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Introduction
Different approaches to screening and treatment of cervical precancer
Anatomical considerations
Anatomical considerations
Gross anatomy of female genital organs, External genitalia
Internal genital organs
Gross anatomy of the cervix
Cervical epithelium
Squamous epithelium
Columnar epithelium
Squamocolumnar junction (SCJ)
Physiological changes of the cervical epithelium
Ectropion
Squamous metaplasia
Transformation zone of the cervix
Changes induced by pregnancy
Atrophic changes
Congenital transformation zone (CTZ)
Neoplastic changes of the cervical epithelium
Genesis of cervical cancer – Role of HPV
HPV structure and types
Genesis of precancerous lesions and cervical cancer
Cervical intraepithelial neoplasia (CIN)
Adenocarcinoma in situ (AIS)
Cervical cancers
HPV tests – Variation between tests
Instruments, consumables, and setup required
for collection of samples for HPV testing (provider-collected)
for self-collection of samples for HPV testing
Procedure to collect samples for HPV testing
Sample collected by a health provider
Counselling of a woman undergoing HPV testing
History taking
Preparation for sample collection for HPV testing
Steps for inspection of the external genitalia
Steps for insertion of the speculum and exposure of the cervix
Steps for collection of cervical samples
Steps for self-collection of samples
Storage of the samples after collection, and transportation to the laboratory
Interpretation of HPV test results
Management of women with a positive HPV test result
Management of women with a positive HPV test result
The different strategies
Triage with cytology
Triage with VIA
Triage with colposcopy
Treatment of cervical intraepithelial neoplasia – principles
Steps to determine eligibility for ablative treatment
Criteria used to determine eligibility for ablative treatment
Steps to determine eligibility for ablative treatment
Role of Lugol’s iodine in identifying the transformation zone for treatment
Role of Lugol’s iodine in identifying the transformation zone for treatment
Steps for applying Lugol’s iodine to the cervix
Pre-treatment assessment
Treatment by cryotherapy
Principles
Cryosurgical unit
Ancillary instruments and consumables
Steps
Side-effects and complications
Post-treatment advice and follow-up
Video
Treatment by thermal ablation
Principles
The benchtop model
The battery-operated model
Complications
Video
Using an HPV test as the test of cure in women treated for cervical abnormalities or cervical intraepithelial neoplasia (CIN)
Infection prevention
Standard procedures for protection from infection
Essential steps for infection prevention in a cervical cancer screening clinic
Preparation of 0.5% chlorine solution
Case studies
VIA triage outcome (applicable in screen-and-treat setting only) – negative cases
VIA triage outcome – positive cases
VIA triage outcome – suspicious of cancer cases
Foreword
Acknowledgement
Authors
Suggested citation
Copyright
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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide
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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide
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Click on the pictures to magnify and display the legends
Age:
41
HPV outcome:
HPV positive
Before application of acetic acid
: A small mucous polyp appearing red is seen protruding through the external os.
Cervix before application of acetic acid:
Normal
Abnormal
Infective vaginal discharge:
Trichomoniasis
Candidiasis
Bacterial vaginosis
Non-specific
Strawberry appearance of cervix
Cervicitis
Polyp
Bleeding on contact
White patch
Growth
Ulcer
Erosion
After application of acetic acid:
The SCJ is fully visible on the ectocervix.
Cervix after application of acetic acid:
Squamocolumnar junction visibility:
Fully visible
Not visible
Partially visible
Squamocolumnar junction location:
On ectocervix
Partly on ectocervix and partly on endocervix
On endocervix
Inside canal
Acetowhite area:
Absent
Present
VIA triage outcome category
:
Negative
Positive
Suspicious of cancer
Determine eligibility for ablative treatment
:
Eligible for ablation
Not eligible
Histopathology
: Not done
Remarks
: Polyps are overgrowths of the endocervical columnar epithelium. Such small polyps do not cause any difficulties in ablative treatment.
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