A cone biopsy is a surgical procedure in which a cone-shaped tissue sample from the cervix is removed for examination. Also called cervical conization, a cone biopsy is done to diagnose cervical cancer or to remove cancerous or precancerous tissue.
The cervix is the neck-shaped opening at the lower part of the uterus. The American Cancer Society estimated that in 2003, approximately 12,200 women would be diagnosed with cancer of the cervix and 4,100 women
A cone biopsy is performed to diagnose cancer of the cervix or to detect precancerous changes. The procedure is often recommended if a Pap test indicates the presence of abnormal cells. In some cases, a cone biopsy may be used as a conservative treatment for cervical cancer for women who wish to avoid a hysterectomy (surgical removal of the uterus).
The risk of developing cervical cancer increases with age through a woman's 20s and 30s; the risk remains about the same for women over the age of 40. Minority women and women of low socioeconomic status have higher rates of cervical cancer and an increased mortality rate. According to the Centers for Disease Control and Prevention (CDC), African-American, Asian-American, and Hispanic women have a higher-than-average incidence of the disease, while African-American and Hispanic women have a higher rate of cervical cancer-related death.
The procedure is performed with the patient lying on her back with her legs in stirrups. General anesthesia is commonly used, although regional (spinal or epidural) or local anesthesia may also be used. A speculum is inserted into the vagina to hold it open during surgery.
There are several different methods that may be used to perform a cone biopsy. Cold-knife conization is the removal of a cone-shaped wedge of tissue with a scalpel (surgical knife). The tissue may also be removed using a carbon dioxide laser (called laser conization). A loop electrosurgical excision procedure (LEEP) uses low-voltage, high-frequency radio waves to excise the tissue. Some surgeons choose to cover the open cervical tissue with flaps of tissue stitched into place.
The tissue sample will then be examined under a microscope for the presence of cancerous cells. If abnormal cells are found around the edge of the biopsy, then further surgery will be required to excise any remaining cancer. If there is evidence of invasive cancer (i.e., the cancer has spread to surrounding tissues), then other treatments (more extensive surgery, chemotherapy, and/or radiation) may be recommended.
A number of tests may be performed prior to cone biopsy to determine if precancerous or cancerous cells exist. A Pap test involves scraping the cervix for a sample of cells and then staining and examining the cells for any abnormalities. Colposcopy is a procedure that allows a physician to examine a woman's cervix and vagina using a special microscope called a colposcope. A cervical biopsy involves the extraction of a smaller tissue sample and is less invasive than a cone biopsy. Based on the results of these tests, a cone biopsy may be indicated if moderate to severe cell abnormalities are found.
As cone biopsy is commonly performed under general anesthesia, the patient is usually instructed to refrain from eating and drinking after midnight on the day of surgery.
After the procedure, the patient may experience some cramping, discomfort, or mild to moderate bleeding. The biopsy site may take up to six weeks to completely heal. The patient will be instructed to avoid intercourse, tampons, and douches for at least three weeks following the procedure.
Bleeding during and after cone biopsy is the most common complication. Rarely, uncontrolled bleeding during the procedure may result in an emergency hysterectomy. Other potential complications include reaction to the anesthesia, infection of the biopsy site, injury to the uterus or other tissues, cervical stenosis (when the cervical canal narrows or becomes closed), and failure to remove all cancerous tissue. If too much tissue is removed during a cone biopsy so that the internal opening of the cervix to the uterus (called the internal os) is affected, a woman may have difficulty carrying a pregnancy to term, increasing her risk of miscarriage or premature birth.
Numerous studies have indicated that cone biopsy is successful in excising all cancerous tissue in 90% of patients with cervical cancer.
Two to 8% of women who undergo a cone biopsy will experience bleeding for up to two weeks. One study found that cervical stenosis occurs at a rate of 3–8%, depending on the method of conization.
Cryotherapy (freezing and destroying of abnormal cells) or laser vaporization (using a laser to destroy abnormal cells) may be used to treat early-stage cancer. A hysterectomy may be necessary to remove more invasive cancer. In a subtotal hysterectomy, only the uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries, fallopian tubes, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends on how far the cancer has spread. In all cases, menstruation stops and a woman loses the ability to bear children.
Brun, J. L., A. Youbi, and C. Hocke. "Complications, Sequellae and Outcome of Cervical Conizations: Evaluation of Three Surgical Techniques." Journal of Gynecology and Obstetrics and Reproductive Biology 31, no. 6 (January 10, 2002): 558–64.
Canavan, Timothy, and Nipa Doshi. "Cervical Cancer." American Family Physician 61 (March 1, 2000): 1369–76.
