What is a cone biopsy?

A cone biopsy is a minor operation where a cylindrical or cone-shaped piece of  the cervix, including the abnormal cells, is removed. This is sent for pathological examination to confirm the diagnosis and to ensure that all the abnormal cells have been removed.

Why is it performed?

It is usually recommended when:

  • The entire abnormal area cannot be fully seen at colposcopy, eg. When is extends into the endocervical canal, which is the canal that leads from the vaginal through the cervix into the uterus.
  • The Pap smear test repeatedly shows abnormal cells but the colposcopy result in normal. This may mean that the abnormal cells are from the endocervical canal.
  • The doctor is concerned that the abnormal cells have actually formed a very early cancer.

Pathological examination of the specimen usually confirms the diagnosis and ascertains if all the abnormal cells have been removed.

How is it done?

You would be positioned as for a gynaecological examination.

It may be done with local anaesthetic (when you would be awake but not feel any pain) or with a general anaesthetic (when you would be asleep throughout the procedure).
In general, this procedure could be done with one of three methods:

  • With a surgical knife
  • With a laser
  • With a electrical loop wire – the procedure is also known as LEEP (loop electrosurgical excision procedure or LLETZ (large loop excision of transformation zone)

There is usually little discomfort after this procedure. A brown- coloured paste (Monsell’s solution) may be used to arrest any bleeding. A vaginal pack may or may not be inserted temporarily to stop any bleeding, and a tube (catheter) may  or may not be placed in the bladder to keep the  bladder empty until the gauze is removed. Painkillers and antibiotics may be prescribed after the procedure.

What are the risks associated with Cone Biopsy?

Cone Biopsy is a very safe operation. However, like all surgical operations, complications may occasionally occur. These include:

  • Bleeding
  • Infection
  • Injury to surrounding tissues
  • A narrowing of the cervical opening or a weakening of the cervix, both of which may cause complications during pregnancy. This however is a very rare complication.

How do I prepare myself for the operation?

  1. Find out more about the procedure so that you would be mentally and emotionally prepared for this operation.
  2. Do not eat or drink anything (including plain water) after midnight on the night before your surgery, unless your doctor has told you otherwise.
  3. Be accompanied by a partner, friend or relative.
  4. You may be fit to be discharged home on the same day or the following day
  5. You would generally be given medical leave to rest after the operation.

Post- operative advice

-After your operation, you may experience:

  • Vaginal discharge
  • Some discomfort in the lower part of the abdomen – this is to be expected and pain- killers should help relieve the discomfort.
  • Vaginal bleeding – mild to moderate amount of red watery discharge during the first 10 to 14 days after treatment is quite normal. You may want to wear a protective sanitary pad (not a tampon) during this period.
  • Your next period – may be lighter or heavier than normal.

-You should refrain from:

  • Strenuous exercise, swimming or tub baths until you are feeling fully fit. You may return to normal activity after about 2 weeks.
  • Using tampons, douching or sexual intercourse until 4-6 weeks after the operation.

-You should return immediately to the clinic or the hospital (after office hours) if you experience:

  • Heavy bright red bleeding (like periods or menses) within the first 3 weeks after the operation- this generally occurs within the firs after the operation, It may, of course, be due to your periods. It would be safer, however, to see the doctor who could exclude bleeding from the wound site.
  • Foul- smelling vaginal discharge within the first 3 weeks – this may be due to infection.
  • Severe abdominal pain not relieved by painkillers
  • Fever associated with abdominal pains.

Follow-up visits

After treatment, follow-up appointments are necessary to ensure that all the abnormal areas have been treated and the cervix has healed well. To ensure that you remain well, regular follow- up is needed.

 

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