University of Sulimany

College of Nursing
Third Stage 2018-2019
Maternity Department
A.L \ Gona Fars

Cervical Polyp

Prepared by
Bahaddin Saaed
Balen Kamal
Balen Mohamad
Osama Edris
Outline:

 Cervix
 Polyp
 Cervical polyp
 Histopathology of cervical polyps
 Types of cervical poly
 Signs & Symptoms
 Causes and risk factors
 Diagnoses
 Treatment
 Complication
 Prognosis
 Facts
 Recovery & Preventions
 Inflammation of cervix
 Benefit of Removal of Cervical Polyps
 risk of Removal of Cervical Polyps
 Consent
 Procedure
 Recommendation after Procedure
 Reference
 Summary
Cervix

The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus.
Located at the lowermost portion of the uterus, the cervix is composed primarily of
fibromuscular tissue. There are two main portions of the cervix:
The part of the cervix that can be seen from inside the vagina during a gynaecologic
examination is known as the ectocervix. An opening in the centre of the ectocervix,
known as the external os, opens to allow passage between the uterus and vagina.
The endocervix, or endocervical canal, is a tunnel through the cervix, from the
external os into the uterus.

Polyps
Polyps are abnormal fleshy tumours that can arise within hollow organs such as the
large intestine, stomach, urinary bladder and even the nose. Generally, these are
benign but sometimes, as in the case of certain types of colon polyps, they can exhibit
characteristics of malignancy. Typically, they are either flat or bulbous in form,
projecting into the cavity of the organ. Polyps may appear singly, scattered or
clustered together. Often, they develop as a consequence of chronic irritation or
inflammation of the delicate mucosal tissues lining the inside of the organ. Such
abnormal growths are sometimes also seen projecting from the cervix of the uterus.
Cervical Polyps
The cervix is a tube like channel that connects the uterus to the vagina. Such growths
appear like fleshy bulbous structures on stems, appearing singly or in groups of two
or three. They may protrude from the cervical canal or from the ectocervix, the
portion of the cervix that bulges out into the vagina. They may be red or purplish in
appearance with a smooth surface. Cervical polyps are usually not cancerous (benign)
and can occur alone or in groups. Most polyps are small, about 1 centimetre to 2
centimetres long. Because rare types of cancerous conditions can look like polyps, all
polyps should be removed and examined for signs of cancer.

Histopathology of cervical polyps

Histopathological description of cervical polyps are mainly classified as

 Asymptomatic polyps are mainly benign in nature.

 Some polyps can bleed and their nature is benign, but few of them degenerate
 Presence of HPV can change polypectomy at colposcopy
Types of Cervical Polyps
Depending on the specific site of origin, polyps of the uterine cervix may be
classified into two broad categories. The uterine cervix is roughly cylindrical in form
and serves as a sort of vestibule or link between the vagina and the hollow cavity of
the uterus. The lower section of the cervix that bulges into the top of the vaginal canal
is known as the ectocervix and it opens into the vagina through a small aperture
called the external os. This opening is linked to another one facing the inside of the
uterus and known as the internal os. These two openings are linked by a 2-3cm long
stretch called the cervical canal or endocervix.

There are two types of cervical polyps:

1- Ectocervical polyps: originate and grow generally from the cells forming
the outer surface layer of the cervix, ectocervix, and are more common in
post-menopausal women.

2- Endocervical polyps: originate and develop from cervical glands, which

secret mucous, inside the cervical channel. Most cervical polyps are
endocervical polyps and by far are more common in premenstrual women.
Signs & Symptoms
Cervical polyp’s growths are painless which means that they can be undetected for a
long period of time, often show no symptoms. However, some signs as follow:
1 Abnormal vaginal bleeding, especially between periods or spotting.
2 Abnormally heavy bleeding or spotting during menstrual periods
3 Bleeding or spotting after sexual intercourse periods or vaginal douching.
4 Bleeding in postmenstrual women
5 Abnormal discharge from the vagina; white or yellowish in colour which can
be foul-smelling if there is infection
6 Infertility, if a polyp is blocking off the aperture of the cervix.

