Cone biopsy for cervical cancer detection and treatment

What is Cone Biopsy?

cone biopsyCone biopsy, also known as cervical conization, is a surgical procedure where a cone-shaped tissue sample is removed from the cervix and examined under the microscope. It is a more extensive form of cervical biopsy which is usually done when a Pap test indicates moderate to severe cell changes.

Purpose of cone biopsy

You may be advised by your doctor to have a cone biopsy for to the following reasons:

  • When abnormal tissue collected in a cervical biopsy cannot be seen through colposcopy
  • When abnormal tissue seen in colposcopy extends high into the cervical canal
  • As a diagnostic procedure to determine the length, severity, and extent of cancerous cells when cervical cancer is suspected based on Pap tests, cervical biopsy, and colposcopy
  • To examine abnormal cell changes and remove them at the same time
  • Treatment of very early stage cervical cancer

Preparation for cone biopsy

Commonly, you may be given a general anesthesic so that you will be unconscious during the procedure. Regional anesthesia may also be given during cone biopsy, which will numb the entire genital area. When using the Loop Electrical Excision Procedure (LEEP), cone biopsy may be done under cervical block (anesthetic procedure that numbs the cervix) together with intravenous pain medications. To avoid risks involved with anesthesia, you will be asked to take nothing by mouth after midnight on the day of the operation.

Cone biopsy is usually done on an outpatient basis. You can expect to be discharged a few hours after the procedure. An overnight stay in hospital is usually not necessary.

Before surgery, you will be asked to sign an informed consent form, ensuring that you understand the benefits and risks involved in the procedure. You will have to remove your clothes from the waist down and you will be draped with a sterile cloth or paper. You will be positioned lying on your back with your feet in stirrups (also known as the lithotomy position). An instrument called a speculum will be inserted into your vagina by your doctor, which will spread the vaginal walls and allow your vagina and cervix to be seen clearly.

The procedure can be done in three different ways. The first method is known as cold- knife conization, which is the removal of a cone- shaped tissue sample using a scalpel. Another method is called laser conization, where the sample is removed using a carbon dioxide laser. Meanwhile, a technology called Loop Electrosurgical Excision Procedure (LEEP) uses low-voltage, high-frequency radio waves to obtain the tissue.

Taking care of yourself after a cone biopsy

For at least 4-6 weeks after surgery, you should remember to avoid the following:

  • Using tampons
  • Douching
  • Sexual intercourse

While it is normal to feel slight cramping, discomfort, and some vaginal bleeding for up to a week, it is important to call your doctor when you experience the following symptoms:

  • Moderate to heavy vaginal bleeding
  • Persistent pelvic pain
  • Fever
  • Yellowish or foul smelling vaginal discharge

Risks of cone biopsy

Rarely, cone biopsy may result in more serious complications such as:

  • Uncontrolled bleeding that may lead to hysterectomy (removal of the uterus)
  • Reaction to anesthesia
  • Infection
  • Cervical stenosis (narrowing of the cervix) which may cause infertility
  • Incompetent cervix (inability of the cervix to remain closed) which may cause miscarriages and premature births in the future

Further Treatment after a cone biopsy

If cone biopsy is successful in removing all of the abnormal tissue, then no further treatment is necessary, other than follow up Pap tests every 4 to 6 months or as recommended by your doctor. On the other hand, if precancerous or cancerous cells remain, you can talk to your doctor regarding further treatments such as a repeat cone biopsy, hysterectomy, radiation, or chemotherapy.

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