This Sexual and Reproductive Health and Rights (STARS) - Cervical Cancer Screening and Treatment skills module trains nurses, midwives, and clinical officers to become confident and competent in performing visual inspection with acetic acid (VIA), and thermal ablation of cervical pre-cancer lesions as part of cervical cancer screening and treatment procedures.
Pelvic Examination and Inspection of Cervix[edit | edit source]
Prepare the patient for a pelvic examination.
Before each step, tell the woman what you will do and what she may feel.
Insert a pelvic speculum lubricated with a water-based lubricant.
Look at the cervix, and note any abnormalities, such as:
- discharge from the os
Record the findings.
Visual Inspection with Acetic Acid (VIA)[edit | edit source]
Conduct a naked eye examination of the cervix:
- Is the transformation zone (TZ) fully visible?
- Is the whole lesion visible?
- Does the lesion extend into the endocervix?
- Can the probe reach the whole lesion?
Characterize the lesion by size and site:
- A type 1 TZ is completely ectocervical and is therefore fully visible.
- A type 2 TZ is partially endocervical but is still fully visible. It may be shallow and within range of an ablative probe or may extend beyond reach of an ablative probe.
- A type 3 TZ extends out of view up the endocervical canal, i.e., the squamocolumnar junction (SCJ), and is not fully visible.
- Test Negative
- Test Positive
- Suspicious for Cancer
Thermal Ablation[edit | edit source]
Determine if lesion is suitable for thermal ablation:
- the TZ is fully visible, the whole lesion is visible and it does not extend into the endocervix, or
- the lesion is type 1 TZ; or
- the lesion is type 2 TZ
Inspect the thermocoagulator (TC) before use:
- Inspect for visible damage to the TC handle, battery and probes and all its connections.
- Make sure that no parts are missing or loose.
- Make sure that connecting elements between instruments function properly.
- Verify that the TC and accessories are in good working condition.
Apply the ablative probe for 20–40 seconds to lesion until epithelial and stromal destruction is observed (multiple applications may be required).
Follow the manufacturer's instructions for use for your thermocoagulator device.
Post-Procedure Care[edit | edit source]
Check to ensure the woman is not having excessive cramps.
Give patient a sanitary napkin.
Advise patient about post-treatment care and follow-up instructions:
- Expected symptoms after treatment include mild cramping and vaginal discharge
- Advise woman to abstain from sexual intercourse for 4 weeks after treatment and to present to the clinic in case of any concerning adverse effects, including foul smelling discharge, severe pain, heavy bleeding, or fever
- All women who have received treatment should receive post-treatment follow-up at 1 year to ensure effectiveness of treatment
Complete the documentation to record the treatment.
Reprocessing the Thermocoagulator[edit | edit source]
*** Follow your device manufacturer's instructions on the cleaning and disinfection process before use.**
Self assessment[edit | edit source]
References[edit | edit source]
Sections of the STARS - Cervical Cancer Screening and Treatment module are copied or adapted from: Training of health staff in VIA, HPV detection test and cryotherapy - Facilitators' guide. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC-BY-NC-SA-3.0 IGO; and WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. Geneva: World Health Organization; 2019. Licence: CC-BY-NC-SA-3.0 IGO. The World Health Organization (WHO) is not responsible for the content or accuracy of any translation. The original English edition shall be the binding and authentic edition.
- Training of health staff in VIA, HPV detection test and cryotherapy - Trainees' handbook. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC-BY-NC-SA-3.0 IGO. The World Health Organization (WHO) is not responsible for the content or accuracy of any translation. The original English edition shall be the binding and authentic edition.
- WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. Geneva: World Health Organization; 2019. Licence: CC-BY-NC-SA-3.0 IGO. This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition.
- HTU-IFU-002 TC Thermocoagulator Instructions for Use Rev B 04/2021 CN 0354 [product insert]. Liger Medical; 2021.
- Mungo C, Osongo CO, Ambaka J, Randa MA, Omoto J, Cohen CR, Huchko M. Safety and Acceptability of Thermal Ablation for Treatment of Human Papillomavirus Among Women Living With HIV in Western Kenya. JCO Glob Oncol. 2020 Jul;6:1024-1033. doi: 10.1200/GO.20.00035. PMID: 32634066; PMCID: PMC7392781.