CHAPTER 4: SCREENING FOR CERVICAL CANCER

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152PS 12: CryotherapyPS 12Practice Sheet 12: CryotherapyPER<strong>FOR</strong>MING CRYOTHERAPYBefore the procedure1. Explain the procedure, and why it is important to return forfurther management as requested. Ensure that the woman hasunderstood and obtain informed consent.2. Show her the cryotherapy equipment and explain how you willuse it to freeze the abnormal areas on the cervix.3. Prepare the patient for a gynaecological examination, and perform a speculumexamination (see Practice Sheet 7).4. If there is no evidence of infection, proceed with cryotherapy.PS6&7PS6 Informed consentPS7 Pelvic exam5. If there is a cervical infection, provide treatment as described in Annex 8. Youmay proceed with the cryotherapy, or you may give the patient an appointmentto return once the infection is cured.Procedure6. Wipe the cervix with a saline-soaked cotton swab and wait a few minutes.7. Apply acetic acid to outline the abnormality and wait a further few minutes.8. Tell the woman she might feel some discomfort or cramping while you arefreezing the cervix. 169. Wipe the cryoprobe surface with saline to ensure optimum effectiveness.10. Apply the cryoprobe tip in the centre of the os and make sure the probeadequately covers the lesion (Figure PS12.2). If the lesion extends more than 2mm beyond the probe, discontinue the procedure. Explain to the woman why youare doing this and what needs to be done for her as an alternative.11. Ensure that the vaginal wall is not in contact with the cryoprobe or you maycause a freezing injury to the vagina.12. Set the timer and release the gas trigger to cool the probe.13. You will observe the ice forming on the tip of the cryoprobe and on the cervix(Figure PS12.2). When the frozen area extends 4–5 mm beyond the edge of thecryoprobe, freezing is adequate.16 In some cases, the patient may have a vasovagal reaction, with fainting and plummeting bloodpressure. If this happens, stop the treatment immediately and raise the patient’s legs as much aspossible.
PS 12: Cryotherapy 153Figure PS12.2 Position of cryoprobe on the cervix and ice formingPS 12cervical canalcervix14. Allow two cycles of freezing and thawing: 3 minutes freezing, followed by 5minutes thawing, followed by a further 3 minutes freezing.15. Once the second freezing is complete, allow time for thawing before attemptingto remove the probe from the cervix. Removing it before it is fully thawed willpull tissue off the cervix.16. Gently rotate the probe on the cervix to remove it. The area you have frozen willappear white.17. Examine the cervix for bleeding. If bleeding is noted, applyMonsel’s paste.18. Do not pack the vagina.19. Remove the speculum.cryotipfrozen areacryoprobeAnnex 9Monsel’s pastePractice Sheet 12: CryotherapyAfter the procedure20. Provide a sanitary pad.21. Instruct the woman to abstain from intercourse and not to use vaginal tamponsfor 4 weeks, until the discharge stops completely. This to avoid infection.22. Provide condoms for use if she cannot abstain from intercourseas instructed. Teach her how to use them.23. Invite her to return in 2–6 weeks to be checked for healing,and again in 6 months for a repeat Pap smear and possiblecolposcopy.PS5Condom use
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CHAPTER 4: SCREENING FOR CERVICAL CANCER

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