CHAPTER 4: SCREENING FOR CERVICAL CANCER

128 Chapter 5: Diagnosis and Management of Precancer5Chapter 5: Diagnosis and Management of Precancerlocally where possible, or referring them to a higher-level facility. They also need tocounsel women who undergo diagnostic and treatment procedures on the importanceof abstaining from sexual intercourse, or using condoms correctly and consistently, forsome time afterwards.STORYMaria is a 60–year-old Nicaraguan mother with12 children, who has been married to the sameman for 45 years. The teacher at her literacy classtold her about a clinic to be held in her village totest women for cervical cancer, and advised her toattend. At the clinic, she had a Pap smear. When shereturned for her test results, she was told she had aHSIL, a condition that needed to be treated becauseotherwise it could get worse and become cancer. She was referred to thedistrict hospital, where a doctor looked inside her vagina with a colposcopeand took a biopsy from the abnormal area. The biopsy confirmedthat she had a precancerous lesion and she was treated with cryotherapy.The doctor explained the importance of regular examinations after treatment,as sometimes a few abnormal cells remain and continue to progresstowards cancer. But Maria was leaving the country and did not return formany months. When she came back, she was told that the health workerhad come to visit her and had left a message that it was very important forher to attend the follow-up visit. She finally attended the clinic 18 monthsafter treatment. The doctor in the hospital repeated the colposcopy, whichrevealed that there was again a suspicious lesion. The biopsy confirmed aCIN 3 lesion, needing further treatment. Maria was admitted to the hospitalfor a cold knife conization under anaesthesia; she was operated on earlyin the morning and discharged the same day. The entire abnormal areawas removed, and she has had normal follow-up tests since then.