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A - MSRA Gynaecology [8] > [38] Cervical Polyps > Flashcards

[38] Cervical Polyps Flashcards

1
Q

What are cervical polyps?

A

Benign growths protruding from the inner surface of the cervix

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2
Q

Why are cervical polyps clinically significant?

A

A very small minority can undergo malignant change

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3
Q

What is the prevalence fo cervical polyps/

A

Estimated 2-5% of women

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4
Q

What do cervical polyps develop as a result of?

A

As a result of focal hyperplasia of the columnar epithelium of the endocervix

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5
Q

What causes cervical polyps?

A

The aetiology is unclear, but suggested causes are;

  • Chronic inflammation
  • Abnormal response to oestrogen
  • Localised congestion of cervical vasculature
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6
Q

Who are cervical polyps more common in?

A

Multigravidae

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7
Q

At what age is the peak incidence of cervical polyps?

A

50-60 years of age

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8
Q

What is the most common presenting of cervical polyps?

A

Most often asymptomatic, identified only via routine cervical screening

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9
Q

If symptomatic, what is the most common clinical feature of cervical polyps?

A

Abnormal vaginal bleeding

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10
Q

What forms can the abnormal vaginal bleeding take in cervical polyps?

A
  • Menorrhagia

- Intermenstrual, post-coital, or post-menopausal bleeding

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11
Q

What are the less common presentations of cervical polyps?

A
  • Increased vaginal discharge

- Infertility

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12
Q

How can cervical polyps cause infertility?

A

If they grow large enough to block the cervical canal

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13
Q

What is found on speculum examination in cervical polyps?

A

Usually visible as polypoid growths projecting through the external os

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14
Q

What are the other causes of abnormal vaginal bleeding?

A
  • Cervical ectropion
  • Cancer
  • STIs
  • Fibroids
  • Endometritis
  • Pregnancy related bleeding
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15
Q

What is an important differential to exclude in cervical polyps in post-menopausal women?

A

Endometrial carcinoma

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16
Q

What is an alternative diagnosis if a polypoid lesion has be visualised within the cervix?

A

Endometrial polyp, which could be projecting through the cervical canal

17
Q

How is the definitive diagnosis of cervical polyps made?

A

Histological examination after its removal

18
Q

What is the main role of investigations in suspected cervical polyps?

A

To rule out differentials

19
Q

What investigations may be done to rule out differentials in cervical polyps?

A
  • Triple swabs

- Cervical smear

20
Q

Why can cervical smear be difficult in cervical polyps?

A

Sometimes the polyp can prevent the smear being taken, in which case the smear should be repeated after the polyp has been removed

21
Q

What % of women with cervical polyps have associated endometrial polyps?

A

27%

22
Q

What should be done if symptoms of bleeding persist after the removal of the cervical polyp?

A

Ultrasound scan should be arranged to assess endometrial cavity

23
Q

What is the risk of malignant transformation of cervical polyps?

A

Less than 0.5%

24
Q

What is the result of the risk of malignant transformation of cervical polyps?

A

It is common practice to remove them when they are identified, even if asymptomatic

25
Q

When can cervical polyps be removed in a primary care setting?

A

If small

26
Q

How are small cervical polyps removed in a primary care setting?

A

The polyp is grasped with polypectomy forceps. and twisted several times. The polyp is avulsed as the pedicle becomes twisted

27
Q

Should you pull the cervical polyp when removing it with polypectomy forceps?

A

No, as this will result in more bleeding

28
Q

What should be done if there is any bleeding when removing small polyps in primary care?

A

Should be cauterised with silver nitrate

29
Q

When will cervical polyps need to be removed in a colposcopy clinic?

A

Larger polyps, or those that are more difficult to access

30
Q

How are cervical polyps removed in a colposcopy clinic?

A

Diathermy loop excision

31
Q

When should cervical polyps be removed under general anaesthetic?

A

If the base of the polyp is broad

32
Q

What should be done with all excised cervical polyps?

A

They should be sent for histological examination to exclude malignant

33
Q

What is the recurrence rate of cervical polyps?

A

6-12%

34
Q

What are the complications of polypectomy?

A
  • Infection
  • Haemorrhage
  • Uterine perforation (very rare)
35
Q

How is the risk of uterine perforation caused by polypectomy reduced?

A

Only polyps that are visible easily should be removed in the outpatient setting

A - MSRA Gynaecology [8] (52 decks)

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