Cone Biopsy of the Cervix, Operative

What is an operative cone biopsy of the cervix?

Operative cone biopsy of the cervix is surgery to remove abnormal tissue from the cervix. The cervix is the lower part of the uterus that opens into the vagina. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus, through the cervix.

Another term for cone biopsy of the cervix is conization of the cervix.

When is it used?

This procedure is done to:

• Remove abnormal, precancerous, or cancerous cells from the cervix or the canal of the cervix.
• Diagnose cancer
• Try to answer questions not answered by a colposcopy. Your healthcare provider may not have been able to see all of the problem tissue with a colposcope.
• Better understand the results of a Pap test.

Alternatives may include:

• cryosurgery (destruction of cervical tissue by exposure to very cold temperatures)
• conization of the cervix with a laser
• loop electrosurgical excision procedure (LEEP)
• interferon medicine
• removal of the whole uterus and cervix (hysterectomy)
• other forms of cancer treatment if you have cancer

You should ask your healthcare provider about these choices.

How do I prepare for a cone biopsy?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Find someone to drive you home after the surgery. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any other instructions provided by your healthcare provider. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a local or general anesthetic. A local anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. IV sedation or general anesthesia may be given instead of a local anesthetic. An IV sedative will help you relax and may put you to sleep. A general anesthetic relaxes your muscles, makes you feel as if you are in a deep sleep, and keeps you from feeling pain.

Your healthcare provider will bathe the cervix with a solution that makes it easier to see abnormal tissue and put 2 stitches on the sides of the cervix to help control bleeding. Your provider will then cut around the opening in the cervix and remove a cone-shaped piece of tissue with the opening to the uterus running through the center. He or she will try to make the cone large and wide enough to remove all of the abnormal tissue. The tissue sample will be sent to the lab for tests.

What happens after the procedure?

You may go home later in the day or you may stay overnight in the hospital. This will depend on how much tissue was removed, how fast you recover from the anesthetic, and how much bleeding you have.

You may have a little cramping after the procedure. You may also have some minor bleeding or spotting the first day or so after the procedure. For about 2 weeks you may have a brownish discharge. This is a normal part of the healing of your cervix. Your cervix should heal completely within a month.

Your healthcare provider may advise that you avoid heavy lifting, tampons, douching, sexual intercourse, and hot tubs for 4 weeks after the procedure.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

• The abnormal tissue in the cervix is removed. This may decrease the risk of developing cancer.
• It may help your healthcare provider make a better diagnosis and determine the best treatment for your problem.
• It may prevent the need for removal of the uterus (a hysterectomy).

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• You may need more surgery.
• The cervix may start to bleed several days after the operation and need more surgery.
• If a lot of tissue was removed, you may have trouble holding a pregnancy to its full term.
• If you have cancerous or precancerous cells and your healthcare provider removes too little tissue, some of the abnormal cells may remain.
• You may have an infection or bleeding.
• You may have scarring or narrowing of the cervical canal.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• You have a fever over 100.5°F (38°C).
• You start to bleed again.
• You have a lot of pain in the lower abdomen.
• You have a vaginal discharge with a bad odor.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.