cm and 8cm may be described as smaller, equal to, or greater than a free-range egg (medium). Between 8 and 10cm, a melanoma is said to be 'the size of a very small grapefruit', and so on."

I also found on various forums, numerous women asking exactly the same question, and never getting the answer.

After ALOT of research, and also aggravation from the NUFF web site's fibroid support list, where I remarkably got told to quit worrying about such details and take care of my stress,  because there is a reason why women weren't meant to have our radiology reports (actually, there is a reason why the law allows us copies of all test results), I was able to learn the following, which I present for the benefit of other harassed women.

Units of (usually) Uterine Measurement

Pregnancy reference

Pelvic ht

Length reference

Fruit reference

Sports reference

Inches

Cm

Weight

Uterine volume

8 weeks

             

200 cu cm

20 weeks

             

600 cu cm

24 weeks

             

750 cu cm

NORMAL

   

Small pear

Tennis ball (2 ½ in or hockey puck (3 in)

3 in

7.5 cm

8 oz

 

NORMAL

   

Pear

   

8 – 10 cm x 6 cm diameter

   

NORMAL

   

Orange

         
     

Apple seed

 

¼ in (tumor size)

     

10 weeks

   

Orange

Baseball (9 in circumf)

3.5 in

9 cm

12 oz

 

     

Small Grapefruit – EU Standard

   

8-10 cm (tumor size)

   
     

Grapefruit

   

10 cm

   

12 weeks

Pubic bone

 

Grapefruit

Softball (12 in circumf)

4.5 in

11.5 cm

1-2 lb

300 cu cm

12 weeks

Just above bladder

             

12 weeks

   

Grapefruit

         
     

Grapefruit – EU Standard

   

11.5 (tumor size)

   
     

Cantaloupe

   

12 cm (tumor size)

   

13 weeks

 

12.5 cm

 

   

12.5 cm

   

“16 week pregnancy”

         

12 cm – tumor size

   

16 weeks

4 finger breadths above pelvic bone

 

Melon

 

6.3 in

16 cm

3-5 lb

450 cu cm

16 weeks

   

Cantaloupe

         
     

Good sized cantaloupe

   

17cm x 11 cm x 11 cm

   

20 weeks

             

600 cu cm

20 weeks

   

Honeydew melon

     

 

 

22 weeks

At naval

 

Pineapple

Soccer ball (8 ½ in)

8.7 in

22 cm

8 – 12 lb

 

     

Cantaloupe

   

> 25 cm (tumor size)

 

 

24 weeks

             

750 cu cm

28 weeks

3 fingerbreadths above naval

 

Pumpkin

Football (10 ¼? In)

11 in

28 cm

17.5 – 25 lb

 

                 

 

Ultrasound length of uterus (cm) = 3.68 + 0.68 x no weeks (pregnancy equiv); 12.5 on ultrasound = 13 weeks of pregnancy (Bill Parker, MD, fibroids list)

Fibroid size; gynecologists take the smallest dimension, and drop the figures after the decimal.   Ie 4.3 x 3.1 x 2.1 fibroid is a 2 cm fibroid.   

Size descriptions may refer to the uterus with the fibroids, or may refer to the fibroids.  (What Your Doctor May Not Tell you About Fibroids)

 

Just so people know, most large fibroids weigh 2 to 3 pounds.

 

I learned from the head radiologist of the outfit that read the scans, as well as experience, that ultrasound cannot measure accurately.   Transvaginal and transabdominal scans get different measurements, and all measurements were consistently a good deal smaller than the earlier CT scan, which, I was told, presents accurate dimensions.  

Also, not only can fibroids themselves be expressed in very strange measurements, but there apparently is no system to how the uterus is measured, when it is measured in actual centimeters, with a ruler.    Allegedly it is measured including the fibroids unless it says otherwise.    One of my reports specified that the uterus was measured without the fibroids, and, when you compare those dimensions (10 cm long x 6.5 cm wide x 4.5 cm deep) with the transverse images from the CT scan taken a year and a half earlier, which clearly show a roughly triangular lobed uterus about 13 cm across and atleast 10 cm deep, this becomes hilarious.   Now, on the Jan 08 scan, the radiologist whose answer to my questions as given her by her administrator was to throw them in the recycling bin, measured the thickness of the uterus through the middle of the uterus, in which there are no fibroids, to yet again describe it as 6.5 cm thick; and she measured the width of the triangular lobed uterus that is really 13 cm across, using midpoints of two of the legs of the triangle, to come up with something like 8 cm, which is outright deceptive.   Also, the fibroids are intruding on the bladder, adn though this was shown to me during the exam, the radiologist never mentioned it, nor did my doctor receive any images before I sent them to him.   

