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Cancer of the cervix

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HealthWiki > A Book for Midwives > Chapter 20: The Pelvic Exam: how to examine a woman's vagina and womb > Cancer of the cervix


Cancer of the cervix can be a deadly disease, but if it is found and treated early, it can usually be cured. Treatment to stop cancer is simple in the early stages. A trained health worker can freeze and destroy the abnormal cells. If it is further along a doctor or nurse can remove or destroy the diseased parts of the cervix in a clinic or medical center. After treatment, the woman will usually get better. But hundreds of thousands of women die every year from this cancer, because they did not get treatment.

Contents

Why do so many women die if the disease is preventable and easily treated?
  • Poor communities cannot afford to train health workers to test women for cancer or HPV and make sure women get the treatment they need.
  • Rural and poor women may not be able to travel to medical centers that do testing and treatment.
  • Women and men do not know that they can prevent cancer of the cervix by protecting themselves from HPV. Wearing condoms can prevent both women and men from getting HPV.
  • Some women cannot protect themselves from HPV because they do not have access to condoms. Some women cannot protect themselves because they are forced to have sex or to have unsafe sex. Some couples do not like to use condoms.

Cryotherapy treatment to prevent cervical cancer

Cryotherapy is a treatment that freezes any abnormal cells on a woman’s cervix so they do not develop into cancer. Cryotherapy uses a tool called a cryoprobe with carbon dioxide or nitrous oxide gas to freeze the surface of the cervix. Freezing destroys the abnormal cells.

Cryotherapy is used after a woman has a positive vinegar test or a positive Pap test.

Negative vinegar test
(no white patches)
Positive vinegar test (white patches) After cryotherapy treatment cervix returns to normal
(no white patches)

Cryotherapy is very safe and has helped save many thousands of women’s lives. It is not painful, though some women say they feel a mild cramping like menstrual cramps, and others say they feel cold in their vagina. Cryotherapy will not affect a woman’s ability to enjoy sex or to have children, although the woman should avoid having sexual intercourse for 4 weeks after cryotherapy treatment.

A woman should NOT get cryotherapy if she:

barrel
cryoprobe
tip
tank of coolant gas
  • is pregnant. It is best if she waits until 12 weeks after giving birth to have cryotherapy.
  • has PID. Once her PID has been treated, she can have cryotherapy.
  • is currently having heavy monthly bleeding. Heavy bleeding can make it difficult to see the white patches on the cervix from the vinegar test. She should wait until her bleeding has lessened or ended to have cryotherapy.

The cryoprobe is connected to a tank of coolant gas. The barrel of the cryoprobe is inserted into the vagina and the tip is held against the cervix. The gas cools the cryotip which freezes the area, and destroys the abnormal cells. This is done twice, waiting 5 minutes between the 2 freezing treatments.

How to do cryotherapy

cervix
(opening of womb)
White patch on cervix after vinegar test
Area of cervix covered by cryotip
  1. Insert a speculum into the vagina and do a vinegar test. The vinegar will make any abnormal cells on the cervix show as white patches. Make sure the white patch:
    • is not too large. The white patch cannot go more than 2 mm beyond the area covered by the tip of the cryoprobe. (2 mm is about the thickness of a grain of rice.)
    • does not go inside the opening of the cervix.
    For either of these, cryotherapy will not work. The woman will need a different kind of treatment and should go to a medical center.
  2. Insert the barrel of the cryoprobe into the vagina, and place the tip at the center of the cervix. Be careful not to let the probe touch the sides of the vagina. This can freeze the vaginal wall and may cause harm.
    Note: If you cannot insert the cryoprobe without touching the vaginal wall, remove the speculum, cut a small hole in the tip of a condom and place it over the speculum. Re-insert the speculum. This will protect the walls of the vagina.
  3. With the tip of the cryoprobe on the center of the cervix, check again to make sure the white patch does not go more than 2mm beyond the area covered by the tip.
  4. Set a timer for 3 minutes. Start the gas coolant, keeping the tip of the cryoprobe pressed against the cervix. After about a minute or so, ice will form on the tip of the cryoprobe and on the cervix. The frozen area will turn white.
  5. After 3 minutes, stop the flow of gas coolant. You will see that the frozen area goes 4 to 5 mm beyond the cryotip.
  6. Do not remove the probe immediately. Wait until the cervix has thawed enough for the cryotip to fall away from the cervix by itself. If you remove the cryoprobe before the cervix is thawed, it will tear tissue off the cervix. After the cryotip falls away, gently rotate the probe to remove it.
  7. Keep the speculum in place and let the cervix thaw for 5 minutes or until it becomes pink again.
  8. After it has thawed, insert the cryoprobe again and place the cryotip at the center of the cervix. Set a timer for 3 minutes, and start the gas to begin a second time of freezing.
  9. At the end of the second freeze, stop the flow of gas. Allow the cervix to thaw again and the cryotip to fall away before removing the probe. Gently rotate the probe on the cervix to remove it. The frozen area will be white and then returns to pink as it thaws.
  10. Remove the speculum and clean and disinfect it and the cryoprobe. See the section on cleaning and sterilizing tools.

After cryotherapy a woman should avoid having sex or putting anything inside her vagina for 4 weeks. (Use pads or clean cloths, not tampons, for monthly bleeding or any vaginal discharge.) This is to prevent infection. If she cannot abstain from sex, advise her to use a condom.

She may have mild cramping like a menstrual period. She may have a watery discharge from her vagina for up to one month after. Reassure her that these are normal signs and not dangerous.

The woman should have another vinegar test for abnormal cells in 1 year to make sure the cryotherapy worked. If the vinegar test still shows white patches on her cervix, cryotherapy treatment can be done again.

WARNING! Complications from cryotherapy are very rare, but if a woman has any of these signs after cryotherapy, get medical help:

  • Fever (temperature higher than 38° C / 101° F) for more than 2 days.
  • Severe abdominal pain or strong cramping for more than 2 days.
  • Heavy bleeding from the vagina for more than 2 days.
  • Bad smelling discharge from the vagina.



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