From the Guidelines
An enlarged or indurated cervix is a significant finding that may indicate underlying inflammation, infection, or potentially a more serious condition such as cervical cancer, and thus warrants further evaluation and testing, as outlined in the most recent guidelines from 2019 1. When a healthcare provider describes a cervix as indurated, they are noting that the tissue feels unusually firm or rigid during a pelvic examination, rather than having the normal soft, smooth texture. Common causes of cervical induration include:
- Cervicitis (inflammation of the cervix)
- Pelvic inflammatory disease
- Cervical neoplasia Infections that may cause cervical induration include:
- Sexually transmitted infections like chlamydia, gonorrhea, or human papillomavirus (HPV) The enlargement or induration occurs because of inflammatory responses that cause fluid accumulation, cellular infiltration, and tissue changes. Any woman who has been told her cervix is enlarged or indurated should follow up with appropriate testing, which may include:
- Cervical cultures
- Pap smear
- Colposcopy
- Biopsy depending on the suspected cause Treatment will depend on the underlying condition, ranging from antibiotics for bacterial infections to more extensive interventions if cancer is detected, as recommended by the NCCN guidelines 1. It is essential to note that the diagnosis and workup of cervical cancer involve a combination of clinical evaluation, imaging studies, and histopathological examination, as outlined in the guidelines from 2017 1 and 2013 1. However, the most recent and highest quality study from 2019 1 should be prioritized when making a definitive recommendation. Therefore, it is crucial to follow the most recent guidelines and recommendations for the diagnosis, evaluation, and treatment of cervical cancer, as outlined in the NCCN guidelines from 2019 1.
From the Research
Cervical Enlargement or Induration
- Cervical enlargement or induration can be caused by various factors, including cervical fibroids, which can lead to cervical elongation and prolapse 2.
- A study defined cervical elongation as a length of 5 cm or more between the internal and external cervical ostium, which can be correlated with cervical enlargement 3.
- Cervical fibroids can manifest as a bulky mass on the cervical tissue, mimicking cervical malignancy, and can cause bleeding, necrosis, and discharge 2.
- The clinical presentation of cervical enlargement or induration can resemble malignancy, making biopsy a crucial diagnostic tool to determine the underlying cause 2.
- Cervical cytology can be affected by various treatments, including radiation and chemotherapy, which can cause changes in cell morphology and anatomy 4.
- Imaging techniques, such as ultrasonography, can be used to evaluate the cervix and detect abnormalities, including cervical enlargement or induration 5.
- Cervical elongation can be associated with increased operative time in women undergoing hysterectomy at the time of prolapse repair 3.