Malignant Uterine Polyps: Diagnosis, Treatment & Prognosis
What are Uterine Polyps?
Uterine polyps are abnormal new growths in the inner ling of the uterus, which is also called the endometrium. They may have a flat base or a stalk connecting them to the uterine wall. Sizes may vary from a few millimeters to several centimeters.
Most polyps in the uterus are benign and they are usually found in 24% of women between the ages of 40-50. Although the exact cause of these new growths is unknown, several factors are associated with their development such as:
- Hormonal imbalance – an increase in estrogen levels is favorable to the development of endometrial growths.
- Using estrogen for treatment of menopausal symptoms
- Use of tamoxifen in women with breast cancer
- High blood pressure
- Increasing age
Studies show that about 0.5 to 1.5 percent of uterine polyps are malignant. Aside from those mentioned above, some factors that are associated with malignant uterine polyps are:
- High fat diet
- Family history of polyps and cancer
- Ovarian or breast cancer, polycystic ovarian syndrome
- Previous pelvic radiation therapy
- Women who had their menstruation very early in life and had a late menopause
The common symptoms of uterine polyps are unusual bleeding between menstrual periods, unusually heavy menstrual bleeding, long menstrual periods and vaginal bleeding after menopause. Some women have no symptoms, while some experience infertility.
Complications include infertility, miscarriage and anemia due to bleeding. Malignant polyps can likewise spread and recur, and can be life threatening if left untreated.
Diagnosis, Treatment and Prognosis
A woman usually consults a doctor for unusual vaginal or uterine bleeding. History, physical examination and laboratory examinations are done, including transvaginal ultrasound and hysterosonography which produce images from sound waves introduced in the uterus.
Hysteroscopy is a useful procedure, and it involves inserting a scope to the uterus, providing direct visualization of the tumors. A sample specimen may then be taken by getting a small sample or biopsy, or curettage may be done, where areas of the uterine wall are scraped by a long instrument. This tissue sample is then sent to the laboratory for analysis. Whether a polyp is benign or malignant, the type of cells present can then be determined.
Other tests are done to evaluate the extent of the malignancy, especially if the tumor is large and the patient has other symptoms like weight loss, abdominal pain, and general body symptoms. CT scan, MRI, blood tests and other imaging tests may be done to inspect for spread of the cancer cells and assess the stage of the disease.
The treatment of endometrial cancer involves surgical removal of the uterus and the cervix, or a hysterectomy. It may be done with an incision through the abdomen, in which case it is called a Total Abdominal Hysterectomy, or trans-vaginally, which is called a vaginal hysterectomy. The ovaries and fallopian tubes may also be removed, which is termed bilateral salpingo-oophorectomy. The reason for this rather radical surgery is that the growth of the tumors is controlled by the hormones produced in these organs and incidence of recurrence may be high.
If surrounding lymph nodes are affected, they may also be removed surgically. Other modes of treatment for uterine cancer that has spread to distant parts of the body are radiotherapy, chemotherapy and hormone therapy.
The 5-year survival rate for malignant uterine polyps is high especially for those diagnosed in the early stages. Since these tumors are easily detected and diagnosed, early consultation for any abnormal vaginal bleeding and infertility is recommended. Prevention is not totally guaranteed, but one can improve on lifestyle factors like diet, exercise and avoiding tobacco and alcohol to decrease risks for cancers in general. People who have risk factors like personal and family history of other premalignant and malignant conditions may also profit from screening tests done at the age of 40-50, when these tumors are most commonly found.
Atlas of Genetics and Cytogenetics in Oncology and Haematology, “Uterus Tumours: an Overview” accessed 12/11/10
American Cancer Society, “Endometrial (Uterine) Cancer” accessed 12/11/10