Reference Manual - IARC Screening Group

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Pathophysiology of Cervical CancerWarts by themselves are usually low-grade lesions. Extensive warts, asseen in this case, however, may mask higher grade lesions in the deepertissue. Studies indicate that such lesions often regress spontaneously andthat treatment is not always successful in the long run. If treatment isdesired, a variety of techniques can be provided, including cryotherapy orLEEP. It is important to note that warts are transmitted by sexual contact.In order to avoid transmission to a partner, patients should be advised touse condoms during sexual intercourse.SquamousIntraepithelialLesionsThe face (exocervix) of thenormal cervix is largelycovered with squamousepithelium (Figure 3-5).The endocervix, whichconsists of glandularcolumnar epithelium, linesthe cervical canal and isvisible at the cervical os.Low-grade squamous intraepitheliallesions (LGSIL),or CIN I, are ones in whichup to a third of theepithelium is occupied bydysplastic cells (Figure3-6). Such lesions are alsooften visible during VIA.Figure 3-5. Normal CervixFigure 3-6. Microanatomy of DysplasiaHigh-grade squamous intraepithelial lesions (HGSIL), or CIN II and CINIII/CIS, are ones in which more than one third of the depth of the cervicalepithelium is occupied by dysplastic cells, as shown in Figure 3-6.Therefore, when acetic acid is applied to the cervix, it is more thoroughlyabsorbed than in low-grade lesions, thereby resulting in more clearlyvisible acetowhite lesions.3-8 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Pathophysiology of Cervical CancerIn the cervixes shown here,there are noticeable areasof “white” epithelium atvarious locations on thecervix. One can also seethat in some cases, somemanipulation may berequired to ensure that theentire exocervix is visible.In high-grade lesions, suchareas are usually larger,thicker and demonstrate amore clearly dull whitearea of abnormality thanlower grade lesions. Suchlesions must be treated. Ifthe entire lesion is clearlyseen, and its limits do notexceed the area that couldbe covered with a cryotherapyprobe (< 75% of thecervix), cryotherapy is anexcellent treatment choice.With good technique, curerates of 90% can beachieved.Cervical Cancer Prevention Guidelines for Low-Resource Settings 3-9
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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 and 50: With the onset of puberty, whichis
Page 51 and 52: Pathophysiology of Cervical Cancerp
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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 87 and 88: Client Assessment and VIA Testingsp
Page 89 and 90: Client Assessment and VIA Testingth
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
Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: 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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