 

Calculation is by size in weeks for gynecological nonpregnant uterus; based on fundal location of enlarged pregnant uterus.  

However, gynecological uterus may not have a commensurate rate of increase of the tranverse and anterior-posterior (A) dimensions to that of a pregnant uterus, even though the uterine fundus may be at the corresponding level.

For instance, the uterus at 12 weeks by fundal height may have a transverse dimension of 8 weeks and AP dimension of 16 weeks, not 12 weeks.  

These authors use uterine volume instead.    Their system:

 

< 12 weeks; uterine volume increases 100 cm every 4 weeks

> 12 weeks; uterine volume increases 150 cm every 4 weeks to 24 weeks.

Can vary; from 50 to 150 until 16 weeks; varies more after that.  (From book Vaginal Hysterectomy,

 

 From Vaginal Hysterectomy by Shirish S. Sheth and John Studd, p 18 (Google Books result, 2001 edition)

The source on the different references for uterine size:  What Your Doctor May Not Tell You About Fibroids.  

 

My uterus: 

Uterine size plus external fibroid, if I read the report correctly

Volume = 4/3 * pi * ½ (length) * ½(depth) * ½(width)

Uterus = either 4.19 * 3.25 * 4.5 * 6.26, or 4.9 * 3.25 * 4.5 * 4, = 375 or 245.

External fibroid = 4.19 * 4.7 * 3.7 * 3.7 = 270

Total uterine volume = 645 cu cm or 515 cu cm

 

Size chart for vaginal hysterectomy:

Uterine volume.

< 100 cm          easy

101 – 200         easy

201 – 400        needs expertise

300 – 350        needs debulking

401 – 500        tentative or trial VH; needs debulking, consider laparoscopic assistance.

700 – 900        sometimes.

 

http://www.obgyn.net/hysterectomy-resource-center/display.asp?page=Kivnick-Yera_laparoscopic_supracervical_hysterectomy_wm

Seth Kivnick MD and Ramon Yera MD, Kaiser-Permanente, West Los Angeles perform a Laparoscopic Supracervical Hysterectomy on a 26 week uterus using the Gyrus ACMI PKS Cutting Forceps, PKS Lyons™ Dissecting Forceps, and PKS Needle. Dr. Kivnick gives valuable narration on how they are able to accomplish this LSH on an abnormally large uterus.

"A common criterion suggests that the size of a three-month pregnancy (equivalent to a grapefruit) is probably the largest your pelvis can accomodate without danger or discomfort.   When a fibroid grows to the size of a four month pregnancy (a cantaloupe), it may start pressing sigificanlty on other organs.   Usually at that point the woman is aware of its presence and may be quite uncomfortable.

"Physcians begin to differ in opinion when the mass reaches the size of a grapefruit.  My position is that anything larger than a cantaloupe, or four month pregancy, should come out.  It is difficult to believe that any woman can be comfortable with a mass the size fo a five month pregancy (or a honeydew melon) in her belly; She may have gotten used to the feeling and be able to put up with it, but it can't be comforable.   Teh more seriuos issue is that at this size the mass may well be compromising her ureters, the tubes from the bladder to the kidney."  

"Opinion on the size fibroid tha tmust be removed surgically varies from gynecologist to gynecologist.  Some physicians say you should have a hysterectomy if you have a fibroid the size of a two month pregnancy; but since there is plnety of space in teh plevis for a mass the size of a tennis ball or even a small grapefruit, you probably don't have to have surgery for a fibroid this size unles you have significant discomfort.  If your physician tells you that you have a mass the size of a two month pregnancy and that you should have a hysterectomy, you should get a second opinion."

(A Woman's Guide To Menopause And Perimenopause - Google Books Result

by Mary Jane Minkin, Carol V. Wright - 2005 - Health & Fitness - 413 pages