Cervical Polyps

 

Cervical polyps are the most common benign neoplasms of the cervix and are often coincidental findings during cervical screening.  Polyps tend to occur as single, smooth grey-white lesions that may also present with abnormal bleeding (such as during intercourse, heavy menstrual periods, between menstrual periods or after the menopause).  Occasionally, they may grow big enough to obstruct the external os and so cause infertility. Malignancy is rare (less than 1 in 200 cases) and the malignancy tends to arise from sources beyond the cervix

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Exclude Red Flag Symptoms

Refer on an urgent 2ww pathway if either of the following are seen:

  • Fungating growth on cervix or
  • any other signs suspicious for cervical cancer

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Primary Care Management

Cervical polyps up to 2cm long by 1cm wide are suitable for primary care management

  • All symptomatic polyps should be removed
  • For asymptomatic polyps, offer the choice of removal but it is preferable to remove as the polyp is likely to continue to grow

NOTE:  Surgical dilatation and curettage, electrosurgical excision or hysteroscopic polypectomy may be performed for more persistent lesions

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Technique for removal of a cervical polyp:

  1. Obtain consent - removal of polyps is similar to taking a cervical smear test
  2. The polyp should be grasped at the base with sponge-holding forceps and twisted several times. The polyp can now be pulled upon and avulsed
  3. Send polyp for histology and advise patient when she will learn results
  4. Patient should be warned to expect some vaginal bleeding for up to 24 hours
  5. If histology results show it is a normal benign cervical polyp - no further action is required
  6. If histology results show the polyp is of endometrial origin - a pelvic USS should be ordered to rule out other lesions

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When to refer

Refer to secondary care if:

  • suspected prolapsed endometrial polyp (base of polyp not visible)
  • large polyp >1cm wide or 2cm long
  • unable to remove in primary care due to significant discomfort or other difficulty

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Information to include in referral letter

Include the following information when making a referral:

  • Presence of wide based polyp or suspected endometrial polyp
  • Any current hormonal treatment
  • Smear history
  • Relevant PMH
  • Current drug history and allergies
  • Cervical smear history and results
  • Pelvic USS result if endometrial polyps suspected

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Ultrasound

For ultrasonography investigations you refer a patient to one of the following acute or community ultrasound providers (find details here)

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

Have a question or query?

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