Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment / Activity 6

The steps to determine eligibility for ablative treatment require addressing the following questions:

1. Is the SCJ fully visible?
2. Is the SCJ located on the ectocervix or at the external os?
3. Is the size of the lesion (when a lesion is present) less than 75% of the ectocervix?
4. Does the lesion (when a lesion is present) extend to the vagina and/or to the endocervix?
5. Is there any suspicion that the lesion could be an invasive cancer?

The examination of the patient should try to address these questions. The setup, consumables and equipment required, patient preparation, and the steps of the examination are exactly the same as those described for VIA.

On the basis of the VIA findings, if the response to questions 1, 2, and 3 above is YES and the response to questions 4 and 5 is NO, then the patient is eligible for ablative treatment. If cryotherapy is being used, an additional question to be answered is whether the tip of the largest cryotherapy probe can adequately cover the entire transformation zone. Usually, a visual assessment can answer this question. When in doubt, apply the probe on the transformation zone and confirm.

Ablative treatment should not be performed in presence of active acute infection of cervix. The patient should be advised appropriate antibiotics to treat infection and recalled for treatment after the course of antibiotics in complete.