VINEGAR AND SOME INNOVATION BATTLE GEARS AGAINST CERVICAL CANCER By Maria Kristina D.

Siuagan, RN

Cervical Cancer is considered to be one of the major causes of morbidity and mortality in the world today. In the Philippines, it is regarded as one of the leading cancers afflicting Filipinas. For almost five decades, there had been a steady surge of mortality rates, which continue to rise even in the recent years. Such has been attributed to several risk factors that increase the chance of developing the disease. Before discussing further, what is there to know about this illness? Cervical Cancer is a disease that involves the cervix. The cervix is the neck-like opening to the uterus, which is connected at the top of the vagina. The most common site of cellular dysplasia (abnormal cell proliferation innate to any cancer), however, occurs in the external end of the structure. There are several types of cervical cancer that may develop in women, and squamous cell carcinomas are accounted as the most common variants to occur. On the other hand, Adenocarcinomas (arising from the endocervical glands) are forms of cervical cancer that are less likely to occur, but are said to be the most difficult to identify. There are several factors that give rise to this disease that put women at risk. Most often than not, some form or degree of cervical irritation will be identified before the actual diagnosis of cervical cancer takes place. According to medical experts, the major risk factor nowadays, for developing cervical cancer, is a Human Papilloma Virus (HPV) infection. This virus accounts for almost 90% of all identified cervical cancer cases. Aside from that, other predisposing factors also include having multiple sex partners, promiscuous lifestyle or practices, sexual relations with promiscuous individuals, or starting sexual intercourse at a very young age. Those women belonging to the lower socio-economic status are also considered to be at high-risk of developing such disease. Other etiological factors include infection from Sexually Transmitted Diseases (STDs), smoking, and untreated cervicitis (cervical inflammation). Unlike other common reproductive system disorders, Cervical Cancer is a slow and progressive disease that may take even five to ten years of elapse before actual detection. Several signs and symptoms may include bleeding after sexual intercourse, polymenorrhea (increased frequency of menstrual bleeding), foul-smelling or malodorous vaginal discharge, and pain that can only manifest during the advanced stages. Meanwhile, while these manifestations are highly indicative of cervical cancer, however, further cytological evaluation should be employed in order to rule out other kinds of cervical diseases. Cervical cancer is preventable. As a matter of fact, several diagnostic methods are now utilized in order to facilitate early detection before the disease reaches its more advanced stages. A common diagnostic examination performed in women to achieve such goal is the Pap Smear Test. This method involves collection of tissues, which will be examined under cytological studies, from suspicious areas. Other diagnostic tests include Endocervical Curettage and Cone

Biopsy. Apparently, these examinations are indispensable in order to detect cervical cancer. However, such procedures may cause a lot of money. The challenge to employ these diagnostic procedures lies within the financial capabilities of every Filipino woman who would avail them. Aside from that, necessary local government funding is deemed necessary in order to make these diagnostic tests readily available up to the grassroots levels. Unfortunately, given the status of most women thriving beneath the poverty line, it may become a challenge to dedicate sufficient financial allotment for such tests, even though they are performed only once or a couple of times a year.

THE SINGLE VISIT APPROACH VIA/CRYOTHERAPY With more women in the Philippines missing the great opportunity to be tested for initial cervical abnormalities (that may be suggestive of cancer) due to financial constraints, innovative measures should be explored and taken into great consideration. Such initiative may benefit all Filipino women, especially those belonging to poor families and far-flung communities. In line with this, the Single Visit Approach, which combines VIA and Cryotherapy, should be the next target of local medical practice and government units. The Single Visit approach is comprised of Visual Inspection with Acetic (VIA) that employs the use acetic acid or VINEGAR. It is utilized in conjunction with Cryotherapy, a procedure which involves the use of a metal probe programmed in an extremely low temperature. Nitrous oxide or carbon dioxide, either of which can be both obtained from soft drink power plants, may be used as the main chemical component for freezing pre-cancerous cells and suspected tissues. By using only vinegar, cotton swabs, and good light source, these combined methods are considered as effective as Pap Smear. In case the woman yields a positive result, which may indicate presence of pre-cancerous lesions, she could be treated on the same day of visit with Cryotherapy. Altogether, these methods can work as tandem of screening and treatment modalities. The Single Visit approach was developed by medical experts from the John Hopkins University and is being utilized by several other countries namely Thailand, Ghana, and Zimbabwe. It is considered a low-cost screening and treatment procedure combined and implemented by way of single visits at proximal community health centers. In addition, results can be obtained and validated on the same day of the examination. Hence, this paves way to more prompt detection of cervical abnormalities. Not to mention, this would also enable Filipino women to save as much time and viable financial resources as they can. One depicted disadvantage of the said modality, however, is the occurrence of false positive results upon application of vinegar or acetic acid. In turn, the woman gets an unnecessary cryotherapy treatment. However, freezing off suspicious cervical tissues were said to be 90% safer as compared to performing routine biopsies, which may cause massive bleeding. Apart from that, the only noted side-effect from VIA and Cryotherapy is a stinging or tingling sensation in the womans genital organ that resolves after a week.

VIA and Cryotherapy are considered to be semi-specialized procedures. Hence, they can be readily performed by any trained and certified health professional. This may serve as a new avenue of community employment for nurses, under the developing specialization of reproductive health practice. Could the SINGLE VISIT APPROACH of VIA and Cryotherapy be the next breakthrough in battling cervical cancer in the grass root levels? Why not! This shall be recommended for review and deliberation by medical and nursing professionals alike to ensure fast, accurate, and economical provision of cervical cancer detection. In addition to beneficial results for the community, this can also be an opportunity for nurses to become employed in the community and public health settings and could somehow alleviate unemployment predicaments among nurse professionals. Coupled with comprehensive delivery of information directed towards prevention and awareness, the Single Visit Approach for Cervical Cancer prevention is really something everyone should look forward to.

Copyright by Maria Kristina D. Siuagan, RN