Reference Manual - IARC Screening Group

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Talking with Women About Cervical CancerTable 4-1. Expected Side Effects of CryotherapySide EffectManagementCramping • Counsel patient before the procedure to expect somedegree of cramping during and after the procedureand that cramping usually stops shortly afterprocedure.• Reduce cramping by pressing lightly on the cervixwith the cryotherapy probe.• If cramping is severe, provide oral analgesic(acetaminophen or ibuprofen).Vaginal discharge(profuse, watery)• Counsel patient to expect a discharge lasting 2–4weeks. Provide patient with undergarment andfeminine pads. a• Counsel patient to expect discharge to change colorfrom a pink tint to clear white or a yellow tint(occasionally streaked with blood).• Counsel patient to return if discharge changes tofoul-smelling or is pus-colored (if so, evaluate forinfection and treat with antibiotics).• Strongly advise abstinence from sexual intercoursefor 4 weeks.• If abstinence is unlikely, advise condom use for 4weeks to prevent pelvic infection.Spotting/light bleeding • Counsel patient to expect spotting/light bleeding for1–2 weeks.• Counsel patient to return for evaluation if there isheavy bleeding.aIf undergarments or feminine pads are not available, cloth or other soft material may beused.• Allow time for and encourage the woman to ask questions anddiscuss her condition.• Ask the woman if she gives consent for treatment.A woman with evidence of precancerous cervical changes (VIA testpositive)should be given the above information plus additionalinformation about STIs and how to prevent them.COUNSELING FOLLOWING CRYOTHERAPYBefore leaving the health facility, a woman should receive counselingregarding:• the details of self-care at home,• conditions that might require coming to the clinic as soon as possiblefor care outside of the scheduled visits (Figure 4-1),4-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Talking with Women About Cervical Cancer• the need to abstain from sexual intercourse for 4 weeks followingtreatment and a 2-month supply of condoms in case total abstinencefor this long is not possible, 2 and• when she should return for her next scheduled visit.Figure 4-1. Warning SignsIf you have any of the following, you should return to this or the nearest healthfacility:• Fever for more than 2 days• Severe lower abdominal pain, especially if you have a fever• Bleeding for more than 2 days that is heavier than your heaviest days ofmenstrual bleeding• Bleeding with clotsQUESTIONS FREQUENTLY ASKED BY WOMENQ: Why should I have this screening test?A: Cervical cancer is a serious health problem for women living indeveloping countries. It is a major cause of cancer death amongwomen between the ages of 35 and 60.Women with cervical canceroften have symptoms such as bleeding or lower abdominal pain.When these symptoms are present, the cancer is usually advanced andlittle treatment is available. But cervical cancer can be easilyprevented through a simple test such as VIA to detect abnormal cellson the cervix. By examining the cervix before there are anysymptoms, any abnormality can be found and effective treatmentprovided so that the cancer will be prevented.Q: What is cervical cancer, and how would I get it?A: Cervical cancer is a consequence of an STI. This means that thecervix has been exposed to one or more cancer-inducing types ofHPV that, over time, have produced abnormal changes in the cells ofthe cervix. HPV is transmitted by sexual contact. Sometimes thepresence of the virus takes the form of warts, either on the outside ofthe genital area or internally, such as on the cervix. When abnormalcells are present on the cervix and are not treated, they can becomecancerous and eventually spread the disease beyond the cervix andpelvic organs. If it is not diagnosed and treated early, the cancer willlead to death.2 Because women who are seropositive for HIV may have increased shedding of the HIV virus following treatmentand during the healing process, abstinence for up to 4 weeks is strongly recommended in all women.Cervical Cancer Prevention Guidelines for Low-Resource Settings 4-7
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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
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
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Page 51 and 52: Pathophysiology of Cervical Cancerp
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Page 59 and 60: FOURTALKING WITH WOMEN ABOUTCERVICA
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Page 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
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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
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
Page 111 and 112: Treatment and FollowupBerget A, B A
Page 113 and 114: 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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