A Rare Case of Bleeding From A Cancerous Uterine Polyp
M, 68, was taken aback one morning when she discovered slight staining on her underwear after passing urine. Three days later, she noticed some spotting again after peeing.
She alerted her husband who brought her to see a urologist. A thorough urological investigation was carried out and included urine culture, ultrasound examination of the kidneys and cystoscopy (examination of the bladder using a telescope). The tests were found to be normal. She was then referred to me to exclude the source of bleeding from the genital organs.
M was obese with a medical history of high blood pressure and diabetes. She had menopause 15 years ago. She denied any recent trauma to the vagina and did not have sexual intercourse for years. Vaginal examination using a speculum did not reveal any bleeding from the cervix and vaginal wall. Pelvic ultrasound examination showed that the uterus and ovaries were small and atrophic. There was no pelvic mass. She was advised to have a hysteroscopy, a minor procedure in which a slender telescope was inserted into the uterine cavity to check for abnormality in the uterine lining. This was carried out and a uterine polyp about 1.5cm in size was removed. Microscopic examination of the polyp revealed that it was a cancerous growth.
Cancerous uterine polyp
Uterine polyps or endometrial polyps, are small, soft growths that are attached to the inner wall of the uterus. They come from the tissue that lines the uterus, called the endometrium. (refer “Endometrial Polyp” in this website).
It is rare for uterine polyps to be cancerous. According to various research studies, of those polyps that present with symptoms such as irregular bleeding, 10% to 25% may contain cells that are overactive (hyperplasia) and about 1 to 10 % may undergo malignant changes.
Risks factors of cancerous uterine polyp
There is no consensus among researchers on the exact risk factors that are associated with malignant transformation of polyps. But most workers agree that the risk of malignancy is increased with:
Age: The older the patient, the higher the risk.
Menopausal status: Cancerous uterine polyp is about 1-2 % in pre-menopausal women. The risk increases 3-4 folds after menopause.
Symptoms: Women with symptoms run a higher risk of malignancy than those without symptoms.
Size of the polyp: The larger the size of the polyp, the higher the risk. Some researchers have identified that polyps measuring more than 1.0 cm are associated with malignancy.
Other factors such as obesity, diabetes, hypertension, and use of tamoxifen(anti-breast cancer drug) are found to be less predictive.
Management of cancerous uterine polyp
Removing the polyp by hysteroscopy is the mainstay of evaluation and management of endometrial polyps as the procedure is relatively simple with very minimal risk. It allows visualization of the entire uterine cavity and complete removal of the polyp. If malignancy is found within the polyp, further assessment and surgery should be done.
Fortunately, M’s cancerous growth was localized in the polyp with no further spread to the uterine lining. She was advised to have the uterus, tubes and ovaries removed. This was done via keyhole surgery. Post-operative recovery was well and she was discharged from the hospital after 2 days.