Causes and risk factors of Polyps

The true cause of the cervical polyps remains unclear and unknown to science. However,
there are a few theories that have been proposed as follow:

1- Chronic irritation and inflammation of the cervix can occur due to untreated sexually
transmitted infections. Also inflammation could also arise as a consequence of
pregnancy or surgical procedures.
2- Sometimes the chemical present spermicide gels, condoms or cervical diaphragms
can irritate the cervix. Over long term, this can induce abnormal alterations in the
cells of cervix.
3- Congestion or clogged of blood vessels in the cervix.
4- An abnormal response to increased levels of the female hormone, estrogen.

The list below outlines some risk factors:

Women who have attained menarche are at risk of developing cervical polyps.
The risk is higher for women who have had multiple pregnancies.
Having a history of cervical polyps; having an untreated sexually transmitted
infection, since this can give rise to cervical inflammation.
Diagnosis
Pelvic examination is essential for finding the polyps; they are visible as red or purple
coloured finger shaped growth on the cervix and may protrude from the cervical
canal.
Checking for malignancy biopsy is taken and small tissue sample is collected from
the polyps for biopsy and send to laboratory. The usual result is polyps are benign in
nature; however, rarely neoplastic tissue or precancerous tissue may be present.
Routine Pap smear test is recommended for patients who are having a history of
previous polyps. Pap smear test provide the information about HPV infection, which
is one of the causes of cervical cancer and can affect any female age. In Pap smear
test small sample of tissue is taken from the cervix by scraping and send to the
laboratory for examination.

The health care provider will see smooth, red or purple, finger like growths on the
cervix. A cervical biopsy will most often show cells that are consistent with a benign
polyp. Rarely there may be abnormal, precancerous, or cancer cells in a polyp.

Treatment
There are often no symptoms and the polyp will only be noticed when a woman
has had a smear test. However, some polyps can cause bleeding after sexual
intercourse, bleeding between periods, bleeding after the menopause, or discharge.

Occasionally, cervical polyps will disconnect from the cervix on their own and can
occur during menstruation or sexual intercourse.
Treatment consists of simple removal of the polyp and prognosis is generally good.
About 1% of cervical polyps will show neoplastic change which may lead to cancer.
They are most common in post-menstrual, pre-menopausal women who have been
pregnant.

Doctors do not routinely remove cervical polyps unless they cause symptoms.
Cervical polyps removed surgically and the health care provider can remove polyps
during a simple, outpatient procedure. The doctor or the registered nurse uses a
special instrument, called polyp forceps, by grasping the base of the polyp stem and
then gently pluck the polyp with gentle twisting motion of a cervical polyp may
remove it, bleeding is usually brief and limited.
However, larger polyps and polyp stems that are very broad may require removal
with electrocautery in operating room using local, regional or general anaesthesia.
Patients may need to stay in hospital overnight.
In some occasions, the patient may feel a brief, mild pain during removal and mild to
moderate cramp for a few hours afterward. And spotting and vaginal bleeding may
occur for one or two days after removal.
Patient may feel mild discomfort similar to period pain afterwards. If you are
uncomfortable, a mild painkiller will be offered to you.

Although most cervical polyps are not cancerous (benign), the removed tissue should
be sent to a laboratory and checked further for reassurance of free from precancerous
cells.

Methods for removing cervical polyps include:-

1- Twisting the polyp off at the base.

2- Tying surgical string around the base of the polyp and cutting it away.
3- Using ring forceps to remove the polyp.

Methods to destroy the base of the polyp include the use of:-

1- Liquid nitrogen
2- Electrocautery ablation, which involve using an electrically heated needle.
3- Laser surgery

Possible Complications
If a woman has cervical polyp, she will not probably be able to feel it or see it, and do
not always cause any noticeable symptoms at all. Therefore, patients may hear of
cervical polyp and discover they have them during routine pelvic examination or
evaluation of bleeding or while getting a Pap smear and this indicate the importance
of routine and regular check-up for the women to reduce the risk of developing
cervical cancer.
So what are some complications to watch out for?

