Cone Biopsy

What is a cone biopsy?

A cone biopsy (also known as conization or cold knife biopsy) is a surgical procedure to remove abnormal tissue from your cervix. It can detect cervical cancer or changes in some of the cells of your cervix, typically referred to as cervical dysplasia, that could lead to cervical cancer. Your cervix is the part of your body that separates the upper part of your vagina and the lower part of your uterus.

It’s called a cone biopsy because your surgeon cuts a cone-shaped piece of irregular tissue from your cervix. This type of biopsy allows them to get to the deeper layers (or inner parts) of your cervix. Then, your provider sends the tissue to a laboratory for further testing.

Cone biopsy is an outpatient procedure (you don’t have to stay overnight) done in a surgical center or hospital.

Why is a cone biopsy performed?

Cone biopsy is a treatment option to remove abnormal and precancerous cells from your cervix. It also diagnoses precancerous and cancerous cells in your cervix.

Your healthcare provider performs a cone biopsy when:

• A Pap smear finds changes in the cells on your cervix that could lead to cervical cancer.
• You need treatment to remove abnormal cells on your cervix if they’re cancerous or precancerous.
• You need treatment to remove early-stage cervical cancer (stage 0 or IA1).

Your provider may also offer a cone biopsy when other methods such as colposcopy or punch biopsy don't find the cause of abnormal cell changes.

Who performs a cone biopsy?

An obstetrician-gynecologist (Ob/Gyn) performs a cone biopsy.

How do I prepare for a cone biopsy?

Your healthcare provider will give you instructions on preparing for a cone biopsy. Since you'll probably be under general anesthesia, you must stop eating and drinking for several hours before the procedure. There may also be restrictions on sexual intercourse or inserting anything into your vagina before surgery.

Are you awake during a cone biopsy?

No, you’re usually asleep under general anesthesia for a cone biopsy. However, in some cases, your provider may suggest a local anesthetic like a nerve block to numb you from your waist down. Either way, you will not feel pain during a cone biopsy.

What should I expect during a cone biopsy?

Cone biopsy involves using a surgical knife (scalpel) to cut abnormal tissue from your cervix. The tissue is sent to a lab where a pathologist studies it for precancerous or cancerous cells. The procedure takes about 15 minutes, but pre- and postoperative care take several hours.

• First, you’ll be put under anesthesia and then you’ll be positioned in a similar position you do for a pelvic exam or Pap smear, with your feet in stirrups.
• Next, your surgeon will insert a speculum into your vagina. A speculum is a device that holds your vaginal wall open during the procedure.
• Then, the surgeon places a colposcope into your vagina to better see the cervix. A colposcope is a lighted magnifying glass that guides them to the area that needs to be removed.
• Next, your surgeon will remove abnormal tissue in addition to some normal tissue surrounding it.
• They’ll then stop any bleeding with several methods, including stitches and cauterization. They may pack your vagina with gauze.

The pathologist will then examine the tissue to be sure the surgeon removed all the abnormal tissue and that only normal tissue is left.

Cone biopsy is an outpatient procedure, which means you don’t stay overnight. Your healthcare provider will send you home once you've recovered enough to leave the hospital or surgical center.

What can I expect after a cone biopsy?

You’ll recover at the hospital or surgical center for a few hours afterward. Your healthcare provider will monitor your blood pressure, pulse, bleeding and pain to ensure you're well enough to go home. Before leaving, your provider may remove the gauze pack in your vagina.

You can expect menstrual period-like pain for several days, but you can manage this with pain medication. In some cases, your surgeon will provide you with prescription pain medication, but typically, over-the-counter pain relievers work well.

Most people can return to their daily activities in about one week. Lean on your family and friends for help with household chores like vacuuming and laundry for the first week of your recovery. Cramping and bleeding are normal during this time. Use pads to catch blood and vaginal discharge. It’s normal to have vaginal discharge that changes from red or pink to light brown.

Your healthcare provider will give you a list of activities to avoid until your follow-up appointment. Some of the items on this list may include:

• Keep items out of your vagina for four weeks. This includes sexual intercourse, tampons, fingers and douching.
• Avoid heavy lifting and strenuous exercise.
• Don’t swim or take baths.

