Reference Manual - IARC Screening Group

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Treatment and FollowupMaiman M et al. 1999. Vaginal 5-fluorouracil for high-grade cervicaldysplasia in human immunodeficiency virus infection: a randomized trial.Obstetrics & Gynecology 94(6): 954–961.Mitchell MF et al. 1998. A randomized clinical trial of cryotherapy, loopelectrosurgical excision for treatment of squamous intraepithelial lesionsof the cervix. Obstetrics & Gynecology 92: 737–744.Olatunbosun OA, FE Okonofua and SO Ayangade. 1992. Outcome ofcryosurgery for cervical intraepithelial neoplasia in a developing country.International Journal of Gynecology & Obstetrics 38: 305–310.Prendiville W, J Cullimore and S Normal. 1989. Large loop excision ofthe transformation zone (LLETZ). A new method of management forwomen with cervical intraepithelial neoplasia. British Journal ofObstetrics & Gynecology 96:1054–1060.Schantz A and L Thormann. 1984. Cryosurgery for dysplasia for theuterine ectocervix. Acta Obstetricia et Gynecologica Scandinavica 63:417–420.Wright TC, RM Richart and A Ferenczy. 1992. Electrosurgery for HPV-Related Diseases of the Lower Genital Tract: A Practical Handbook forDiagnosis and Treatment by Electroexcision and FulgurationProcedures. BioVision Inc.: Montreal, and Arthur Vision, Inc.: NewYork.Wright VC and EM Davies. 1981. The conservative management ofcervical intraepithelial neoplasia: The use of cryosurgery and the carbondioxide laser. British Journal of Obstetrics & Gynecology 88: 663–668.7-22 Cervical Cancer Prevention Guidelines for Low-Resource Settings
APPENDIX ATESTS FOR CERVICAL CANCER SCREENINGDEFINITION/MECHANISM OFACTIONAutomated Pap SmearPROCEDURE BENEFITS LIMITATIONSUses highly sophisticatedcomputer “neural network”approach wherebycomputer can rapidlyscreen cells on a slide and,according to criteriaprovided, identifyabnormal cells. Theseareas are then reviewed bya cytotechnician/pathologist on a monitor.Used as adjunct test and/orused for primary screeningResults usually reportedas:• Normal• Inflammation• Atypical Cells ofUncertain Significance(ASCUS)• LGSIL• HGSIL• CancerProcedure is described towoman• Reason for test• Procedure (what toexpect)• FollowupInsert the speculumView the cervixUse a wooden or plasticspatula to “scrape” cellsfrom the cervix andsmear them on a glassslideSlides are read bycomputerAbnormal cells orgroups of cells identifiedand confirmed bycytopathologistMeets some of the criteriaof a good screening test• Noninvasive• Treatment exists• Sensitive/specificAccording tomanufacturer and otherpublished studies,sensitivity and specificityare acceptable to someclinicians andpolicymakersPermanent recordavailable in form of slide,computer imageRequires purchase leaseor access to veryexpensive andsophisticated equipmentRequires elaborate,complex infrastructure• Materials (slides,spatulas)• Reagents (fixatives,stains)• Microscopes• Trainedcytotechnicians/• cytopathologists• Equipmentmaintenance• Reliable transport ofslides to site whereslides are preparedand read“See and treat” notpossibleCervical Cancer Prevention Guidelines for Low-Resource Settings A-1
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
Page 61 and 62: Talking with Women About Cervical C
Page 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82: Client Assessment and VIA TestingFi
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Page 91 and 92: SEVENTREATMENT AND FOLLOWUPBACKGROU
Page 93 and 94: Treatment and Followupregardless of
Page 95 and 96: Treatment and FollowupFigure 7-1. L
Page 97 and 98: Treatment and FollowupTable 7-6. Co
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Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
Page 105 and 106: Treatment and FollowupStep 6 Point
Page 107 and 108: Treatment and FollowupNote: When CO
Page 109 and 110: Treatment and FollowupStep 5Advise
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Page 115 and 116: Tests for Cervical Cancer Screening
Page 121 and 122: APPENDIX BSCREENING TEST QUALITIES
Page 123 and 124: Screening Test Qualities and Their
Page 125 and 126: APPENDIX CINFECTION PREVENTION PROC
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Page 133 and 134: Table C-4. Preparing and Using Chem
Page 135 and 136: Infection Prevention ProcessesStora
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Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 141 and 142: Technical Overview of the Cryothera
Page 143 and 144: Figure D-5. Removing Protector Tube
Page 145 and 146: Technical Overview of the Cryothera
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Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
Page 157 and 158: Processing Surgical GlovesSTEP 10:
Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
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Figure G-2. Breast Puckering or Dim
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Figure G-5. Checking for Nipple Dis
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Performing Breast and Pelvic Examin
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Figure G-18. Speculum in Place with
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APPENDIX HPERCEIVED BARRIERS TO PRO
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AVAILABILITY OF BASIC SUPPLIES AND
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GLOSSARYAcetic AcidAcetowhite Chang
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PatulousSquamocolumnarJunction (SCJ
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ADDITIONAL READINGAlliance for Cerv
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innovating to save liveswww.jhpiego
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Reference Manual - IARC Screening Group

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