What are the implications and necessary steps for a bump on the cervix?

Evaluation and Management of a Cervical Bump

A bump on the cervix requires immediate colposcopic evaluation with directed biopsy to exclude malignancy or high-grade dysplasia, as any visible cervical lesion warrants tissue diagnosis regardless of cytology results. 1

Initial Assessment

The first priority is determining whether this represents a benign finding versus a potentially malignant or premalignant lesion. The approach differs dramatically based on clinical context:

Benign Cervical Findings (Common and Reassuring)

Several cervical findings appear as "bumps" but are entirely benign 2, 3:

• Nabothian cysts: Retention cysts appearing as smooth, round, yellowish bumps on the cervix—completely benign and require no intervention 3
• Cervical ectropion: Normal developmental finding where columnar epithelium is visible on the exocervix, appearing as a red, bumpy area—particularly common in adolescents and regresses with age 2, 3
• Small cervical polyps: Benign growths that may appear as smooth, pedunculated bumps—generally require removal only if symptomatic 3

Concerning Cervical Findings (Require Immediate Workup)

Any of the following features mandate urgent colposcopy with biopsy 1, 2:

• Irregular surface texture or ulceration 1
• Friability (bleeds easily when touched) 2, 4
• Associated symptoms: postcoital bleeding, abnormal vaginal discharge, or pelvic pain 3, 4
• History of abnormal Pap smear or HPV positivity 1
• White plaques that cannot be removed with swab (concerning for condylomata or dysplasia) 2
• Any clinically visible lesion >5mm 1

Diagnostic Algorithm

Step 1: Speculum Examination with Documentation

Document the following cervical characteristics 2:

• Position: anterior, mid-position, or posterior
• Consistency: soft, medium, or firm
• Lesion characteristics: size, color, texture, friability, bleeding
• Discharge: presence, color, odor

Step 2: Risk Stratification

High-risk features requiring immediate colposcopy and biopsy 1:

• Any visible lesion with irregular borders or surface
• Lesion >5mm in any dimension
• Associated bleeding or friability
• History of abnormal cytology (ASC-H, HSIL, or higher)
• Postcoital bleeding

Lower-risk features (may observe if clearly benign-appearing) 2, 3:

• Smooth, round, yellowish cyst (Nabothian cyst)
• Uniform red area consistent with ectropion in young patient
• Small, smooth polyp without bleeding

Step 3: Colposcopy and Biopsy Protocol

All women with ASC-H, HSIL, or any clinically suspicious lesion require colposcopic evaluation 1:

• Perform colposcopy with acetic acid application
• Obtain directed biopsies of any acetowhite lesions or abnormal vascular patterns
• Perform endocervical curettage (ECC) if colposcopy is unsatisfactory or no lesion is identified but cytology is abnormal 1

Step 4: Management Based on Biopsy Results

If biopsy shows CIN I 1:

• Repeat cytology, colposcopy, and ECC every 6 months until 2 consecutive negative results
• Alternative: LEEP or CKC for definitive diagnosis

If biopsy shows CIN II 1:

• LEEP or CKC required to establish definitive diagnosis
• Treatment options: LEEP, cryotherapy, CKC, or laser ablation
• May observe without treatment in young women desiring fertility who are reliable for follow-up (physician discretion)

If biopsy shows CIN III 1:

• Options: LEEP, CKC, or total hysterectomy
• LEEP or CKC recommended before hysterectomy to confirm diagnosis
• Hysterectomy only if other indications present (e.g., symptomatic fibroids)

If biopsy shows microinvasive or invasive cancer 1:

• CKC required for microinvasive findings
• Staging workup with MRI (superior to CT for tumor extension) 1
• Treatment per cervical cancer guidelines based on FIGO stage 1, 5

Imaging Recommendations

MRI is superior to CT for assessing tumor extension and should be preferred for pelvic and abdominal imaging if malignancy is suspected 1, 5. MRI provides critical information about:

• Tumor size and local extension (T staging)
• Parametrial involvement
• Lymph node assessment (equal to CT)
• Vaginal involvement

Critical Pitfalls to Avoid

• Never assume a visible cervical lesion is benign without tissue diagnosis—even smooth-appearing lesions can harbor dysplasia or malignancy 1
• Do not rely on cytology alone—a normal Pap smear does not exclude significant pathology in the presence of a visible lesion 1
• Avoid delaying colposcopy in high-risk patients—any woman with ASC-H, HSIL, or suspicious visible lesion requires immediate colposcopy regardless of other factors 1
• Do not misinterpret normal ectropion as pathology in adolescents—this is a normal developmental finding that regresses with age 2, 3
• Ensure adequate biopsy—superficial biopsies may miss underlying invasion 1

Special Populations

Pregnant patients: Colposcopy and biopsy are safe and indicated for abnormal cytology or suspicious lesions during pregnancy, but treatment is typically deferred until postpartum unless invasion is suspected 6

Adolescents: Ectropion is extremely common and benign in this population; avoid overtreatment of normal developmental findings 2, 3