Soutter, W. P., et al. "Is Conservative Treatment for Adenocarcinoma In Situ of the Cervix Safe?" British Journal of Obstetrics and Gynaecology 108, no. 11 (November 2001): 1184–9.
American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org .
American College of Obstetricians and Gynecologists. 409 12th St., S.W., PO Box 96920, Washington, D.C. 20090-6920. http://www.acog.org .
"All About Cervical Cancer: Overview." American Cancer Society, 2003 [March 18, 2003]. http://www.cancer.org/docroot/CRI/CRI_2_1x.asp .
"Cone Biopsy (Conization) for Abnormal Pap Test." National Cervical Cancer Coalition, May 23, 2002 [cited March 18, 2003]. http://www.nccc-online.org/news_052302_9.asp .
Nyirjesy, Istvan. "Conization of Cervix." eMedicine, June 28, 2002 [cited March 18, 2003]. http://www.emedicine.com/med/topic3338.htm .
Ries, L. A., et al., (eds). "SEER Cancer Statistics Review, 1973–1999." National Cancer Institute, 2002 [cited March 18, 2003]. http://seer.cancer.gov/csr/1973_1999 .
Stephanie Dionne Sherk
A cone biopsy is usually performed by a gynecologist who specializes in the areas of women's general and reproductive health, pregnancy, labor and delivery, and prenatal testing. Tissue samples are analyzed by a pathologist who specializes in the diagnosis of diseases from microscopic analysis of cells and tissues. The procedure is generally done on an outpatient basis in a hospital or doctor's office.
I have had two sets of LLETZ treatments to my cervix one of which was about 7-8 weeks ago. Then on the 24th September 07 I had a cone biopsy...since then I have had severe bleeding and went to GP who prescribed strong antibiotics. The bleeding started to slow down but today while I was in work I began to feel the blood pouring out of me again and it is very heavy...I am getting no help from GP they just say that they don't think it is caused by my cone biopsy!! What is causing it then?? Argh! Doctors are useless sometimes..
Thank You
I have had a cone biopsy and also a leep done. but my hpv is still not going away now my doctor tells me they want to do a deep cone biopsy and but me to sleep. then do another leep and scrape the sides to see if she can get all the adnormal cells. What should I expect if she can't get them all and if I keep having adnormal pap smears with hpv.
thanks Terri
I had a laser cone biopsy at Sloan Kettering (NYC) in January 1995 when I was 16 weeks pregnant. The procedure was brand new then. I was the first at SK to have the surgery while being pregnant. NY Hospital was on alert in case I miscarried. Thank God I delivered my beautiful boy (by c-section) in June 1995. Surgeon was as aggressive as he could have been without causing miscarriage. 2 months after the surgery the cancer had come back, but not enough to be fatal, as it had been before the surgery (prognosis was 9 months to live!). I had a second procedure in August 1995 and have been cancer free ever since.
I went on to have two more kids - boy in 1998 and girl in 2000 - both delivered by c-section because scar tissue prevented my cervix from opening. Actually, doctors believe the scar tissue kept the babies inside!
I am so grateful for the skill of my surgical team and the person who developed the procedure!!
in colour and some pain, bloating at the same time and call my doctor about he said i must for check up
Thank you
Now the question that i really wanted to know is: DO I REALLY HAVE CANCER OR NOT? My Doctor says no, but is she telling me everything i need to know or not? I kinda get worried thinking about this.
Please some one could help answer this question for me Please.
I just had this procedure done this past Monday. It's a really easy procedure. I had pretty bad cramps the day after the surgery once the hospital meds wore off. They will fade. The back pain and leg pain is completely normal because of the way you're positioned during the surgery. My bleeding got heavier after about the 3rd day. And it's still going. Just take it easy and follow instructions. It's really not that bad :)
Found out cervix was left. Started having problems. Had Cone Biopsy done by Leep (loop electrosurgical excision procedure) on 08-26-10. Have excessive pain & minimal bleeding. Now almost week later, am passing clots. Do not know what to expect! When will this end?
All the best to everyone, I hope all works out okay.
Last Year I tried to get pregnant and had 3 miscarriages in a row all prior to 10 weeks. I was sent to a fertility clinic where everything tested fine but the specialist told me that the pregnancies could literally be falling out. This february I got pregnant again and the only difference was I was on progesterone once becoming pregnant for the first 12 weeks, I was carefully monitered and am now 30 weeks pregnant with a healthy baby girl. Im a bit nervous about preterm delivery but I feel pretty great. I hope this helps!
Good Luck to everyone!
Then came the cold knife cone..that was two weeks ago.
