Free Literature Review On Endometrial Polyps And The Risk Of Malignancy
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The abnormal growths that take place in the inner lining of the uterus, called the endometrium, are known as endometrial polyps. They are also referred to as uterine polyps. The formation of uterine polyps results from the overgrowth of endometrial tissue. Extending inward into the uterus, the polyps, which may be oval or round in shape, remain attached to the endometrium by a thin stalk or a broad base. The size of the polyps varies from the size similar to the sesame seeds to that of a golf ball or larger (Wethington et al, 2011). There may be a cluster of polyps or only one polyp present. The typical symptoms of endometrial polyps include irregular menstrual cycles, excessive bleeding during menstruation, infertility, vaginal bleeding after menopause and bleeding between periods. Most commonly, endometrial polyps are found in women during the stage of premenopause or postmenopause, but they develop in younger women too (Wethington et al, 2011). Though usually benign, these polyps create problems in the menstrual cycle and fertility. Sometimes, these polyps may turn cancerous too. This paper would present a literature review on endometrial polyps and the risk of its malignancy.
The risk of malignancy in women with endometrial polyps is usually very low. However, it has been found that the risk of malignancy in endometrial polyps increases as women age, especially the risk is higher among postmenopausal women who have vaginal bleeding and who are above the age of 50 years (Wethington et al, 2011). Age is a serious risk factor for malignancy in endometrial polyps. The prevalence rate of malignant endometrial polyps is 3.7% in women aged below 40 years, 3.11% in women between the age range of 40 and 59 years, and 5.36% in women aged over 60 years (Costa-Paiva et al, 2011). Obesity is also another factor associated with the malignancy of endometrial polyps. Obesity leads to higher concentration of serum estrogen in women, attributing to the greater risks of endometrial proliferation.
Hypertension is also recognized as a risk factor for malignancy, because hypertension decreases the mechanisms of cell apoptosis in favor of tumor growth. Hypertensive women show a tendency towards developing malignant polyps in the endometrium. Lee et al conducted a meta-analysis in which they found that there is a substantial link between the presence of malignant endometrial polyps and arterial hypertension (Wethington et al, 2011). Diabetes mellitus is also a risk factor for the malignant endometrial polyps. Various researchers have studied the correlation between malignant endometrial polyps and diabetes mellitus. Of all the studies conducted, a few researchers like Gregoriou et al found a correlation between the two (Costa-Paiva et al, 2011). The presence of symptoms like heavy uterine bleeding is indicative of a possible risk factor for malignant endometrial polyps. The size of polyps also indicates malignancy. A few studies were conducted to find out a relationship between malignancy risk of endometrial polyps and polyp size. Although many researchers have indicated a correlation between the size of polyps with malignancy, a few researchers like Gregoriou et al, Goldstein et al, Shushan et al, and Fernandez-Parra et al found no correlation between the two (Costa-Paiva et al, 2011).
Most of the endometrial polyps may not require any treatment. In many cases, they remain undetected throughout the lifespan of a person as there are no symptoms. However, if the endometrial polyps are showing symptoms like heavy bleeding, vaginal pain and abnormal menstrual periods, they should also be treated as early as possible because of the chances of malignancy (AAGL Practice Report, 2012). If a polyp is found during pregnancy or after menopause, then the most common way to treat it is to remove the endometrial polyp.
Medications are the first line of treatment for endometrial polyps. Medications, however, is only a temporary solution. Medications are given to regulate hormonal imbalances in the body so that the condition does not get worse (Wethington et al, 2011). Curettage is one of the most common methods used for endometrial polyps, which are not malignant. In fact, doctors first use curettage to collect polyp tissues and do a biopsy to see if they are cancerous or not. If they are benign, then in most of the cases, scraping of polyps using curettage from the uterine wall are performed to remove the endometrial polyps. However, curettage is not a 100% full proof method for removing polyps. Hysteroscopy with surgical instruments are known to be the best method. In fact, if the endometrial polyps are malignant, then hysteroscopy is strongly recommended so that all the malignant cells are removed properly (AAGL Practice Report, 2012). If larger malignant polyps are present in the uterine wall, then a surgical procedure is used to remove the whole uterus in some cases. Malignant or not, however, a majority of the women prefers to go through the surgical procedure to remove endometrial polyps upon detection.
There is no known way to reduce risk of developing uterine polyps. It is, therefore, important to do regular gynecological checkups. Also, it is important to treat and remove endometrial polyps properly as there are many instances found where endometrial polyps returned after treatment (Wethington et al, 2011). Especially, if the endometrial polyps are malignant, then the chances of polyps returning is higher.
In conclusion, endometrial polyps, which mushroom in the inner lining of the uterus in women, are usually benign and pose no threat to the life of women. Asymptomatic endometrial polyps are benign, whereas the symptoms of heavy bleeding during menstruation, bleeding between periods, and vaginal bleeding after menopause are linked with malignancy. The risk factors of malignant endometrial polyps include advanced age over 50 years, obesity, hypertension, and diabetes. Though medications are the first line of treatment, curettage and hysteroscopy are recommended in case of malignancy.
Costa-Paiva, L., Godoy, C., Antunes, A., Caseiro, J., Arthuso, M. and Pinto-Neto, A. 2011. Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause, 18(12), pp.1278-1282. [Online] Available at <http://www.medscape.com/viewarticle/754861> [Accessed 1st February 2015]
Wethington, S., Herzog, T., Burke, W., Sun, X., Lerner, J., Lewin, S. and Wright, J. 2011. Risk and Predictors of Malignancy in Women with Endometrial Polyps. Annals of Surgical Oncology. 18(13), pp.3819-3823. [Online] Available at <http://www.ncbi.nlm.nih.gov/pubmed/21701931> [Accessed 1st February 2015]
AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps. 2012. Journal of Minimally Invasive Gynecology. 19(1), pp.3-10. [Online] Available at <http://www.aagl.org/wp-content/uploads/2013/03/aagl-Practice-Guidelines-for-the-Diagnosis-and-Management-of-Endometrial-Polyps.pdf> [Accessed 1st February 2015]
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