Polyps Flashcards
What are endometrial polyps (EPs)?
Endometrial polyps are localised outgrowths from the surface of the endometrium. They are usually benign lesions but have been implicated in subfertility, as removal of these polyps improve rates of pregnancy and reduce pregnancy loss!
Epidemiology of endometrial polyps:
What age group of patients are most commonly affected by endometrial polyps?
Endometrial polyps can affect any age from the early reproductive years through to the postmenopausal period
What are the clinical features of endometrial polyps?
Presentations:
- Mostly asymptomatic - hence often detected during Ix for abnormal uterine bleeding and infertility
- However, in those that are symptomatic:
- Abnormal uterine bleeding - intermenstrual bleeding, heavy menstrual bleeding (menorrhagia), or postmenopausal bleeding
- Occasionally, protrusion of the polyp through the cervix may cause post-coital bleeding
- Maybe difficult to distinguish a protruded endometrial polyp from an endocervical polyp
- During menstruation, contraction of the uterus in an attempt to expel the polyp may cause colickly, dysmenorrhoeic pain
- Subfertility/ infertility
Ix for endometrial polyps?
Ix:
- 1st line - Transvaginal USS
- EPs are most easily detected in the secretory phase of the menstrual cycle when glands in the polyp become most prominent and stand out in contrast to the normal surrouding secretory endometrium
- If an endometrial polyp is suspected clinically or on transvaginal USS –> confirm the diagnosis by doing a transvaginal sonohysterography and/or inpatient hysteroscopy with excisional biopsy - the polyp is then sent to the lab for histological analysis to exclude malignancy
- Endometrial polyp carries a small risk of malignancy
How do you treat endometrial polyps?
Mx:
- Small (= 1 cm) asymptomatic endometrial polyps resolve spontaneously –> watchful waiting
-
In women suffering from bleeding symptoms or infertility –> surgical excision
- Involves using a dilator to widen the cervix and removing the polyp by performing curettage under hysteroscopic guidance
- With modern equipment, this can often be done without anaesthesia or with injection of local anaesthetic into the cervix
- Involves using a dilator to widen the cervix and removing the polyp by performing curettage under hysteroscopic guidance
Cervical polyps are benign growths protruding from the inner surface of the cervix.
What are the possible causes of cervical polyps?
The cause is unknown but it’s due to focal hyperplasia of the simple columnar epithelium of the endocervix
Suggested causes are:
- Chronic inflammation
- Abnormal response to oestrogen (cervical polyps are associated with endometrial hyperplasia)
- Localised congestion of cervical vasculature
What epithelial cell type is the endocervix?
Simple columnar epithelium
Give 2 complications of endometrial polyp
Subfertility/ Infertility
Endometrial cancer
Epidemiology of cervical polyps:
a) . Affect what age group more?
b) . Give one risk factor for cervical polyp
a). Affects postmenopausal women more
(*remember that cervical polyps are associated with endometrial hyperplasia which is caused by prolonged/ increased exposure to unopposed oestrogen, so more common in postmenopausal women)
b). Multigravidae (pregnant more than once)
What are the clinical features of cervical polyps?
Presentations:
- Mostly asymptomatic - hence most are diagnosed on routine cervical screening
- However, in those that are symptomatic:
- Abnormal vaginal bleeding - intermenstrual bleeding, menorrhagia, postmenopausal bleeding, post-coital bleeding
- Increased vaginal discharge
- Rarely, they grow large enough to block the cervical canal –> infertility
- Signs
- On cervical speculum examination, they are often visible as polypoid growths projecting through the external os
Give 3 differential diagnoses of cervical polyp
Cervical ectropion
Cervical cancer
Endometrial polyp (it can prolapse through the cervix)
Endometrial cancer (must rule out!)
Uterine fibroids
STIs
What cancer must you RULE OUT in a woman with postmenopausal bleeding?
Endometrial cancer
Ix for cervical polyp?
Ix:
- The definitive diagnosis for a cervical polyp is histological analysis after its removal
- Therefore, other Ix are to exclude alternative causes of symptoms:
-
Triple swabs - if suspected of STIs e.g. purulent discharge
- Consisting of:
- NAAT swab (endocervical or vulvovaginal)
- High-vaginal charcoal media swab
- Endocervical charcoal media swab
- Consisting of:
- Cervical smears (sampling of tissues from the cervix) to rule out cervical intraepithelial neoplasia (CIN) which is a precancerous condition that can progress to cervical cancer
-
Triple swabs - if suspected of STIs e.g. purulent discharge
- Note that 30% of women with cervical polyps also have endometrial polyps, esp in the postmenopausal age group. Therefore, if symptoms of bleeding persist after removal of the cervical polyp –> arrange transvaginal USS to assess the endometrial cavity for endometrial polyps
How do you manage cervical polyp?
Mx:
- Cervical polyps have a small risk of malignant transformation, so treatment is usually removal of the polyps with a polypectomy forceps, which can be done in a primary care setting. The sample is then sent to the lab for histological analysis to exclude malignancy
- The polyp is grasped with the forceps and twisted several times until the polyp is avulsed (the polyp should not be pulled off as it will cause more bleeding!)
- Any bleed can be cauterised with silver nitrate (just like epistaxis lmao)
- Anaesthesia is often NOT needed
- The polyp is grasped with the forceps and twisted several times until the polyp is avulsed (the polyp should not be pulled off as it will cause more bleeding!)
- For larger polyps –> diathermy loop excision (performed in the colposcopy clinic)
What are the complications of cervical polyps?
Cervical cancer
Infertility (rare)
