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Cone biopsy

Published by Bupa's health information team, July 2009.

This factsheet is for women who are having a cone biopsy, or who would like information about it.

A cone biopsy is an operation to remove an area of your cervix (the neck of your womb) where there are abnormal cells. It can be used as a test to diagnose cervical cancer.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

What is a cone biopsy?

A cone biopsy is an operation to remove a cone-shaped piece of tissue from your cervix (the neck of your womb).

Illustration showing the cervix and transformation zone
The cervix and transformation zone

You may need to have a cone biopsy if abnormal cells have been found during a cervical smear test, or if you have symptoms of cervical cancer.

An abnormal cervical smear test result usually means that small changes have been found in your cervix. Changes in your cervix are referred to as cervical intraepithelial neoplasia (CIN). CIN isn't cervical cancer, but an early warning stage. A cone biopsy is one way of removing CIN, so that it can't develop into cervical cancer.

What are the alternatives?

The area of your cervix containing abnormal cells can be removed using a different procedure called large loop excision of the transformation zone (LLETZ), or very rarely with a hysterectomy. The abnormal cells can also be removed using procedures called laser therapy, cold coagulation and cryotherapy.

Your surgeon will let you know which treatment is suitable for you.

Preparing for your procedure

Your surgeon will explain how to prepare for the procedure.

You will usually be given a general anaesthetic. This means you will be asleep during the procedure. Sometimes a cone biopsy can be done under a local anaesthetic instead. Your surgeon will let you know which type of anaesthetic you will have.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. If you're having a local anaesthetic, you will usually be able to eat and drink as you would normally before the procedure.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

About the procedure

Once the anaesthetic has taken effect, your surgeon will cut a cone-shaped piece of tissue from your cervix. This piece of tissue will usually include the whole area of your cervix where there might be abnormal cells.

The tissue can be removed in several ways. It can be done using a surgical knife, laser or electrosurgical loop. It's usually done with an electrosurgical loop - a thin loop of wire with an electrical current running through it. This is called loop electrosurgical excision procedure (LEEP).

If the whole area of abnormal cells isn't removed during the cone biopsy, a sample of the tissue will be sent to a laboratory for testing. This will show whether you have any cancerous cells and help your surgeon to decide whether you need any more treatment.

You will probably need to stay in hospital overnight after the procedure.

What to expect afterwards

You may have some gauze (like a tampon) packed into your vagina to help stop any bleeding. You may also have a thin tube called a catheter inserted into your bladder to drain away the urine. Your surgeon or a nurse will remove the catheter and gauze before you leave the hospital.

You will probably have some period-like pains when you wake up after the operation. If you're in a lot of pain, let a nurse know. He or she may be able to give you some painkillers.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Getting your results

The results of your cone biopsy will either be sent to you by post, or you will be given another appointment where a surgeon will discuss them with you. Make sure you know how you will get your results before you leave the hospital.

Depending on the results of your biopsy, you may need to have further treatment. Your surgeon will let you know whether you need any further treatment and what it will involve.

Recovering from a cone biopsy

It's normal to have some vaginal bleeding for up to four weeks after the procedure. You will need to wear a sanitary towel during this time.

Try not to be too active for the first week or so after the procedure. Don't do any heavy housework or lifting. Don't do any strenuous exercise or have sex for between four and six weeks after the procedure. This will give your cervix time to heal.

What are the risks?

Cone biopsy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.

You may have some period-like pains when you wake up after the operation and you will probably have some vaginal bleeding for a few weeks after the procedure.

Complications

This is when problems occur during or after the operation. Most women aren't affected.

The main complication of a cone biopsy is bleeding. If you start bleeding heavily after your operation, contact the hospital or your GP.

It's possible for the biopsy site to become infected. Contact your GP or the hospital if you develop any of the following symptoms:

  • a vaginal discharge that smells unpleasant
  • a fever (high temperature)
  • period-like pains that last for longer than one or two days after the procedure

Women who have had a cone biopsy may be slightly more likely to have a miscarriage or an early birth. This could be because having a cone biopsy makes your cervix slightly weaker. If your cervix has been weakened, your surgeon can usually prevent a miscarriage or early birth by putting a stitch in your cervix during your pregnancy. This will help to make your cervix stronger. If you're concerned about future pregnancies, ask your surgeon for advice.

Rarely, having a cone biopsy can cause you to have problems getting pregnant. There is a small possibility that, while healing, your cervix will become so tightly closed that sperm won't be able to get in. This will mean you can't get pregnant naturally. It's called cervical stenosis. If you have cervical stenosis you may not have any periods.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Related topics

Further information

Sources

  • Cervical cancer at a glance. Cancer Research UK. http://info.cancerresearchuk.org, accessed 19 February 2009
  • Cervical cancer tests. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 February 2009
  • How cervical cancer is diagnosed. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 19 February 2009
  • Conization of Cervix. eMedicine. www.emedicine.medscape.com, accessed 19 February 2009
  • Beers MH, Fletcher AJ, Porter R, et al, The Merck manual of medical information. New York: Pocket Books, 2003:1407
  • Economou SG, Economou TS, Instructions for surgery patients. 1st ed. Philadelphia: W.B. Saunders Company, 1999
  • Pregnancy and abnormal cervical cells. Cancer Research UK. www.cancerhelp.org.uk, accessed 26 February 2009
  • Pregnancy after a cone biopsy. Cancer Research UK. www.cancerhelp.org.uk, accessed 18 February 2009
  • Tests after an abnormal smear test result. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 19 February 2009
  • CIN (pre-cancer). Jo's Trust. www.jotrust.co.uk, accessed 6 April 2009
  • CIN (pre-cancer) treatment. Jo's Trust. www.jotrust.co.uk, accessed 26 February 2009
  • Treating CIN. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 21 April 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for advice from a qualified health professional.

Publication date: July 2009

 

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