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Cervical cancer represents the fourth most common cancer among women worldwide and eighth most commonly occurring cancer overall. There were 5,69,847 new cases and 3,11,365 deaths reported worldwide due to cervical cancer. In India cervical cancer is the second most common cancer among women. India has the highest incidence rate of cervical cancer as 22 per 1,00,000 women per year. Every year in India, 1,22,844 women are diagnosed with cervical cancer and 67,477 die from the disease 2. 80% of cervical cancer cases occur in low and medium-income countries (LMIC). Morbidity and mortality of cervical cancer can be definitely decreased because most cases of cervical cancer are preventable by routine screening and treatment of precancerous lesions.

Various screening modalities for cervical precancerous lesions are Pap smear, Liquid based cytology (LBC), Visual inspection with acetic acid (VIA)/ Visual inspection with lugol’s iodine (VILI) and HPV testing. Although population-based programs offering pap test every 3 to 5 years have reduced cervical cancer incidence and mortality in high income countries, such programs have been less successful in reducing cervical cancer burden in LMICs due to poor organization, lack of coverage and lack of quality assurance. In developing countries, only approximately 5% of eligible women undergo cytology-based screening in a 5-year period. This is because there are very few trained and skilled professionals to implement screening programs effectively. Further, due to delay in reporting of cytology results, women either do not collect their reports or do not receive treatment. The challenges in introducing high quality cytology screening in LMICs have led to evaluation of alternative screening approaches such as VIA as a “single visit screen and treat”.

WHO has recommended VIA as an alternative to PAP smear in Low resource setting. It is cheap and non-invasive and can be done in low level health facilities. More importantly, VIA provides instant results and those eligible for treatment can receive treatment of the precancerous lesions using ablative procedure on the same day and in the same health facility. This “screen and treat” method ensures adherence to treatment soon after the diagnosis, so number of lost to follow up patients are reduced. VIA detects abnormal areas on the cervix by applying 3- 5% acetic acid. Acetic acid dehydrates the abnormal cells containing increased nuclear material and protein which turn aceto white. Normal cells containing glycogen remains normal. It has a Sensitivity of 67.65% and specificity of 84.32%. VIA Lesions that requires treatment are distinct, well defined, dense (opaque, dull or oyster white) acetowhite areas with regular or irregular margins close to or abutting the squamocolumnar junction in the transformation zone or close to the external os if the SCJ is not visible.

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Treatment modalities available for treatment of precancerous lesions includes ablative and excisional procedures. Ablative methods include cryotherapy and thermocoagulation. Excisional method includes Cold knife conization, large‐loop excision of the transformation zone (LLETZ) and Loop Electrosurgical excision procedure (LEEP). More conservative ablative methods are preferred in low grade lesions and in younger patients of child‐bearing age. Ablative methods are simple treatment methods that can be performed as an out‐patient basis. Cryotherapy is one of the ablative procedures that uses freezing gas to destroy precancerous cells on the cervix by crystallization of intracellular fluid. Freezing is done by using gases CO2 or N2O. It has an efficacy of 85-92%5. It does not require anesthesia and electricity and it is appropriate for non -physician provider. But it has certain disadvantages like it requires purchase of compressed gas, supply of which is expensive and often erratic in many LMICs, heavy weight of gas cylinder (15-20 Kg) and post procedure vaginal discharge. So, cryotherapy has failed to adequately address the problem in LMICs.

Globally, there is a pressing need for a simple treatment for cervical precancerous lesions. Current methods are expensive and difficult to implement on a large scale. In the given context, thermocoagulation represents an attractive alternative for the treatment of cervical precancerous lesion. It can be used in a single visit “screen and treat” approach and management of low grade cervical precancerous lesions. Thermal coagulation (also known as cold coagulation) has been used as an alternative ablative method for treating CIN lesions since 1980s. However, this method has resurgence in view of easily portable and light equipment, less treatment time, faster patient turnover, less discomfort, use of minimal amounts of electricity as consumable, less vaginal discharge following treatment and a similar efficacy in treatment of ectocervical precancerous lesions as compared to cryotherapy.

Thermocoagulation is a feasible approach for treatment of precancerous lesions in LMICs. It destroys cells by causing tissue necrosis. Treatment is performed by heating the tissue to 100˚C for a period of 60 seconds. It has an efficacy of 85-95% 5. It has certain advantages like it precisely destroys the abnormal area under direct visual control, it requires shorter treatment time than cryotherapy, it does not require compressed gas and it’s a light weight device of approximately 3.6 kg that makes it easy to handle. It is being tried in certain LMICs like Bangladesh, Malawi, Brazil, Madagascar, Nigeria, Uganda, the United Republic of Tanzania and Zambia. There is still limited data available from India regarding thermocoagulation and its comparison with cryotherapy as a method for treatment for low grade lesions, hence this study was planned to evaluate its safety and efficacy and to compare it with that of cryotherapy.

#heathcare #medical #medicalcare #pharmaceuticals #healthcareprofessional #nurses #healthprofessionals

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