[38] Cervical Polyps Flashcards
What are cervical polyps?
Benign growths protruding from the inner surface of the cervix
Why are cervical polyps clinically significant?
A very small minority can undergo malignant change
What is the prevalence fo cervical polyps/
Estimated 2-5% of women
What do cervical polyps develop as a result of?
As a result of focal hyperplasia of the columnar epithelium of the endocervix
What causes cervical polyps?
The aetiology is unclear, but suggested causes are;
- Chronic inflammation
- Abnormal response to oestrogen
- Localised congestion of cervical vasculature
Who are cervical polyps more common in?
Multigravidae
At what age is the peak incidence of cervical polyps?
50-60 years of age
What is the most common presenting of cervical polyps?
Most often asymptomatic, identified only via routine cervical screening
If symptomatic, what is the most common clinical feature of cervical polyps?
Abnormal vaginal bleeding
What forms can the abnormal vaginal bleeding take in cervical polyps?
- Menorrhagia
- Intermenstrual, post-coital, or post-menopausal bleeding
What are the less common presentations of cervical polyps?
- Increased vaginal discharge
- Infertility
How can cervical polyps cause infertility?
If they grow large enough to block the cervical canal
What is found on speculum examination in cervical polyps?
Usually visible as polypoid growths projecting through the external os
What are the other causes of abnormal vaginal bleeding?
- Cervical ectropion
- Cancer
- STIs
- Fibroids
- Endometritis
- Pregnancy related bleeding
What is an important differential to exclude in cervical polyps in post-menopausal women?
Endometrial carcinoma
What is an alternative diagnosis if a polypoid lesion has be visualised within the cervix?
Endometrial polyp, which could be projecting through the cervical canal
How is the definitive diagnosis of cervical polyps made?
Histological examination after its removal
What is the main role of investigations in suspected cervical polyps?
To rule out differentials
What investigations may be done to rule out differentials in cervical polyps?
- Triple swabs
- Cervical smear
Why can cervical smear be difficult in cervical polyps?
Sometimes the polyp can prevent the smear being taken, in which case the smear should be repeated after the polyp has been removed
What % of women with cervical polyps have associated endometrial polyps?
27%
What should be done if symptoms of bleeding persist after the removal of the cervical polyp?
Ultrasound scan should be arranged to assess endometrial cavity
What is the risk of malignant transformation of cervical polyps?
Less than 0.5%
What is the result of the risk of malignant transformation of cervical polyps?
It is common practice to remove them when they are identified, even if asymptomatic
When can cervical polyps be removed in a primary care setting?
If small
How are small cervical polyps removed in a primary care setting?
The polyp is grasped with polypectomy forceps. and twisted several times. The polyp is avulsed as the pedicle becomes twisted
Should you pull the cervical polyp when removing it with polypectomy forceps?
No, as this will result in more bleeding
What should be done if there is any bleeding when removing small polyps in primary care?
Should be cauterised with silver nitrate
When will cervical polyps need to be removed in a colposcopy clinic?
Larger polyps, or those that are more difficult to access
How are cervical polyps removed in a colposcopy clinic?
Diathermy loop excision
When should cervical polyps be removed under general anaesthetic?
If the base of the polyp is broad
What should be done with all excised cervical polyps?
They should be sent for histological examination to exclude malignant
What is the recurrence rate of cervical polyps?
6-12%
What are the complications of polypectomy?
- Infection
- Haemorrhage
- Uterine perforation (very rare)
How is the risk of uterine perforation caused by polypectomy reduced?
Only polyps that are visible easily should be removed in the outpatient setting
