What is a Cone Biopsy?

A cone biopsy is a comprehensive form of a cervical biopsy. It is known as a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. A cone biopsy allows the removal of abnormal tissue that is high in the cervical canal. A small amount of normal tissue around the cone-shaped wedge of the abnormal tissue is also removed so that a margin free of abnormal cells is left within the cervix.

A cone biopsy could:

• Remove a thin or a thick cone of tissue from the cervix, depending on how much tissue needs to be examined.
• Be used to diagnose and at times treat abnormal cervical tissue. The abnormal tissue is removed and sent to a laboratory to be examined.

A sample of tissue could be removed for a cone biopsy using:

• A surgical knife (scalpel).
• A carbon dioxide (CO2) laser.
• Loop electrosurgical excision procedure (LEEP).

How it is done

A cone biopsy is generally performed as an outpatient procedure. You do not have to stay overnight at the hospital.

The hospital or surgery center might send you instructions on how to get ready for your surgery. Or a nurse might call you with instructions before your surgery.

You will be required to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie down on your back on an examination table with your feet raised and supported by footrests (stirrups). Your doctor will insert a lubricated tool known as a speculum into your vagina. The speculum gently spreads apart the vaginal walls, enabling the inside of the vagina and the cervix to be examined.

Medicine that makes you unconscious (general anesthesia) or that makes the whole genital area numb (regional anesthesia, like a spinal or epidural) might be used.

A cone biopsy using LEEP might be performed in your doctor's office with an injected medicine that numbs the cervix (cervical block). If a cervical block is used, oral pain medicine or pain medicine is given into a vein (intravenous, or IV) might be used along with the local anesthetic.

What To Expect After Surgery

Right after surgery, you will be taken to a recovery area where nurses will care for and monitor you. You probably will stay in the recovery area for one to four hours, and then you will go home. In addition to the special instructions from your doctor, your nurse will give you information to help you in your recovery. You will probably go home with a sheet of care instructions that include who to contact if a problem comes up.

Most women are able to return to their normal activity level in one week.

If you have a cone biopsy, you need regular follow-up Pap tests and colposcopic exams. A Pap test should be repeated every four to six months or as recommended by your doctor. After several Pap test results are normal, you and your doctor could decide how often to schedule future Pap tests.

After a cone biopsy

• Some vaginal bleeding is normal for up to one week.
• Some vaginal spotting or discharge (bloody or dark brown) might happen for about three weeks.
• Pads should be used instead of tampons for about three weeks.
• Sexual intercourse should be avoided for about three weeks.
• Douching should not be performed.

When to call your doctor

Call your doctor if you have one of these symptoms:

• A fever
• Moderate to heavy bleeding (more than you would generally have during a menstrual period)
• Increasing pelvic pain
• Bad-smelling or yellowish vaginal discharge, which might point to an infection

Why It Is Done

A cone biopsy might be performed after a Pap test shows moderate to severe cell changes and:

• The abnormal tissue can’t be seen with colposcopy but was found in cells collected from a biopsy of the cervical canal, or the abnormal tissue seen with colposcopy extends high into the cervical canal. A cone biopsy is performed to remove and examine the abnormal tissue.
• The abnormal cells found on a Pap test can’t be seen with colposcopy or found in cells collected from a cervical biopsy. The cone biopsy might be used to diagnose the cause of the abnormal cell changes and remove the abnormal tissue at the same time.
• Cervical cancer is suspected based on the Pap test results, colposcopy, and cervical biopsy. A cone biopsy could determine the extent, depth, and severity of the cancerous tissue and could guide treatment decisions.

How Well It Works

The cone biopsy might remove all of the abnormal tissue. This would mean that no further treatment is required other than follow-up Pap tests.

The edges of the cervical tissue removed by a cone biopsy might contain abnormal cells, meaning that abnormal tissue might be left in the cervix. The cone biopsy might be repeated to remove the remaining abnormal cells. If follow-up tests show normal cells, then no further treatment might not be needed. If abnormal cells remain, you and your doctor might discuss other treatments, like the removal of the uterus (hysterectomy).

The cone biopsy might show cancer that has grown deep into the cervical tissue (cervical cancer). Further treatment, like surgery, radiation, or chemotherapy, will be recommended.

Risks

A cone biopsy is a surgical treatment with a few risks.

• A few women might have severe bleeding that needs further treatment.
• Narrowing of the cervix (cervical stenosis) that causes infertility might happen, but that is rare.
• The inability of the cervix to stay closed during pregnancy (incompetent cervix) might happen. Women who have had a cone biopsy might have an increased risk of miscarriage or preterm delivery.

What To Think About

Cone biopsy (conization) could be performed using a carbon dioxide laser or loop electrosurgical excision procedure (LEEP). One possible disadvantage of these methods is that the abnormal tissue at the margin with the normal tissue could be changed by the heat from the laser beam or the wire loop. This might make the lab study of the biopsied tissue more difficult.

The healing and scarring process after a cone biopsy might make it hard to identify abnormal tissue in the future.

Hill Regional (HRH) Hospital is here to assist all your medical needs with specialists and surgeons trained and experienced in the most advanced treatments. Our highly qualified doctors, nurses, and administrators are dedicated to caring for you with compassion in our state-of-the-art facilities.

Call us on 254-580-8500 to book an appointment with our specialist doctors.