Yes,I know I did wrong but the fear that I had the night before the CFC I slept not a wink,and even knowing I was going to be put under I took a half of a .05 xanax,,which set not at all well with my ob-gyn,so much in fact that she almost was ready to cancel the surgery.I could not help it though,my fear far out-weighed my logic.
Just as the 1st three tries my discharge started out as a dark rust color,turning to gray-charcoal color,then black,with a fowl odor.I should have made an appointment to go back to the Dr. this Monday,but have kept putting it off.Now this morning I awoke to bright fresh red blood.It has been well over a year since my last normal period.So not sure what is going on.Except for this fear that I have of going to my ob-gyn.Does ANYONE have any sugguestions to help me get over this fear?? PLEASE!! A VERY SINCERE Thank you in advance for your help.
How long is going to take to stop the bleeding?
Thanks
. If your doctor takes a biopsy sample, he or she will put a thick, brownish-yellow paste on that area to stop any bleeding. When this paste mixes with blood, it forms a thick black discharge. It's normal to have this discharge for a couple of days after the procedure. It's also normal to have a little spotting for at least two days after a Biopsy.
Please ask for the anesthesia... I for one was not offered it.. and i endured pain, the procedure was very uncomfortable... It feels like severe cramps... a horrible.. horrible feeling...
My history is 10 yrs of clear pap smears, cervical cancer vaccine 5 years ago and my first pap came back 2 months ago with CIN3 carcinoma in situ, glandular cells (never detected until now, age 29). No kids yet, a few long term relationships. I have been trhough what i call trauma mainly becauase I want to have children later and doctors use scary terminilogy, and websites give you worst case scenarious. My GYNO is excellent and repeated to me that i do not have cancer but stages before cancer (precancerous) and early detection has resolved this. I have also asked surgeon, GYNO, GP lots and lots of questions to clarify my fears. Hope it is helpful..
Good news is - 90% of women have a full recovery from cone biopsy with no serious
concerns (REGARDLESS of whether they have abnormal cell CIN 2,3, or even cervical cancer). becuase it cuts out a section of skin this can be diagnostic (have cells gone beyond CIN stages) or a treatment (cuts out infection, abnormal cells, precancer cells, cancer cells).
Recovery and less infection- you can recover better and reduce infection by making sure your immune system is strong and you relax to recover, dont consume anything that will prolong healing. im trying vitamins vitamin C (immune system) and B, magnesium (cramps)
Pregnancy- cone biobsy of abnormal cells is not related to getting pregant but retaining a pregancy as it weakens the cervix. My GYNO said that when pregnant a stitch is put on cervix as a reinforcer to carry weight of baby after cone biop but this is not always necessary . Women who have had prolapsed wombs or multiple pregancies have also had a stitch to strenthen their cervix.
abnormal cells ONLY become cancerous if they spread deep into layers of tissue and other organs. Much like getting a mole removed and having the biopsy tested to check if surrounding skin has been effected by the cells, groups of abnormal cells also called lesion, carcinoma, tumor(benign/inactive or malignant/cancerous). I think since the cone biopsy is in the cervix it makes recovery complicated and more painful.
I have been going there for maybe 10 years now. No longer do I have that uncontrollable shaking fear. I am going to have my 2nd cone biopsy done this month. My doctor puts me under anesthesia and does it in the hospital. There is no reason that women should have to suffer. Insist on anesthesia. Gotta pay more out of pocket to get a more reasonable doctor? It's worth it.
I have been going there for maybe 10 years now. No longer do I have that uncontrollable shaking fear. I am going to have my 2nd cone biopsy done this month. My doctor puts me under anesthesia and does it in the hospital. There is no reason that women should have to suffer. Insist on anesthesia. Gotta pay more out of pocket to get a more reasonable doctor? It's worth it.
Thank You.
I am scheduled for a cone biopsy in just a few days. My doctor said no intercourse for 24 hours before the procedure and none for 3 or 4 weeks after.
After reading these posts, I am so scared that I feel nauseated. My doctor, whom I completely trust, said I would bleed for 3 to 4 weeks, but here I am reading about gushing blood, cramping in the legs, yeast infections, irregular periods. I will call and talk to her nurse tomorrow. I am having it on Friday and plan to be back at work on Monday. Now I'm not sure what to expect.
Thank You
Kimberly Hoffman
This article discusses that. E
Keeping the ovaries is important. My daughter is now going thru the same: cervicitis, etc. Her dr. recommended conization and then hysterectomy. I recommended her to have a hysterectomy. She has kids and also salping for not having any more kids. I would not want her to go through all I went that could have been solved with only one surgery, instead of several procedures.
