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Cone Biopsy

By

Hedy Marks, MPH

What is a cone biopsy?

A cone biopsy is surgery to remove abnormal cells from the cervix. The cervix is the neck-shaped opening at the lower, narrow part of the uterus that connects the uterus to the vagina. During the procedure, a cone-shaped piece of tissue is removed from the cervix and sent to a lab for analysis. 

Cone biopsy may be used to treat cervical disease, such as cervical dysplasia or early cervical cancer. Cone biopsy is also used to diagnose the cause of moderate to severe cell abnormalities. 

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Your doctor may recommend a cone biopsy after other gynecologic screening tests, such as a Pap test, colposcopy, or a cervical biopsy, detect pre-cancer or early cervical cancer. A cone biopsy may be the only treatment needed to cure your condition or biopsy results can help guide future treatments.

Cone biopsy is only one method used to treat cervical abnormalities. Other treatments with fewer risks may be available. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on cone biopsy. 

Why is a cone biopsy performed?

Your doctor may recommend a cone biopsy under these circumstances: 

  • A Pap test or cervical biopsy finds moderate to severe cervical cell changes.

  • You need treatment of precancerous cells or very early cervical cancer.

  • Your doctor is unable to see or access abnormal cervical tissue with colposcopy.

  • Your doctor needs to diagnose the cause of the abnormal cell changes. Your doctor may also use the results of a cone biopsy to help guide future treatment. 

Who performs a cone biopsy?

An obstetrician-gynecologist (Ob-Gyn) commonly performs cone biopsy. An Ob-Gyn is a doctor who specializes in women’s reproductive health. 

How is a cone biopsy performed?

Your doctor will perform a cone biopsy in a hospital. The procedure, also called cold knife cone biopsy, takes about 15 minutes, but you will be in the hospital for several hours for pre and postoperative care. 

Cone biopsy involves gently inserting a speculum into your vagina to view and access the cervix. A colposcope (a special magnifying glass) may be used to examine the cervix and find the abnormal areas. 

Your doctor will use a scalpel (surgical knife) or laser to remove the abnormal cervical tissue. The amount of tissue removed varies but is usually about 1.5 cm wide and 1 cm deep. A small amount of normal tissue around the abnormal area is also cut out. This ensures all abnormal cells are removed. The specimen is then examined using a microscope.

Types of anesthesia 

Your doctor will perform a cone biopsy using either general anesthesia or regional anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb the surgical area. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your cone biopsy

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The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team
    will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV. 

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during recovery until you are alert, breathing effectively, and your vital signs are stable. 

What are the risks and potential complications of a cone biopsy?  

As with all surgeries, a cone biopsy involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery, recovery or later. 

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a cone biopsy

Complications of a cone biopsy can be serious and include: 

  • Bleeding

  • Increased risk of miscarriage and preterm birth in future pregnancies  

  • Infection

  • Infertility due to narrowing of the cervix

  • Recurrence of abnormal cervical cells requiring repeat surgery

  • Tissue injury

  • Vaginal tear

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor if you are nursing or if there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed 

  • Telling all members of your care team if you have allergies

How do I prepare for my cone biopsy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a cone biopsy by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of your surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. For a cone biopsy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery. 

It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:

  • Why do I need a cone biopsy? Are there any other options for diagnosing or treating my condition?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? 

  • How will you treat my pain?

  • When should I follow up with you? 

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my cone biopsy?

Knowing what to expect can help make your road to recovery after a cone biopsy as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

Your cervix may be packed with a pressure dressing. Your doctor will tell you when and how to remove the packing. You will likely go home the same day of surgery. 

Recovery after surgery is a gradual process. Recovery time varies depending on the type of anesthesia, your general health, your age, and other factors. You should be able to return to work two to three days after surgery. Full recovery takes about two weeks.

You may feel weak, tired, and have mild abdominal cramping for one to two days. You may have bloody discharge, similar to a light period, for 12 to 14 days. 

Follow your doctor’s advice for recovery. General recovery tips include:

  • Avoid lifting heavy objects or aerobic exercises for two weeks.

  • Don’t drive if you are taking medication that makes you drowsy. 

  • Don’t put anything in the vagina and avoid vaginal douching, sex, and tampons for four weeks. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor? 

It is important to keep your follow-up appointments after a cone biopsy. Call your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: 

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 100.5 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Heavy vaginal bleeding or clotting that requires hourly pad changes

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot 

  • Pain that is not controlled by your pain medication

  • Persistent or severe abdominal or vaginal pain

  • Yellow or green foul-smelling vaginal discharge

How might a cone biopsy affect my everyday life?

A cone biopsy may cure your condition or significantly reduce your risk of developing a more serious condition such as cervical cancer. 

A cone biopsy can also cause significant changes to your body that may affect your everyday life, such as:

  • Difficulty interpreting abnormal Pap test results

  • Higher risk of pregnancy complications including infertility, miscarriage, and incompetent cervix 

  • Painful periods 

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 24, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Cervical Biopsy. Better Medicine. http://www.bettermedicine.com/article/cervical-biopsy.
  2. Cervical Cone Biopsy. Dana-Farber Cancer Institute. http://www.dana-farber.org/Health-Library/Cervical-cone-biopsy.aspx.
  3. Colposcopy. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq135.pdf?dmc=1&ts=20130830T1246282949.
  4. Cone Biopsy. American Society for Colposcopy and Cervical Pathology. http://www.asccp.org/Portals/9/docs/pdfs/Patient_Education/Cone_Biopsy.pdf.
  5. How are cervical cancers and pre-cancers diagnosed? American Cancer Society. http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-diagnosis.
  6. Loop Electrocautery Excision Procedure (LEEP) and Cone Biopsy. University of Washington. http://www.uwmedicine.org/patient-care/our-services/medical-services/gynecology/pages/articleview.as....
  7. Rock JA, Jones HW III (Eds.) TeLinde’s Operative Gynecology (10th ed.). Philadelphia: Lippincott Williams & Wilkins, 2008.

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