Reference Manual - IARC Screening Group

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Client Assessment and VIA TestingCotton swabs are used to remove mucus and discharge from the cervixand to apply acetic acid to the cervix. These swabs should be generouslycovered with clean cotton so that they will be able to wash the cervixthoroughly with acetic acid and not scratch or injure the cervix. Thecotton swabs do not have to be sterile. Cotton “wool” formed into ballsand applied to the cervix with a forceps is also acceptable.Examination gloves should be new. (If surgical gloves are being reused,they should be decontaminated, cleaned and high-level disinfected aftereach use. Sterile gloves are not necessary.) Use a new pair of gloves forevery woman.The wooden spatula is used to push away the lateral walls of the vaginaif they protrude through the speculum blades. Use a new spatula for everywoman. Alternatively, a condom with a cut tip can be rolled over thespeculum blades to prevent the walls of the vagina from pushing into thespace and preventing an adequate view of the cervix.Acetic acid is the main ingredient of vinegar. A dilute (3–5%) solution isrecommended. In some countries, vinegar is not available. Often what issold in the market is a “vinegar-substitute” that in fact is acetic acid. Ifneither vinegar nor an acetic acid substitute is available, apharmacist/chemist or local chemical supplier can make the dilute aceticacid using the following formula:% ConcentrateTotal Parts (TP) water = ⎡ 1⎣ ⎢ ⎤% Dilute ⎦⎥ −For example, to prepare a dilute solution (5%) from a 20% concentratedacetic acid solution:20%TP water = ⎡ 1 = 4 -1 = 3 parts water to 1 part concentrate⎣ ⎢ ⎤5% ⎦⎥ −20%concentratedacetic acidsolutionWater1 partacetic acidsolution1 partwater1 partwater1 partwaterand1part1part1part1part5%dilutesolutionChlorine solution (0.5%) is used to decontaminate the speculum andsurgical gloves after each use. After decontamination, the speculum,instrument tray or container and surgical gloves should be washed withsoap and water, thoroughly rinsed and then high-level disinfected or6-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Client Assessment and VIA Testingsterilized. (See Appendix C for detailed information on how to preparechlorine solutions.)VISUAL INSPECTION WITH ACETIC ACID (VIA)General ProcedureClassification of VIATest ResultsTo perform VIA, the provider applies a dilute acetic acid solution to thecervix. This solution shows any changes in the cells covering the cervix(epithelial cells) by producing the “acetowhite” reaction. First, theprovider performs a speculum examination to see the cervix. Then, thecervix is cleaned to remove any discharge, and acetic acid is appliedthoroughly to the cervix. After at least 1 minute the cervix, including theentire SCJ, is inspected for any acetowhite change. The results of the test(i.e., either test-positive or -negative) should be discussed with thewoman, and treatment should be offered after counseling, if it isappropriate and immediately available.The assessment findings should be recorded using the standardizedcategories summarized in Table 6-1.Table 6-1. VIA Classification Relative to Clinical FindingsVIACLASSIFICATIONTest-positiveTest-negativeCancerCLINICAL FINDINGSRaised and thickened white plaques or acetowhiteepithelium, usually near the SCJ (see Figure 6-3)Smooth, pink, uniform and featureless; ectropion, polyp,cervicitis, inflammation, Nabothian cystsCauliflower-like growth or ulcer; fungating massFigure 6-3. Clinical Significance and Location of Acetowhite LesionsAdapted from: International Agency for Research on Cancer (<strong>IARC</strong>).Cervical Cancer Prevention Guidelines for Low-Resource Settings 6-7
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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
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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
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
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
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
Page 127 and 128: Infection Prevention Processesfor m
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Page 131 and 132: Infection Prevention ProcessesFigur
Page 133 and 134: 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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