Keeping the ovaries is important. My daughter is now going thru the same: cervicitis, etc. Her dr. recommended conization and then hysterectomy. I recommended her to have a hysterectomy. She has kids and also salping for not having any more kids. I would not want her to go through all I went that could have been solved with only one surgery, instead of several procedures.
(w.cancerscreening.nhs.uk/cervical/faq08.html)
Siron I beg to differ. The uterus contracts when some women have an orgasm. And the uterus has other functions- like holding the internal organs in the right postion.
Nothing is more disheartening when women repeat the male doctor mantra of " all the in the head".
It's disrespectful to women. Masters and Johnstone proved that the uterus does have a role to play in sexual pleasure.
Ago and now bleeding again, but this dark rusty color with small clots. I still have pelvic and vaginal pain off and on. At my recent postop appt my GYN said it looked to be healing well with no signs of infection etc., but couldn't explain why I was still having the pain, its a different type of pain I've ever felt and I'm a little scared. Any suggestions??
my aunty. has undergone the HPE : CERVICAL BIOPSY.
in her report it says
GROSS: One GW irregular soft tissue piece 1.2 cm *1 cm *0.3 cm in size;AE.
MICRO : SECTIONS show features of moderately well differentiated nonkeratinizing large bell squamous cell carcinoma infiltrating the whole depth of the specimen.
DIAGNOSIS : MOD.WELL DIFFERENTIATED SQUAMOUS CELL CARCINOMA.
and my question is that ,is my aunt is in the first stage ,can she be normal after treatment, plz help me regarding the treatment also.
I'm concerned, anyone have any idea if this is normal? I have another appointment in July but I'm not sure if I should wait until then.
I hope all will come out as i was ecpecting to get pregnant but unfortunate i got the bad pap results !
This may sound like a lot, but if you relax listen to your Dr. Utilize these helpful tips you can and will heal faster, & avoid risky complications like; blood clots, torn stitches, infection, & prolonged unnecessary pain.
Take your temp often as often as you take your prescribed medications. Have some Benedryll on hand in case of allergy, or Ginger Root for nausea. Call your Dr if your fever exceeds 100.4, your in inadequate pain while taking your medication, persistent nausea/vomiting, unusual strainage, redness, or bleeding from the surgical site, itching or a rash, or inability to urinate. All within the first week mind you. If you can't get a hold of your Dr go to the ER don't wait!!
You may experience light bleeding by the 3rd day, especially when you urinate. You may see charcoal color tissue and may look like sand in your urine, its normal. Its the heavy red blood your wanting to avoid. You can see clotting and that can be both good and bad call your Dr. The clotting looks like thick gel like tissue and is full of blood.
I can't share enough how all this can really help you. I did a lot of research and asked my Gyno a lot of questions before I underwent this procedure.
I was diagnosed with CIN from an abnormal PAP. Within months it became CINIII. Within the end of the year it became apparent that my Colposcopy with EEC, & L.E.E.P. with EEC, were unsuccessful in removing the CINIII. I refused to have a hysterectomy as I am 34 and want children, I got another opinion which lead to finding a woman Gyno who had the experience and expertise to help me. I had this surgery, and she was able to successfully remove all the CINIII, the endometrial biopsy confirmed no invasive carcinoma. I was very lucky. This only happened because I was persistent, and didn't settle for just any procedure to happen. Its your body, you have the power and control to become educated and ask questions of your OBGYN. Get another opinion, seek out forums where women are talking about what your going through, including forums about Cervical Carcinoma. Its scary but the more you know the better informed you can be to talk with the right Dr. Don't give up. Never give up. I wish all who read this the best, I hope the information I have left here will help you. Not everyone will experience what I have, but my hope is that with what I leave it helps enough women get through this. :)
I posted in here not too long ago. I figured I'd come back and check in. April 2 2013 I had my surgery. I am a rare case apparently as I had 2 post surgery bleeding's. Those are complications from surgery. If you bleed through a peri-pad in less than an hr, hell in less than 30mins CALL YOUR DR and get to the ER right away!!! I feel genuinely lucky to have had such a thorough physician and nurses. I did bleed everyday for 3wks post surgery. I had a whole wk that I didn't, had a stitch fall out, and eventually I saw my Dr and she cut a few more. I've not been in major pain but as I listed above in what to do, really stick to it. The only pain I really had post surgery was when I tried to vacuum. Ladies that is a huge no no for a month. Yeah no joke. I was told I'd have a heavy period the following month after surgery, well, its not like it was pre surgery and definitely nothing like it was post.
