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Cone biopsy

A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal (the pathway from the uterus to the vagina). A cone biopsy is also called cervical conization.

Why a cone biopsy is done

A cone biopsy may be done to:

  • follow-up on consistently abnormal Pap tests
  • diagnose precancerous conditions of the cervix
  • diagnose invasive cervical cancer (cancer that is growing into surrounding tissue or has spread beyond the cervix)
  • treat precancerous conditions of the cervix, carcinoma in situ or stage IA1 cervical cancer

Find out more about precancerous conditions of the cervix and staging cervical cancer.

How a cone biopsy is done

All cone biopsies are done during a colposcopy. A colposcopy is a procedure that uses a colposcope (a lighted magnifying instrument). It allows the doctor to view the area and guide the tools used to do the cone biopsy. The doctor places a speculum (the same instrument used during a Pap test) into the vagina to keep it open. Then the doctor uses a colposcope to view the vagina and cervix.

There are 3 ways to do a cone biopsy:

  • Loop electrosurgical excision procedure (LEEP) uses a thin wire loop heated by an electrical current to remove the cervical tissue.
  • Cold-knife excision uses a surgical scalpel to remove the cervical tissue.
  • Laser surgery, or laser excision, uses a laser (an intense, narrow beam of light) to remove the cervical tissue.

After the cervical tissue is removed, it is sent to a lab and examined under a microscope.

The way a cone biopsy is done will determine where it is done. You may have a cone biopsy in your doctor’s office, at a colposcopy clinic or at a hospital. The way the cone biopsy is done will also determine if you have a local anesthetic (freezing) or general anesthetic (you will be unconscious). It will also determine whether or not you need stitches to close the wound after a cone biopsy.

After a cone biopsy, there is often some discharge from the vagina. This discharge can last for a few weeks, so your healthcare team will tell you to use sanitary pads. Don’t insert anything into the vagina, such as tampons or a vaginal douche, for 2–6 weeks after the procedure. You should also avoid having sexual intercourse for 2–6 weeks after the procedure. Report any unusual pain in the pelvis, heavy bleeding (with or without blood clots), severe abdominal pain or signs of infection (foul-smelling discharge or fever) to your doctor.

Find out more about loop electrosurgical excision procedure (LEEP) and laser surgery.

Side effects

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.

Short-term side effects

Short-term side effects can happen during, immediately after or a few weeks after a cone biopsy. They are usually temporary. Short-term side effects of a cone biopsy include:

  • mild cramping and discomfort
  • spotting or bleeding
  • dark-brown or yellow discharge
  • infection

Long-term side effects

Long-term side effects can show up long after the procedure is over and can last a long time. Long-term side effects are different depending on the type of cone biopsy you had.

LEEP seems to have fewer long-term side effects than the other types of cone biopsy. Women who become pregnant after LEEP may deliver their babies a little early.

Cold-knife excision has been linked to second-trimester miscarriages and premature delivery.

Laser surgery has been linked to scarring of the cervix, which may make menstrual periods painful.

If you become pregnant, tell your doctor that you have had a cone biopsy. Your doctor will talk to you about the best way to manage your pregnancy.

What the results mean

A pathologist will examine the tissue removed during a cone biopsy under a microscope. The pathologist’s report will tell your doctor if the cells of the cervix are normal, there is a precancerous condition of the cervix or there is cervical cancer.

What happens if a change or abnormality is found

Based on the pathology report, your doctor will decide if you need more tests, procedures or treatments.

Follow-up may include:

  • Pap test
  • HPV test
  • colposcopy
  • biopsy
  • endocervical curettage (a procedure that uses a special tool, called a curette, to remove cells from the endocervical canal, usually done at the same time as a colposcopy)


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