Cone biopsy (cervical biopsy) at Cheltenham Hospital

What is a cone biopsy?

A cone biopsy, also called a cervical biopsy or conisation, is a small operation to remove a cone-shaped piece of tissue from your cervix. It can be used both to diagnose and to treat abnormal or cancerous cells, often in a single procedure.

Why might I need a cone biopsy?

Your doctor may recommend a cone biopsy if:

• a cervical screening test has found changes in your cervical cells that could lead to cancer
• a colposcopy or smaller biopsy hasn't been able to find the cause of abnormal cell changes, or previous results were unclear
• you need treatment to remove abnormal or early-stage cancerous cells from your cervix
• you have very early-stage cervical cancer and would like to preserve your fertility, since a cone biopsy removes only part of the cervix, leaving the womb in place.

What are the benefits of a cone biopsy?

• It can act as both your test and your treatment in one step, since removing the abnormal tissue can also get rid of it for good
• It provides a larger, more thorough tissue sample than a smaller biopsy, which can help if previous results were unclear
• For very early-stage cervical cancer, it can preserve your fertility by removing only the affected part of your cervix rather than your womb
• It's usually done as day surgery, so you can go home the same day.

Are there different types of cone biopsy?

There are 3 main methods, and which one is used depends on your circumstances and your doctor's preference.

• Cold-knife conisation uses a surgical scalpel
• Laser conisation uses a focused beam of light
• LEEP (loop electrosurgical excision procedure) uses a wire loop heated by an electric current.

The type of anaesthesia used, local, regional or general, also depends on the complexity and size of the biopsy needed.

How do I prepare for a cone biopsy?

Your team will give you specific instructions, but in general:

• you may need to avoid eating and drinking for several hours beforehand, particularly if you're having a general anaesthetic
• your doctor may ask you to stop taking blood-thinning medication temporarily, to reduce the risk of bleeding
• avoid sex or putting anything inside your vagina in the days before your procedure
• you may have an ultrasound scan beforehand, to give your doctor more information about your cervix.

What happens during a cone biopsy?

Here's what typically happens:

1. You're given anaesthesia, which may be local, regional or general depending on your procedure
2. You lie in a similar position to a pelvic exam or smear test, with your feet supported
3. A speculum is gently inserted into your vagina to hold it open, and a lighted magnifying instrument is used to see your cervix clearly
4. The doctor removes the cone-shaped piece of abnormal tissue, along with a small margin of healthy tissue around it
5. Any bleeding is controlled, for example with stitches or cauterisation
6. The tissue sample is sent to a laboratory for examination.

he procedure itself usually takes around 15 to 30 minutes, though you'll need longer at the hospital overall.

What happens after a cone biopsy?

Your cervix usually takes around 4 to 6 weeks to fully heal. In the first 24 hours, drink plenty of fluids and eat well.

For the first 4 days, you may have discharge similar to a period; over the following 2 to 3 weeks this typically becomes clearer and watery before stopping.

For 4 to 6 weeks, or until your doctor confirms you've healed, avoid putting anything inside your vagina, including tampons, and avoid having sex, take showers rather than baths, avoid swimming, and avoid heavy lifting or strenuous exercise. Your next period may arrive late or be heavier than usual.

You'll usually have a follow-up appointment around 4 to 6 weeks later, and your biopsy results are typically ready within about a week, though this can vary.

What are the risks of a cone biopsy?

There's a chance of experiencing:

• bleeding, infection, or rarely, damage to nearby organs such as your bladder or rectum
• narrowing of your cervix (cervical stenosis), which is uncommon but can happen
• a slightly increased risk of premature labour in future pregnancies
• scarring on your cervix, which can make it harder to see abnormal cells on future screening tests.

Contact your doctor if you have a fever of 38.3°C (101°F) or higher, chills, heavy bleeding that fills a pad every 1 to 2 hours, foul-smelling discharge, or pain that painkillers don't help.