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A cone biopsy is an extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. A cone biopsy removes abnormal tissue that is high in the cervical canal. A small amount of normal tissue around the cone-shaped wedge of abnormal tissue is also removed so that a margin free of abnormal cells is left in the cervix.
A cone biopsy can:
A sample of tissue can be removed for a cone biopsy using:
A cone biopsy is usually done as an outpatient procedure. You do not have to spend a night in the hospital.
The hospital or surgery center may send you instructions on how to get ready for your surgery. Or a nurse may call you with instructions before your surgery.
You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your doctor will insert a lubricated tool called a speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.
Medicine that makes you unconscious (general anesthesia) or that makes the entire genital area numb (regional anesthesia, such as a spinal or epidural) may be used.
A cone biopsy using LEEP may be done in your doctor's office with an injected medicine that numbs the cervix (cervical block). If a cervical block is used, an oral pain medicine or pain medicine given into a vein (intravenous, or IV) may be used along with the local anesthetic.
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You likely will stay in the recovery area for 1 to 4 hours, and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will likely 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 1 week.
Call your doctor for any of these symptoms:
A cone biopsy may be done after a Pap test shows moderate to severe cell changes and:
The cone biopsy may remove all of the abnormal tissue. This would mean that no further treatment is needed other than follow-up Pap tests.
The edges of the cervical tissue removed by a cone biopsy may contain abnormal cells, meaning that abnormal tissue may be left in the cervix. The cone biopsy may be repeated to remove the remaining abnormal cells. If follow-up tests show normal cells, then no further treatment may be needed. If abnormal cells remain, you and your doctor may discuss other treatments, such as removal of the uterus (hysterectomy).
The cone biopsy may show cancer that has grown deep into the cervical tissue (cervical cancer). Further treatment, such as surgery, radiation, or chemotherapy, will be recommended.
A cone biopsy is a surgical treatment with some risks.
Cone biopsy (conization) can be done 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 can be changed by the heat from the laser beam or the wire loop. This may make the laboratory study of the biopsied tissue more difficult.
If you have a cone biopsy, you need regular follow-up Pap tests and colposcopic examinations. A Pap test should be repeated every 4 to 6 months or as recommended by your doctor. After several Pap test results are normal, you and your doctor can decide how often to schedule future Pap tests.
The healing and scarring process after a cone biopsy may make it hard to identify abnormal tissue in the future.
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