Reference Manual - IARC Screening Group

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Pathophysiology of Cervical Cancerone or more of the cancer-inducing types of HPV, they will developprecancerous changes that ultimately could result in cancer as they getolder. Using condoms (either male or female) helps protect these delicatecells, but delaying sexual intercourse until nearly age 20 is even moreprotective.APPEARANCE OF THE CERVIX IN NORMAL AND ABNORMAL STATESThe detailed description of each cervix shown in this section is intendedto supplement that provided in the full-color Atlas of Visual Inspection ofthe Cervix with Acetic Acid (VIA). Therefore, when reading this section,please refer to the atlas to better understand the changes in each cervixbeing described.NulliparousNote the smooth roundopening (os) of the cervix.The normal trauma associatedwith the passage of afetus through the cervixduring birth (or lateabortion) usually results ina less symmetrical “worn”cervix. The SCJ is visibleas a faint, thin white line just at the entrance to the cervical canal. Note thedifference in color of the glandular (columnar) epithelium, which is red dueto the blood vessels beneath the single layer of cells. The squamousepithelium is less red (pink) because it is several layers thick.There is a small amount of glare visible, mainly on the squamousepithelium, which is an artifact caused by the photographic flash or lightsource. Clinically, glare can be differentiated from potential pathology byeither moving the light source or changing position while viewing thecervix. Although the artifact due to glare will move with the change inlight source or viewing angle, color changes indicative of diseased tissuewill not.ParousCompare this photo withthe nulliparous cervix.The cervical os is uneven,with a worn appearance.Such a cervix is oftendescribed as having a“fish mouth” appearance.For examiners, the manycontours and surfaces of such a cervix may require that they manipulate thecervix with a swab in order to get as thorough a view of the SCJ as3-4 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Pathophysiology of Cervical Cancerpossible. In the cervix seen here, in order to get a complete view of theSCJ, the lower lip of the cervix needs to be manipulated downward. This isperhaps best accomplished by using a swab either on the cervix itself or byplacing a swab in the cull de sac and pushing upward, thus bringing thecervix downward and into view. In large and patulous (spread apart)cervices, it may be necessary to open the bivalve speculum wider to betterexpose the SCJ. There is also an area of squamous metaplasia (see below)occurring in a patulous portion of the cervix. This patulous area is probablythe result of obstetrical trauma with subsequent scarring and healing.SquamousMetaplasiaSquamous metaplasia is aphysiologic process throughwhich the glandular cellslining the cervical canalnear the SCJ are graduallyreplaced with squamouscells. This process is aresult of the cervix’sexposure to noxiousagents in the environment, such as bacteria, viruses and unclean foreignbodies. In the cervix shown here, there is a visible area of squamousmetaplasia on the lower lip of the cervix, close to the SCJ. It has a faintwhite, translucent appearance, almost as if a thin white veil were laidonto the cervix. Unlike mucus, it will not wipe away.Ectopy/Ectropion Exposure to hormonessuch as estrogen andprogesterone may affectthe appearance of thecervix. This effect istypified by the increasedpresence of glandulartissue on the outer surfaceof the cervix. This finding,often called ectropion orectopy, is not a pathological condition, but rather a variant of cervicalappearance. The cause of ectopy is unclear, but may relate to exposure tointernal hormonal sources (such as may occur during periods ofanovulation, normal menstruation or pregnancy). It may also result fromexposure to synthetic hormones, when patients use hormonal methods ofcontraception such as combined estrogen/progestin pills and progestin-onlymethods. In this photo, there are neither areas of obvious acetowhitechange (see below), nor is this cervix particularly likely to bleed easilywhen touched (friable), both of which indicate a normal cervix.Cervical Cancer Prevention Guidelines for Low-Resource Settings 3-5
Page 1: Cervical Cancer PreventionGuideline
Page 5: TABLE OF CONTENTSPREFACE AND ACKNOW
Page 8: How to High-Level Disinfect Surgica
Page 11 and 12: Table C-2Figure C-1Preparing a Dilu
Page 13 and 14: PREFACE AND ACKNOWLEDGMENTSThis ref
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
Page 49: With the onset of puberty, whichis
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
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
Page 83 and 84: Client Assessment and VIA TestingIN
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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
Page 99 and 100: 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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