Reference Manual - IARC Screening Group

Pathophysiology of Cervical CancerPolypDischargePolyps are found fairlyoften and represent smallsegments of glandulartissue that have grownaway from the lining ofthe cervix or endometriumand become a finger-likeprojection into the cervicalcanal and/or vagina. Patients with polyps may often present withprolonged or heavy menstrual bleeding or, quite commonly, post-coitalbleeding. As in this picture, polyps are often very mobile and can bepushed in different directions in order to reveal the SCJ. The presence ofa polyp sometimes obscures a view of the SCJ, making screening byvisual inspection impossible. Because polyps are composed entirely ofglandular tissue, they do not become acetowhite when stained with aceticacid and should not be confused with cervical cancer or its precursors.Prolapsed fibroid tumors (leiomyoma) can sometimes look like polyps.In some situations, adischarge may be presentat the cervix. The color ofsuch discharges is apurulent-appearing mix ofgreen, yellow and gray, oras shown here, cheesyand white. Any dischargeshould be wiped off thecervix before VIA because discharge can obscure the SCJ or be confusedwith a lesion. The cervix itself is normal and the SCJ can be seen.Warts Cervical condylomata(warts) are caused by HPV.This virus is at the root ofthe pathological processthat results in cervicalproblems such as dysplasiaand cancer. Warts are oftenquite noticeable when theyoccur on the externalgenitalia, but when they infect the cervix can also cause clearly visiblelesions such as the one shown here. Once stained with acetic acid, thewarty tissue will become bright white with a marked thickening of thecervical or vaginal mucosa. If on close inspection, it is often possible tonote a distinctly lumpy, irregular contour to the surface of the affected area.In this cervix, the entire SCJ appears to be occupied by the warty tissue thatalso appears to be extending into the cervical canal.Cervical Cancer Prevention Guidelines for Low-Resource Settings 3-7