The cervical polyps can become inflamed or infected. In such cases, the patient may
notice a change in her vaginal discharge. Polyps that grow especially large can
actually block the external os. Since it is through this aperture that sperms pass
onward into the uterus and fallopian tube; obstruction of the external os by polyps
can lead to infertility.

Furthermore, most often, cervical cancer is associated with the human papillomavirus
(HPV). This virus can be acquired through unprotected sexual contact and often
causes genital warts. However, only certain high risk strains of the virus are capable
of developing cervical cancer.
It is rare for the cervical polyps to cause serious complications. However, if vaginal
bleeding becomes severe, the significant loss of blood could lead to s hock which
could require emergency hospitalization and blood transfusion. Symptoms of
significant blood loss include light-headedness, rapid heart rate, dizziness, fainting,
pale skin or difficulty in breathing.
Some cervical cancers may first appear as a polyp. There may be bleeding and slight
cramping for a few days after removal of a polyp.

Prognosis

Typically, polyps are not cancerous (benign) and are easy to remove. Polyps do not
usually grow back in the site of origin, but might grow in the future from different areas of
the cervix. Women who have polyps are at risk of growing more polyps. Therefore, regular
pelvic examination required to identify and treat further polyps before they cause
symptoms.

Facts
 Cervical polyps usually occur in about 2 – 5% of females.
 Cervical polyps usually occur in females over 20 years of age who have had
children.
 It is estimated that around 99% of the cervical polyps are benign and have a
size less than 1 cm.
 In most of the cases, females have only one polyp; however, some females
may have two or three polyps.
Recovery and Prevention

Polyp removal is a simple, safe and non-invasive procedure. However, if

you have ever had polyps, you are at high risk of developing them again.
Therefore, getting regular pelvic examination helps ensure finding any
growth early in their development and Pap smear is also helpful. The
alternative is to not remove the polyps; if the patient would prefer not to
have the polyp removed you will be monitored at regular intervals.
Since some infections are linked to cervical polyps, a few simple steps
might help reduce the risk of developing one, so
Wear cotton underwear that allow good air circulation, this prevent excess
heat and moisture, which is the perfect environment for infection.
Practice safe intercourse by using condom during the intercourse if
infection suspected from partner.
Seek treatment if infections are suspected as soon as possible.
Get yourself checked regularly by registered medical practitioner, through
regular pelvic examination.
Predisposing factors
Consume meats and dairy products that contain xenoestrogens (man-made
chemicals that are similar to estrogen).
Eat foodstuff heated in plastic containers as chemical estrogen are released
into the food in this case.
Ignore vaginal spotting between periods, after sexual intercourse, after
menopause, after douching etc. Seek medical attention for it.

Inflammation of the cervix:-

An inflamed cervix appears red, irritated, or eroded. Some of the known causes of cervical
inflammation include:-
 Bacterial infection such as
 Human papilloma virus (HPV) infection, which can also cause warts.
 Herpes
 Yeast infection
  Pregnancy
 Miscarriage
 Abortion
 Hormonal changes

Benefits of cervical polyp removal

 A small percentage of polyps (between 2 and 15 in every 1,000) are abnormal and
may develop into cancer if left untreated.
 Removing the polyp should make symptoms such as bleeding after sexual
intercourse or in between periods return to normal.
 A polyp sometimes makes it difficult to take an adequate smear test, which means
you could be asked to have more frequent smear tests.
 If left untreated, a polyp may continue to grow.

Risks of having the cervical polyp removed

 Bleeding sometimes occurs after the polyp has been removed. A chemical
substance called silver nitrate can be applied to stop any bleeding.
 Some polyps are too large to be removed in the outpatient department; and may
need to be removed in theatre. This would need to be arranged for a future
appointment.
 There is a very small risk of infection following removal of a cervical polyp. An
offensive (bad) smelling discharge is a sign that an infection has occurred. If you
suspect that you have an infection you should either contact the clinic or see a
Physician.