Your healthcare provider will schedule a follow-up appointment within four to six weeks of your surgery to ensure everything went well and healed correctly.

After a cone biopsy, your provider may recommend a Pap test every six months. Once several consecutive Pap results come back normal, your provider will return you to a more typical Pap smear schedule (such as every year). This schedule varies depending on your age and medical history.

Do you have stitches after a cone biopsy?

Sometimes. Your surgeon may use stitches, but many times, they’ll use vaginal packing instead. Vaginal packing is similar to a tampon or a large, rolled-up piece of gauze.

Can I go back to work after a cone biopsy?

You can return to work after a few days or when you feel comfortable. However, if your job requires lifting heavy objects or standing for hours at a time, you may need to stay home for up to two weeks.

What are the risks of a cone biopsy?

Cone biopsy is safe but comes with risks. Talk to your healthcare provider about the risks and benefits of the procedure to ensure you know what to expect.

Some of the risks associated with cone biopsy are:

• Bleeding.
• Blood clots.
• Infection.
• Narrowing of your cervix (cervical stenosis).
• Increase risk of preterm labor in future pregnancies.
• Damage to nearby organs like your bladder or rectum.

Cone biopsy may cause scarring on your cervix. This may make it harder for your provider to identify abnormal cells during future Pap tests.

What are the side effects of a cone biopsy?

The most common side effects of cone biopsy include:

• Menstrual-like cramping.
• Discomfort or mild pain.
• Bleeding or spotting from your vagina.

You can expect side effects to be more intense the first week after surgery, but they should lessen over time. Contact your healthcare provider if you're still experiencing moderate to severe pain and bleeding after two weeks.

Can a cone biopsy remove cancer?

Yes, a cone biopsy can remove early-stage cervical cancer.

When will I know the results of a cone biopsy?

Your provider should have the results of your biopsy within about a week. The exact timing varies depending on the laboratory. It's best to ask your provider how it will take to get your results.

What do the results of a cone biopsy mean?

Your cervical tissue goes to a laboratory for analysis under a microscope. Your test results will tell your healthcare provider if the cells are normal, precancerous or cancerous.

A normal result means no precancerous or cancerous cells were found on your cervix.

Abnormal results mean precancerous or cancerous cells were found on your cervix. These cells are called cervical intraepithelial neoplasia (CIN). CIN is classified on a scale of one to three depending on how much cervical tissue contains abnormal cells.

• CIN I: Mild cervical dysplasia. Cells are slightly abnormal.
• CIN II: Moderate to marked cervical dysplasia. Cells are abnormal.
• CIN III: Severe cervical dysplasia or carcinoma in situ (early stage of cervical cancer). Cells are severely abnormal and will likely become cancer.

CIN I cervical dysplasia rarely becomes cancer. CIN II and III are more likely to require treatment to prevent cancer.

When should I contact my healthcare provider?

Contact your healthcare provider right away if you experience any of the following:

• Fever of 101°F or higher.
• Chills, shortness of breath or feeling confused.
• Swelling or cramping in your legs (can be a sign of blood clots).
• Needing to change a sanitary pad every two hours.
• Pain that doesn’t subside with medication.
• Foul-smelling vaginal discharge.

What’s the difference between a cone biopsy and LEEP?

Conization (cone biopsy) and LEEP (loop electrosurgical excision procedure) remove abnormal tissue on your cervix. LEEP uses a small, electrically charged wire loop to remove abnormal tissue. During a cone biopsy, surgeons cut a larger, cone-shaped section of abnormal tissue from your cervix using a surgical knife. Cone biopsy is a more complicated surgery, and surgeons perform it under general anesthesia. The recovery time is longer, and it carries more risk than LEEP.

How many cone biopsies can you have?

It’s possible to need additional cone biopsies if abnormal cells are left behind or develop again. Your healthcare provider will discuss the risks and benefits of additional cone biopsies based on your test results.

A note from Cleveland Clinic

Cone biopsy is a procedure to help diagnose and treat abnormal cells that could lead to cervical cancer. You may feel nervous or worried before the procedure. Lean on your family, friends and healthcare team for support. Don’t hesitate to ask questions about the procedure and your results. In most cases, cone biopsy is successful with no long-term side effects. Regular Pap tests are the best way to detect abnormal cells on your cervix.