A cone of tissue is cut away from your cervix to remove all the abnormal cells. In this procedure the doctor removes a similar sized or slightly larger piece of the cervix than with a large loop excision of the transformation zone (LLETZ) (sometimes called a loop) biopsy. There is not much variation in the size of a cone biopsy, so if only a small area needs removing it will probably be done using a LLETZ. A cone biopsy allows for the cells at the edges of the specimen to be seen clearly through a microscope ensuring that all of the biopsy can be examined by a histopathologist (an expert in studying diseases by looking at cells).
A cone biopsy is usually carried out under a general anaesthetic, which is where you are asleep (very few cone biopsies are performed under local anaesthetic). A vaginal pack will sometimes be put in place in theatre while you are under anaesthetic. This is like a long bandage that puts pressure on the biopsy site and so helps stop any bleeding (a bit like putting pressure on a cut to stop it bleeding). It will be removed before you go home. Not all health gynae-oncologists use vaginal packs, so please discuss this with your medical team if you have any questions. It is advisable to have some painkillers at home (such as you would take for period pains) as some women experience a deep ache and/or tenderness in their pelvis. It is not unusual to feel tired for a few days or even a week or so following a general anaesthetic.
Side effects/complications after cone biopsy
The side effects that you may have after a cone biopsy are very similar to those that you may have after a LLETZ and include some bleeding and discharge for about three to four weeks. The amount and colour of any bleeding/discharge, as well as when/if they begin will vary from woman to woman. The blood can be red or brown and it can vary in heaviness from light spotting to slightly heavier bleeding. Sometimes the discharge can be yellowy in colour, and it can be heavy or watery. Some women find that their next monthly period comes slightly earlier than normal and it may be slightly heavier, which is thought to be caused by the increased blood supply around this area. The bleeding/discharge may begin straight after treatment or a few days to a week later.
These symptoms are very normal following a cone biopsy and in order to help avoid any possible infections it is recommended that you only use sanitary towels, and avoid tampons, sex and swimming, until any discharge has stopped and any bleeding has settled.
However, if you are having particularly heavy bleeding (eg. your sanitary towels are soaking every hour) or discharge that smells really offensive and/or you feel unwell (either of which could be a sign of infection) you should contact a health care professional as soon as possible. This could be your colposcopy clinic or your GP, or any other health care professional you feel comfortable talking to about this. There will be a specialist nurse in your colposcopy clinic who will be able to address any queries you have.