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Cone biopsy

If you are considering having a cone biopsy or have one planned, it is important to know all you can about it. This includes:

 

  • why you need this operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have unhealthy tissue on the lower part of your uterus. This lower part of your uterus is called ‘the neck of the uterus’ or the cervix.

 

What is the cervix?

The cervix is the lowest part of your uterus. It juts into the upper end of your vagina, like an upside down cone. Your cervix has a central hole, or canal, which runs up into the centre of your uterus. The tissue on the outside of your cervix and inside your cervical canal is called epithelium. It is different from the tissue that lines the rest of your uterus, which is called the endometrium.

Cone biopsy

What has gone wrong?

You have probably had a smear test, where cells are taken from the epithelium tissue that covers your cervix. Under the microscope these cells look like they are starting to become malignant. This process is called neoplasia.

 

The unhealthy cells are probably intra-epithelial. This means they are still only in the skin and have probably not spread into the deeper parts of your cervix yet. Over years these cells may change to become an invasive cancer. The condition at this stage is called pre-malignant or cervical intra-epithelial neoplasia (CIN). There are three levels of CIN; one, two and three. The thicker the affected tissue the higher the CIN level.

 

CIN is a grading system for changes in the appearance of the cells. A pathologist identifies this in the laboratory. We know that these changes will develop into cancer if left untreated. The cancerous changes usually happen over many years.

Cone biopsy 2

 

What is a cone biopsy?

To prevent cancer it is sensible to remove the area with the diseased cells. A biopsy means removal of some tissue. We usually only remove small areas on the outside of the cervix to test under the microscope. If we find pre-malignant changes in the inner canal of the cervix we need to remove a bigger, cone shaped piece of tissue. This is called a cone biopsy. We remove the tissue using a knife, a special electric current or a laser.

 

The aims

We aim to remove all of the unhealthy tissue before it changes into invasive cancer. We send the removed tissue to the laboratory for examination under the microscope. Sometimes, the laboratory results suggest that some diseased tissue has been left behind after a cone biopsy. A further biopsy may be needed. Very rarely, the laboratory results show that the disease is beyond the pre-cancer stage. Further treatment is then necessary.

 

The benefits

Complete removal of unhealthy CIN tissue from your cervix gives a high chance of a permanent cure. You would have less risk of developing an invasive cancer.

 

Are there any alternatives?

There are various ways of treating the abnormal tissue in your cervix; it can be removed or destroyed. There is a procedure using an electric cutting wire loop; this is called a LLETZ procedure. It is as good as removing the abnormal tissue with a knife (cone biopsy) or laser, unless a large amount of cervix needs to be removed. LLETZ and cone biopsy remove the whole area containing all the cells that could become pre-malignant or develop into cervical cancer. 

 

Destroying the abnormal tissue using a laser, cold coagulation and cryotherapy treats just the part of the cervix that contains abnormal cells. This allows normal cells to grow back in their place. 

 

The advantage of a removal over destruction is that the removed tissue can be sent for examination to make sure all of the CIN tissue has gone. Other treatments destroy the tissue, so it cannot be sent for examination.

 

If you are past the menopause or have had all the children you want, your doctor may suggest a hysterectomy, where the whole of your uterus is removed. This is more likely if you have had abnormal cells found on your cervix more than once or if severe abnormality was found.

 

What if you do nothing?

The lower levels of CIN may sometimes get better without treatment. You may decide to wait and see if this happens for you. You would need frequent smear tests and examinations of your cervix over several years to see if the tissue is returning to normal. The tissue is less likely to recover if you smoke.

 

If you do not have treatment for a higher level of CIN, there is high chance of cancer developing in your cervix in the future. If you develop cancer the treatment will involve extensive surgery. Curing a cancer is much more difficult. Removing the pre-cancerous changes before they get to this stage is a much simpler operation.

 

Author: Dr David Hutchon. M.R.C.O.G, F.R.C.O.G.  Consultant Gynaecologist.

© Dumas Ltd 2006

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