Chapters

Introduction

Introduction

Visual inspection after application of acetic acid (VIA)

VIA as a screening test for cervical cancer Advantages of VIA Limitations of VIA VIA to triage women positive on the HPV test

Determining eligibility for ablative treatment after application of acetic acid

In the context of VIA screening In the context of HPV screening

Anatomical considerations

Anatomical considerations Gross anatomy of female genital organs

External genitalia Internal genitalia

Gross anatomy of cervix

Cervical epithelium

Cervical epithelium Squamous epithelium Columnar epithelium Squamocolumnar junction

Physiological changes of cervical epithelium

Ectropion Squamous metaplasia Transformation zone of the cervix Pregnancy Atrophic changes Congenital transformation zone (CTZ)

Neoplastic changes of the cervical epithelium

Genesis of cervical cancer Cervical intraepithelial neoplasia (CIN) Adenocarcinoma in situ (AIS) Cervical cancers

Changes in the cervical epithelium after application of acetic acid

Pathophysiological basis

Instruments, consumables, and setup required for examination after application of acetic acid

Instruments and consumables required Preparation of 5% dilute acetic acid Setup for the procedures

VIA procedure

As a screening test or a triage test Counselling History taking Preparation for VIA procedure Steps for inspection of the external genitalia Steps for insertion of the speculum and exposure of the cervix Steps for examination before application of acetic acid

Steps Normal findings

Normal cervicovaginal discharge Bleeding through the external os Nabothian cyst Ectropion

Abnormal findings

Cervicovaginal inflammation Cervical Polyp Leukoplakia Cervical condyloma Growth or ulcer

Examination after application of acetic acid

Steps for applying acetic acid to the cervix Detecting changes in the cervical epithelium after application of acetic acid Normal findings

Squamous epithelium Columnar epithelium Squamocolumnar junction (SCJ) Transformation zone (TZ)

Features during pregnancy Abnormal features

Abnormal features Rapidity of onset of acetowhitening Intensity of acetowhitening Margin of acetowhite area Location of acetowhite area Surface of acetowhite area Size of acetowhite area Conclusion of examination Post-VIA counselling Documentation of findings

Interpretation of VIA test results

Interpretation of VIA test results VIA Negative

No acetowhite area Columnar epithelium appearing white Polyps with faint acetowhite change Nabothian cysts appearing white Line-like acetowhitening at the SCJ Patchy acetowhite areas without any definite margin Thin acetowhite areas with tongue-shaped projections towards the external os Acetowhite areas away from the SCJ

VIA Positive

Dense acetowhite areas in the TZ with well-defined margins Dense acetowhite area on columnar epithelium Entire cervix appearing dense acetowhite Leukoplakia becoming acetowhite CTZ appearing acetowhite

Suspicious of invasive cancer

Preventing errors in VIA

Preventing errors in VIA Inadequate exposure of the cervix Inadequate visualization of the transformation zone Inadequate visualization of the margins of acetowhite areas Errors in assessment

Errors in assessment of acetowhite areas Errors in recognizing cervical cancer Errors in assessment of the postmenopausal cervix

Management of women with an abnormal VIA test

Management of women with an abnormal VIA test

Steps to determine eligibility for ablative treatment

Principles Principles of treating cervical precancerous lesions 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 Lugol’s iodine for pre-treatment assessment Preparation of Lugol’s iodine

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

Videos

Steps of applying acetic acid for VIA and identifying the transformation zone (VIA negative) Steps of applying acetic acid for VIA, determining eligibility for ablation and treatment with thermal ablation

Preparation of Monsel’s solution

Preparation of Monsel’s solution

Infection prevention

Standard procedures for protection from infection Essential steps for infection prevention in VIA screening or triage Preparation of 0.5% chlorine solution

VIA-negative cases VIA-positive cases VIA-suspicious of cancer cases

Quiz Acknowledgement Suggested citation Copyright

Home / Training / Manuals / Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

Filter by language: English / Français / Español / Русский / українська

VIA procedure – Examination before application of acetic acid – Abnormal findings on speculum examination – Cervicovaginal inflammation

Infective conditions of the cervix and the vagina are associated with excessive abnormal discharge that can be seen on opening the speculum blades. The characteristics of the discharge (colour, odour, consistency, and quantity) help in detecting the nature of the infection.

Excessive grey-white or yellow discharge with a fishy odour is characteristic of bacterial vaginosis, an infective condition caused by bacteria.

The presence of thick or thin curdy white discharge indicates candidiasis, an infection caused by a fungus (commonly Candida albicans).

Profuse greenish yellow frothy discharge is commonly seen in trichomoniasis, an infection caused by a protozoan known as Trichomonas vaginalis.

Sometimes pus may be seen coming out through the external os. If purulent discharge is seen at the external os, it is indicative of gonococcal infection (caused by the bacteria Neisseria gonorrhoeae) or chlamydial infection (caused by Chlamydia trachomatis). Examination of the urethra may also reveal purulent discharge.

The cervix may appear congested and oedematous as a result of any lower genital tract infection. In trichomoniasis (caused by Trichomonas vaginalis), small red patches are often visible on the ectocervix, giving rise to a strawberry appearance of the cervix. An infected cervix may bleed on contact during the VIA procedure.

Severe infection or inflammation of the cervix may lead to desquamation (superficial peeling off) of the surface epithelium, which on naked-eye examination may appear as red patches on the cervix. The peeling of the epithelium is known as erosion. The raw area on the cervix may bleed on contact.

Click here to download a table of syndromic management of cervicovaginal infections.

The next section describes cervical polyps.

Click on the pictures to magnify and display the legends

IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2024 - All Rights Reserved.