I can not stress enough how important Pap Smears are no matter your age. Any stage of the cervical dysplasia isn't something to take lightly. I initially had mild that progressed in the course of a year to severe. Before my surgery, I was borderline stage 0 cervical cancer. My biopsy results came back that I did in fact have this dysplasia deep inside my cervix. Most of my cervix had to be removed, though the chances of me having children are now slim to none, I'm hoping those who read this share about it, share to every woman you know. Prevent it, get an annual Pap. Don't sit around and wait like I did. If you think I need a 2nd opinion get a 3rd. There are many ways to help get it under control before it comes to this surgery or a hysterectomy. But YOU have the power to either let it get you or you get it. Don't wait around for any length of time because you don't like what your OBGYN or general practitioner or Planned Parenthood Dr tells you. If your poor and have no insurance, go to the ER. But please don't wait, don't wait it out either. If you smoke like I did, quit! Get your health back its so important. Namaste.
Never give up, I'll keep checking back in. I'm no Dr, ok, but I have gone through this recently enough & had the best Dr's looking after me. I'm truly thankful, I want to give back this is how I can help do that.
And for women who are afraid to have this procedure, it is a very simple procedure, so don't be concerned. Don't let them administer a general anesthesia, and use Ibuprofen instead of pain meds, as they make you constipated, and drowsy for days post op, not to mention a sore throat from the tube going down your throat. Propofol is what they used for my colonoscopy, and it was great.
And for women who are afraid to have this procedure, it is a very simple procedure, so don't be concerned. Don't let them administer a general anesthesia, and use Ibuprofen instead of pain meds, as they make you constipated, and drowsy for days post op, not to mention a sore throat from the tube going down your throat. Propofol is what they used for my colonoscopy, and it was great.
I had a cone biopsy done early this month after diagnosed with CIN III. The operation went well as far as my doctor says. I experienced horrible cramps for the first week but I was given Tylenol with cod so most of the time I was a little loopy. The worst thing for me I guess was being constipated the whole time. Remedy, prunes and stool softener. It has been 3weeks now and I'm still too scared to have intercourse, I just imagine that piece missing and I don't want to get it infected.
To Linda, I would advise you to go to the emergency room or back to the doctor that did your procedure because a foul odor is a sign of infection. I was given a check list after my surgery and that is a problem. As for the string you feel, it maybe stitches so I wouldn't pull it. My honest opinion is I think you need to go to the doctors.
Tanx!
The waiting can drive you so nuts that you start to wonder if you should have a hysterectomy just not to go through the anxiety of testing every 3-6 months. I'm glad now that I didn't ask for one - if you are going for regular paps and seeing a gynecologist who specializes in oncology, you can trust that they will generally find the bad cells before things get too bad.
I was diagnosed with high grade lesions in March, then kept missing my appointment three months later for the punch biopsy. I finally got in this September (8 months later), and they found CIN3 and atypical glandular cells. What did this mean??? They had initially scheduled a LEEP but with the AGS decided that a cold knife biopsy would be a better route to see what was really going on inside of me. For three weeks I was nauseous, imagining the worst, and praying. I drove my family nuts. I drove a friend who is a gynecologist nuts - she told me that less than .01% (like 1 in 1000)of women with HPV get AGS that become adenicarcinoma, and even fewer of those develop an invasive cancer that leads to death.
Then there's the fact that my ECC and pap smear conflicted - it's like you can't trust the tests, and start to go crazy wondering what is really happening. Did the doctors miss something?
I had the cone knife on Monday and the doctor called and said the pathology report came back good. From the research I've read on line, it looks like the majority of women are cured through a cone biopsy (or a repeat cone) - hysterectomy is no more successful in preventing the cancer than a cone biopsy, and should only be used in advanced invasive stages from what I can see in the scholarly research.
It means that we have to stick to those 4 times a year tests and hope the cells don't return, or that they get caught and removed before they become dangerous. It puts us in quite a psychological predicament of always worrying, but I'm still young and may want more kids, so the thought of removing my uterus (aside from the longer recovery and other complications) is an equally upsetting idea. For now, I can ignore that possibility.
Post-procedure: It feels like the beginning of labor cramping with a lot of pressure on my anus as well. I didn't have a lot of bleeding or discharge the first three days, but I have felt a lot of aches and pains and somewhat flu-like symptoms with nausea and light fever...apparently normal symptoms of general anesthesia. Definitely I'd recommend if you could stay home for 3-5 days and pamper yourself, do it. You will feel very tired, and while I went back to work the next day, I can say that I wish I'd had a few days to stay in bed and recover.
I had a cone biopsy almost 2months back but now after the surgery every time i have intercourse my boyfriend complains about something scratching him is this normal or what can it be i am freaking out
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