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

Cervical cancers need not always present as large frank growths. Small growths located close to the endocervical canal may be missed if the SCJ is not carefully assessed.

The criteria for recognizing cervical cancer are the presence of surface irregularity and contact bleeding. Acetowhitening may or may not be present, depending on the presence or absence of the surface epithelium. Although squamous cell cancers of the cervix are the most common, malignancy of columnar epithelium (adenocarcinoma) is seen in about 10–20% of women. To avoid missing adenocarcinomas, the columnar epithelium should be carefully assessed for the persistence of dense, chalky white areas.

The presence of ulcers on the cervix may be due to bacterial or viral infections or due to malignancy. A malignant ulcer may have acetowhite areas on it, but this is not always the case. When in doubt, it is prudent to categorize an ulcer as suspicious of cancer and arrange for referral.