After patient goes home she should not use tampons while bleeding or passing discharge
and sexual intercourse should also be avoided. She can take a bath or shower as normal.
If she feels any discomfort she should take a pain reliever such as paracetamol, following
the instructions on the packet.

If patient has problem or are worried, she can contact her doctor or seek medical advice.

Patient will not have a follow-up appointment and will not routinely be given a follow-up
appointment, but she has any concerns; she will be advised to get the result of the polyp
examination; however, she will be contacted if the polyp is found to be abnormal. The
results will be available within one to two weeks.

Consent required from patient before polyp removal

Involving the patient in decisions about care and treatment is essential. If the patient
decides to go ahead, she will be asked to sign a consent form. This states that you agree
to have the treatment and you understand what it involves. If the patient has further
concerns and would like more information about consent process, she should speak to a
member of staff for further detail.
Procedure to remove the polyp
Cervical polyps are removed with an instrument called polyp forceps. This instrument is
used to grasp the base of the polyp and the polyp is removed with a gentle twisting motion.
Occasionally, if the doctor or nurse cannot see the base of the polyp, a procedure called a
hysteroscopy is performed. This involves passing a small camera through the neck of the
womb to see if the polyp starts in the cervix or in the womb. If bleeding occurs, a caustic
substance called silver nitrate is applied to the area to stop the bleeding.
The polyp is then sent to the laboratory for examination to make sure that the tissue is
normal.

We may suggest an ultrasound scan to check that there are no other polyps within the
womb or to assess where the base of the polyp starts

Recommendation after procedure

We will give you a sanitary towel to wear, as you will have some discharge which can
continue for 7–14 days. If silver nitrate was used, the discharge may be dark brown in
colour for the first few days, and it is particularly important that you do not have sexual
intercourse for at least three days as the chemical can make your partner quite sore.

Reference
• www.webmed.com/cervical-polyps
• www.healthline.com/health/cervical-polyps
• www.nhs.uk
• www.healthgrades.com
• www.drugs.com/health-guide
 Summary
Cervical Polyps
Cervical polyps are finger, bulb, or thin stem, growths on the cervical canal, the passage
that connects the uterus to the vagina. They’re often reddish, purplish, or greyish in colour.
They can range in size from a few millimetres to several centimetres long.

Depending on the specific site of origin, polyps are classified into two categories:
1- Ectocervical polyps: originate and grow generally from the cells forming the
outer surface layer of the cervix, ectocervix, and are more common in post-
menopausal women.
2- Endocervical polyps: originate and develop from cervical glands, which secret
mucous, inside the cervical channel. Most cervical polyps are endocervical polyps
and by far are more common in premenstrual women.
Facts
 Cervical polyps usually occur in about 2 – 5% of females.
 Cervical polyps usually occur in females over 20 years of age who have had
children.
 It is estimated that around 99% of the cervical polyps are benign and have a
size less than 1- 2 cm.
 In most of the cases, females have only one polyp; however, some females
may have two or three polyps.
Signs and symptoms of cervical polyps
Cervical polyp’s growths are painless which means that they can be undetected for a
long period of time, often show no symptoms. However, some signs as follow:
1- Abnormal vaginal bleeding, especially between periods or spotting.
2- Abnormally heavy bleeding or spotting during menstrual periods
3- Bleeding or spotting after sexual intercourse periods or vaginal douching.
4- Bleeding in postmenstrual women
5- Abnormal discharge from the vagina; white or yellowish in colour which can be
foul-smelling if there is infection
6- Infertility, if a polyp is blocking off the aperture of the cervix.

Treatment
Cervical polyps are removed surgically, usually in a doctor's office. A special
instrument, called a polyp forceps for polyps which are small using local, regional
anaesthesia or large polyps and polyp stems that are very broad usually need to be
removed in an operating room under general anaesthesia. The polyp or polyps are
sent to a laboratory for examination to rule out precancerous or cancerous cells.