VIA procedure Ė Examination before application of acetic acid Ė Abnormal findings on speculum examination Ė Growth or ulcer
The presence of a frank growth and/or ulcer on the cervix should raise the suspicion of invasive cancer. However, the appearance may vary depending on the stage of cancer. On speculum examination, early cervical cancers present as red granular areas with an irregular surface on the cervix, often bleeding easily on contact.
Advanced cervical cancers are visible as an obvious exophytic, ulceroproliferative growth, or as a large bulging polypoid mass or an ulcerative growth that completely replaces the cervix. The lesion bleeds on contact and may be friable. The presence of such an obvious growth or ulcer indicates the presence of cancer, and the VIA test is positive for invasive cancer.
In the presence of such a frank ulcer or growth, application of acetic acid has very little benefit. All such cases should be considered as suspicious of invasive cancer and appropriately referred for further evaluation, biopsy, and treatment.
The next section describes how to apply acetic acid to the cervix before interpreting the changes.