Reference Manual - IARC Screening Group

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Figure G-2 Breast Puckering or Dimpling G-5Figure G-3Appearance of Breasts (Left to Right): Arms over Head, Hands on Hips,Leaning Forward G-5Figure G-4 Spiral Technique of Breast Examination G-6Figure G-5 Checking for Nipple Discharge (Left Breast) G-7Figure G-6 Checking the Axilla (Left Breast) G-7Figure G-7 Breast Self-Examination G-11Figure G-8 Average Size of Lumps Detected G-13Figure G-9 Palpating the Abdomen G-15Figure G-10 Woman Positioned for Pelvic Examination on Table with Stirrups G-17Figure G-11 Woman Positioned for Pelvic Examination on Table without Stirrups G-17Figure G-12 External Genitalia G-18Figure G-13 Checking the Skene’s Glands G-19Figure G-14 Checking the Bartholin’s Glands G-20Figure G-15 Inserting the Speculum G-21Figure G-16 Rotating the Speculum G-22Figure G-17 Opening the Speculum Blades G-22Figure G-18 Speculum in Place with Blades Open G-23Figure G-19 Removing the Speculum G-24Figure G-20 Inserting the Fingers into the Vagina G-25Figure G-21 Checking Cervical Movement G-26Figure G-22 Palpation of an Anteriorly Directed Uterus G-26Figure G-23 Feeling a Retroverted Uterus G-27Figure G-24 Locating the Ovary G-28Figure G-25 Performing a Rectovaginal Examination G-30xCervical Cancer Prevention Guidelines for Low-Resource Settings
PREFACE AND ACKNOWLEDGMENTSThis reference manual is designed for use by trainers and healthcareproviders who are embarking on a cervical cancer prevention programthat will focus on visual inspection with acetic acid (VIA) and/orcryotherapy as the core programmatic elements.The information and guidelines contained in this manual were derivedfrom a variety of sources, including field experiences, results of bothpublished and unpublished scientific works and input from many expertreviewers. Moreover, the specific concepts, principles and proceduralrecommendations provided in this manual have been extensively andsuccessfully used in a variety of field settings, most notably in ElSalvador, Ghana, Malawi, Peru, the Philippines, Thailand, andZimbabwe, as part of either training, research or service deliveryprojects.The material is arranged both according to established principles ofmedical education (epidemiology, pathophysiology, clinical intervention)and according to the order in which knowledge and skills might begradually acquired during training. The general approach of competencybasedtraining described in the manual has been used extensively in awide variety of settings worldwide.Although this manual could be used alone in training in providing VIAand cryotherapy services, it is intended to be used as an integral part of acomprehensive learning package that includes a handbook forparticipants, a trainer’s guide, an interactive CD-ROM of cervicalimages, a set of flash cards containing cervical images and questions, an“atlas” of cervical images, a companion manual on performance support,and anatomic models.We wish to acknowledge the contributions of the many colleagues andcollaborators who played a part in the development of this manual asreviewers and trainers. Because of their assistance and persistence, themanual is a much better resource than it would otherwise have been. Theyinclude: Ann Blouse, Dr. Khunying Kobchitt Limpaphayom, Dr. PisakeLumbiganon, Dr. Somkeart Srisupundit, Dr. Bundit Chumworathayee, Dr.Sunguanchoke Luanrattanakorn, Dr. Suwaree Paojirasinchai, Dr. SumonthaPrasertpan, Dr. Choochai Tamthanakitphisan, Dr. Tinnakorn Sirasapoom,Dr. Wachara Eamratsameekool, Dr. Samrat Podapol, Dr. SydneyAdadevoh, Dr. Sylvia Deganus, Saifuddin Ahmed, Dr. Margo Lauterbach,Dr. Ricky Lu, Mark Fritzler, Karen Mazziott, Sara Slade, and SapnaSharma. A special thanks goes to Dr. Fredrik Broekhuizen whosededication to detail and consistency improved the document immensely.Cervical Cancer Prevention Guidelines for Low-Resource Settingsxi
Page 1: Cervical Cancer PreventionGuideline
Page 5: TABLE OF CONTENTSPREFACE AND ACKNOW
Page 8: How to High-Level Disinfect Surgica
Page 11: Table C-2Figure C-1Preparing a Dilu
Page 15 and 16: ONEINTRODUCTIONMAGNITUDE OF THE PRO
Page 17 and 18: IntroductionFigure 1-3. Incidence o
Page 19 and 20: Introductionprevalence areas, a sta
Page 21 and 22: Table 1-2. Reduction in Cumulative
Page 23 and 24: Introductiontheir performance was t
Page 25 and 26: Introductionlesions, or a false pos
Page 27 and 28: IntroductionCompared to other metho
Page 29 and 30: Introductionsignificantly to women
Page 31 and 32: IntroductionBelinson JL et al. 2001
Page 33 and 34: IntroductionMitchell MF et al. 1998
Page 35 and 36: IntroductionYlitalo N et al. 1999.
Page 37 and 38: TWOHUMAN PAPILLOMAVIRUS AND CERVICA
Page 39 and 40: Human Papillomavirus and Cervical C
Page 47 and 48: THREEPATHOPHYSIOLOGY OF CERVICAL CA
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Page 51 and 52: Pathophysiology of Cervical Cancerp
Page 53 and 54: Pathophysiology of Cervical CancerP
Page 55 and 56: Pathophysiology of Cervical CancerI
Page 57 and 58: Pathophysiology of Cervical CancerR
Page 59 and 60: FOURTALKING WITH WOMEN ABOUTCERVICA
Page 61 and 62: Talking with Women About Cervical C
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
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SIXCLIENT ASSESSMENT AND VIA TESTIN
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Client Assessment and VIA TestingFi
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Client Assessment and VIA TestingIN
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Client Assessment and VIA Testingst
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Client Assessment and VIA Testingsp
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Client Assessment and VIA Testingth
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SEVENTREATMENT AND FOLLOWUPBACKGROU
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Treatment and Followupregardless of
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Treatment and FollowupFigure 7-1. L
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Treatment and FollowupTable 7-6. Co
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Treatment and FollowupFigure 7-2 is
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Treatment and Followup• Regulator
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Treatment and FollowupCRYOTHERAPY P
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Treatment and FollowupStep 6 Point
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Treatment and FollowupNote: When CO
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Treatment and FollowupStep 5Advise
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Treatment and FollowupBerget A, B A
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APPENDIX ATESTS FOR CERVICAL CANCER
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Tests for Cervical Cancer Screening
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APPENDIX BSCREENING TEST QUALITIES
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Screening Test Qualities and Their
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APPENDIX CINFECTION PREVENTION PROC
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Infection Prevention Processesfor m
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Infection Prevention Processeswith
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Infection Prevention ProcessesFigur
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Table C-4. Preparing and Using Chem
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Infection Prevention ProcessesStora
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Infection Prevention Processes• h
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APPENDIX DTECHNICAL OVERVIEW OF THE
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Technical Overview of the Cryothera
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Figure D-5. Removing Protector Tube
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Technical Overview of the Cryothera
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Figure D-11. Gas Cylinder Secured t
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APPENDIX ETROUBLESHOOTING WITH THEC
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Table E-1. Following-Up on Commonly
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APPENDIX FPROCESSING SURGICAL GLOVE
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Processing Surgical GlovesTable F-1
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Processing Surgical GlovesSTEP 10:
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APPENDIX GPERFORMING BREAST AND PEL
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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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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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Reference Manual - IARC Screening Group

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