Cone biopsy

About cone biopsy

A cone biopsy is an operation to remove a cone-shaped piece of tissue from your cervix.

If you have had a cervical smear or a colposcopy that showed abnormal cells in your cervix, your doctor may ask you to have a cone biopsy. 

The changes to the cells in your cervix are sometimes called dyskaryosis. These changes can be mild, moderate or severe. Changes to the cells of your cervix are graded according to how deeply the abnormal cells have gone into the lining of your cervix. You might also see these cell changes called cervical intraepithelial neoplasia or CIN.

Abnormal cells found during cervical screening or colposcopy may be pre-cancerous. This doesn't mean you have cervical cancer. It means that some of the cells are a little abnormal and if they were left untreated, they could develop into cervical cancer in the future.

A cone biopsy can help your doctor to diagnose whether you have pre-cancerous cells and what kind of treatment you may need. A cone biopsy can also be used to remove pre-cancerous cells.

Your doctor may also ask you to have a cone biopsy if he or she suspects that you may have cervical cancer.

What are the alternatives?

The area of your cervix where there are abnormal cells can also be removed using a procedure called large loop excision of the transformation zone (LLETZ). During LLETZ a wire loop with an electric current is used to remove abnormal areas of tissue. This is then sent to a laboratory to be checked. LLETZ is the most common way of treating abnormal cells.

Abnormal cells can also be destroyed using procedures called laser therapy, cold coagulation and cryotherapy.

Your doctor will talk to you about which treatment is best for you.

Preparing for a cone biopsy

A cone biopsy is a small operation done in hospital and you may need to stay overnight. The procedure can be done using local or general anaesthesia. A local anaesthetic will completely block pain from your cervix and you will stay awake during the procedure. If you have a general anaesthetic, you will be asleep during the procedure.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a cone biopsy

During the procedure, your surgeon will cut a cone-shaped piece of tissue from your cervix. This piece of tissue will usually include the whole area of your cervix where there might be abnormal cells.

The tissue can be removed in several ways. It can be done using a surgical knife, laser or electrosurgical loop. It's usually done with an electrosurgical loop – a thin loop of wire with an electrical current running through it. The tissue sample will be sent to a laboratory for testing, where it will be checked to see whether all the abnormal cells have been removed. The results of the test will help your surgeon to decide whether you need any more treatment.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have some gauze (like a tampon) packed into your vagina to help stop any bleeding. If you have a gauze pack, you may also have a thin tube called a catheter inserted into your bladder to drain away urine. Your surgeon or a nurse will remove the catheter and gauze before you leave the hospital.

You will need to arrange for someone to drive you home. If you are able to go home on the day of your procedure, try to have a friend or relative stay with you for the first 24 hours afterwards.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Recovering from a cone biopsy

It's normal to have some light vaginal bleeding and discharge for up to four weeks after the procedure. Wear a sanitary towel during this time, rather than a tampon.

Try to rest for the first week after the procedure. Don't do any heavy housework or lifting. Your surgeon will ask you not to do any strenuous exercise or have sex for between four and six weeks after the procedure. This will give your cervix time to heal.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your doctor or nurse will tell you when to expect the results of your cone biopsy. You may need to come back to the hospital for an outpatient appointment, or you may get your results by post.

Depending on the results of your biopsy, you may need to have further treatment. Your surgeon will let you know whether you need any further treatment and what it will involve.

What are the risks?

As with every procedure, there are some risks associated with a cone biopsy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects after a cone biopsy may include:

  • period-like pains for a few days afterwards
  • light vaginal bleeding and discharge for a few weeks after the procedure – you may need to wear a sanitary towel

Complications

Complications are when problems occur during or after the operation. Most women aren't affected.

The main complications of cone biopsy are listed below.

