Cone Biopsy

A cone biopsy (also known as cervical conization) is a surgical procedure to remove abnormal (or precancerous) tissue from your cervix. It can diagnose and/or treat cervical dysplasia and cervical cancer.

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

Your provider may recommend this procedure when:

• A Pap smear finds changes in the cells on your cervix that could lead to cancer
• Other methods, like a colposcopy or punch biopsy, don’t find the cause of abnormal cell changes
• You need treatment to remove abnormal cells if they’re cancerous or precancerous
• You need treatment to remove early-stage cervical cancer (stage 0 or IA1)

Types

There are three main types of cone biopsies based on the kind of tool surgeons use to remove the tissue:

• Cold-knife conization uses a surgical knife (scalpel).
• Laser conization uses a laser beam.
• LEEP conization uses an electrically charged wire loop.

How should I prepare for a cone biopsy?

Your healthcare provider will give you specific instructions. Because the cone biopsy is a same-day surgery, in general, you’ll likely need to stop eating and drinking (fast) for several hours before the biopsy. Your provider may also tell you to avoid sex or inserting anything into your vagina before surgery.

What happens during this procedure?

In general, you can expect the following during a cone biopsy:

1. You’ll get general anesthesia so you’re asleep and don’t feel pain during the procedure. In some cases, your provider may suggest a regional anesthetic, like a nerve block, to numb you from your waist down.
2. You’ll be in a similar position to how you are for a pelvic exam or Pap smear. Your feet will be in stirrups.
3. Your surgeon will insert a speculum into your vagina. It’ll hold your vaginal wall open during the procedure.
4. The surgeon will place a lighted magnifying glass into your vagina to better see your cervix.
5. They’ll remove abnormal tissue using a surgical tool. They’ll also remove some normal tissue surrounding it.
6. They’ll stop any bleeding with several methods, including stitches and cauterization. They may pack your vagina with gauze or use a medicine called “monsouls,” which helps to stop bleeding. The monsouls will look a lot like coffee grounds as it comes out of your vagina. This tends to last about two to three days.
7. Your provider will send the sample to a lab where a pathologist examines it.

A care team will monitor you for any complications as you wake up from anesthesia. You can typically go home the same day as a cone biopsy (it’s an outpatient procedure).

How long does it take?

The procedure itself takes about 15 minutes. But care before and after a cone biopsy can take several hours.

How painful is a cone biopsy?

You shouldn’t feel pain during the surgery because you’ll have general anesthesia or a nerve block. But you’ll likely have some pain or soreness after the procedure. Each person’s pain tolerance is different, though.

Your healthcare provider can walk you through what to expect and how to manage any pain.

What are the potential benefits and risks?

A cone biopsy is highly effective at treating cervical dysplasia (cervical intraepithelial neoplasia). But it’s possible for the abnormal cells to come back again over time.

It’s a generally safe procedure. But it comes with risks, including:

• Bleeding
• Blood clots
• Infection
• Damage to nearby organs, like your bladder or rectum
• Narrowing of your cervix (cervical stenosis)
• Increased risk of preterm labor in future pregnancies
• Scarring on your cervix, which may make it harder for your provider to see abnormal cells with future Pap tests

What happens after this procedure?

After the cone biopsy procedure, you can expect the following common side effects:

• Cramps that feel like period cramps
• Discomfort or mild pain
• Bleeding or spotting from your vagina

These side effects are typically more intense the first week after surgery. But they should lessen over time. Contact your healthcare provider if you still have moderate to severe pain and bleeding after two weeks.

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

Getting the results

Your healthcare provider should have the results of your biopsy within about a week. But this can vary.

Your test results will tell your provider if the cells are normal, precancerous or cancerous. They may also tell you whether the biopsy got all the abnormal cells in your cervix.

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 more cone biopsies.

What is the recovery time?

Most people can return to their daily activities in about one week. Lean on your family and friends for help with household chores 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, like:

• Keeping items out of your vagina for four weeks
• Avoiding heavy lifting and strenuous exercise
• Not swimming or taking baths (showers are fine)

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

When should I call my healthcare provider?

Contact your healthcare provider right away if you have any of the following after a cone biopsy:

• Fever of 101 degrees Fahrenheit 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 get better with medication
• Foul-smelling vaginal discharge