Visual Inspection with Acetic Acid and Camera, or VIAC, is an effective way to prevent cervical cancer in women age 30-50 years old. It involves examining the opening of the womb, or the cervix, for changes that might lead to cancer. If these changes are detected early, the cells can be eliminated before they become cancerous. The cells are usually removed using a method called cryotherapy, or another method called LEEP. Both treatments are briefly described below.
VIAC examinations can also reveal possible advanced cervical cancer and certain noncancerous conditions such as chronic cervitis, pelvic inflammatory disease, and cervical polyps.
Visual inspection with acetic acid and treatment using cryotherapy or LEEP has been well-studied and is endorsed by the World Health Organization. WHO recommends using this “screen-and-treat” approach as an effective, low-cost way to reduce the incidence of cervical cancer in low-income countries. The disease is caused by the human papillomavirus (HPV), and it is the leading cancer killer of women in Zimbabwe and other sub-Saharan African countries.
The Zimbabwe Ministry of Health and Child Care has an established cervical cancer prevention program that offers VIAC screening and treatment at several of the nation’s major hospitals.
The VIAC procedure
- VIAC begins by swabbing the cervix with a vinegar-like solution of dilute acetic acid.
- If precancerous cells are present, the vinegar-like solution turns the abnormal cells white. This portion of the exam is the VIA—”visual inspection with acetic acid”—in VIAC.
- Next, a camera with a special lens is used to photograph the cervix. The photo helps identify the presence of abnormal, precancerous cells.
Cervical cancer arises in the transformation zone of the cervix
The opening of the cervix is a place where two different types of cells meet. The cells that line the cervical canal (the “endocervix”) are tall, narrow, columnar epithelial cells. The cells that cover the surface of the cervix (the “ectocervix”), on the other hand, are squamous epithelial cells, which are very flat.
The place where the columnar cells meet the squamous epithelium is called the transformation zone. Cell division occurs at this junction, and it is in this junction that cervical cancer
occurs. Abnormal cells can arise here spontaneously or they can be induced by exposure to carcinogens such as certain strains of hPV or the chemicals produced during tobacco use. If these abnormal cells are not cleared by the immune system, they can progress to cervical cancer.
Why precancerous cells appear white after swabbing with dilute acetic acid
When precancerous cells arise, they have particular characteristics. They have larger nuclei and less cytoplasm, which is evidence of increased cell division (i.e., mitosis). When the cervix is swabbed with dilute acetic acid, the acid denatures the proteins in the precancerous cells, causing them to clump. It also dehydrates the cells. Light cannot penetrate these dense cells and instead is reflected back, making the cells appear white.
A nurse trained in VIAC can perform the screening exam, but if the exam reveals precancerous changes, possible cancer, or an inconclusive finding, the patient must be seen by a doctor for further care. If the precancerous cells are detected early enough, they are removed using either cryotherapy or LEEP, depending on their extent.
Cervical cancer develops over many years, passing through several stages. The earliest of these is the period in which abnormal cells are present but not yet cancerous. This precancerous stage is called cervical intraepithelial neoplasia (CIN). It is divided into three parts according to the degree of change present in the abnormal cells: CIN 1, CIN 2, and CIN3.
- CIN 1: The cells are mildly abnormal; they are not treated because they often clear up when left alone;
- CIN 2: The cells are moderately altered;
- CIN 3: The cells show a severe degree of change.
Women identified through VIAC screening as having CIN 2 and CIN 3 stage precancer should receive treatment, usually using cryotherapy or LEEP.
Cryotherapy, also called cryocautery, destroys precancerous cells by freezing them with ice-cold gas. It is used when the acetic-acid-induced white areas cover less than 75% of the ectocervix and do not extend into the endocervix. It is a simple outpatient procedure, and clients can go home the same day.
Note: After cryotherapy, a disharge from the vagina might continue for two to four weeks. It is generally a mild discharge and does not need treatment. But if it persists, the woman should see a doctor and a vaginal swab taken for culturing.
LEEP (Loop Electrical Excision Procedure)
LEEP removes abnormal areas from the cervix using a thin heated electrical wire that is passed through transformation zone. It is done under local anesthetic on outpatient basis. The affected tissue is sent for histological review. The margin of the excision is coagulated during the procedure, resulting in minimal bleeding. LEEP is used when the white areas cover more than 75% of the transformation zone or extend into the endocervix.
Both treatments have a healing period of two to four weeks, with certain restrictions on a woman’s activity during that time. Complete healing generally takes about a month.
A few women might experience after-effects that must be treated at a health facility. Following either procedure, a woman should return to the treatment location after about six weeks to be checked and to receive her laboratory report.
After any of these treatments
- Ask the doctor or nurse what to expect during the period of healing. Should you expect a discharge and how long will it last?
- What activities is it OK for you do and what activities should you avoid?
- What signs should you watch for that tell you you should return to the doctor?