  • Bleeding. A small number of women have some heavy bleeding after the procedure. If the bleeding seems heavier than a heavy period, contact the hospital or your GP immediately.
  • Infection. It's possible for the biopsy site to become infected. Contact your GP or the hospital if you have vaginal discharge that smells, a fever and abdominal pain that doesn't get better.
  • Problems during pregnancy. After a cone biopsy you may be slightly more likely to have a miscarriage or an early birth. This is because the biopsy has weakened your cervix. Your doctor can put a stitch in your cervix during pregnancy to prevent this from happening. If you're concerned about future pregnancies, ask your surgeon for advice.
  • Cervical stenosis. This is when your cervix closes tightly when it’s healing. This means that sperm may not be able to enter your womb, which can stop you getting pregnant. This is rare. Cervical stenosis can also mean that you don't have periods, because the lining of your womb can't be shed through the closed cervix.

Can I have a cone biopsy if I'm pregnant?

Answer

Your surgeon won't usually ask you to have a cone biopsy if you're pregnant because it can cause a miscarriage. If you're pregnant, or think that you might be, tell your doctor.

Explanation

A cone biopsy is an operation to remove part of the neck of your womb (cervix) where there are abnormal cells. Having the biopsy can weaken the muscles of your cervix. Because the muscles are weakened this can cause the cervix to open, which may lead to a miscarriage. Your doctor is unlikely to suggest that you have a cone biopsy unless he or she suspects that you may have cervical cancer. If you're pregnant, or think you may be, tell your doctor.

Will a previous cone biopsy affect my pregnancy?

Answer

Having a previous cone biopsy can affect future pregnancies. It can make your cervix weaker, which can increase your risk of an early birth. You may also be more likely to have a caesarean delivery.

Explanation

Your cervix is a muscle that usually keeps the entrance to your womb closed until you're ready to go into labour. Having a cone biopsy can sometimes weaken your cervix. This means that as your baby grows and gets heavier, he or she can push on your cervix and open it, causing your baby to be born early. Your doctor can usually prevent an early birth by putting a running stitch around your cervix to hold it closed. It's sometimes called a purse string suture.

The stitch will keep your cervix closed until your baby can be delivered safely, usually about week 37 of your pregnancy. At this time the stitch can be quickly cut and removed and your cervix will be able to open normally for your baby to come out.

Having a baby with a lower than average birth weight is linked to having a cone biopsy. You’re also more likely to have a caesarean delivery if you have had a cone biopsy.

Will I need more treatment after a cone biopsy?

Answer

For many women, a cone biopsy can remove all of the abnormal cells that may lead to cervical cancer. However, in some women, some of the abnormal cells may not be removed, or may return after treatment. If this happens, you may need further treatment. Hysterectomy (removal of your womb) is one possible further treatment.

Explanation

Cone biopsy can remove all of the abnormal cells that may lead to cervical cancer in the future in as many as nine out of 10 women. However, in some women, cone biopsy may not remove all of the abnormal cells, which is why it’s important to have regular check-ups and cervical screening after cone biopsy.

After a cone biopsy you should have another cervical smear test in six months. This is to make sure that your treatment has worked. You may need to go to the colposcopy clinic to have your smear or your GP or practice nurse may do it.

Some colposcopy clinics may invite you to have a colposcopy six months after your treatment. If everything is normal at this stage, you can go back to having regular cervical smears.

If you had mild cell changes (CIN1), you should have a smear one year later and if that is normal, you can go back to having a smear every three to five years. If you had moderate or severe cell changes (CIN2 or CIN3), you will be asked to have yearly smears for nine more years. If these smears are normal, you should be able to go back to three- or five-yearly smears.

If abnormal cells are found on your cervix again, your doctor may suggest removing the whole of your womb (a hysterectomy). Some women prefer to have a hysterectomy because they can feel reassured that all of the abnormal cells have gone.

During a hysterectomy your surgeon is usually able to leave your ovaries in place, which means the operation shouldn't affect your hormones or cause an early menopause. If your ovaries are removed before the menopause, you may need hormone replacement therapy (HRT).

Having a hysterectomy means that you will no longer be able to have children. Talk to your doctor about the treatment options that are available to you.