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Cone biopsy

A  cone biopsy is a type of surgery that removes a cone-shaped piece of tissue from the cervix. It can be used treat cell changes in the cervix or cervical cancer, as well as to diagnose cervical cancer. 

We know that having surgery, whether it is for cell changes or cervical cancer, can be overwhelming. We hope the information on this page helps you feel prepared, but if you need more support we are here for you. You could give us a call on 0808 802 8000 or use one of our other support services. 

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On this page:

What is a cone biopsy?

A cone biopsy is a small surgery. It removes a cone-shaped piece of tissue from the cervix. 

You might be offered a cone biopsy if:  

  • you have cervical cell changes – these are not cancer but could develop into cervical cancer over time
  • you have suspected cervical cancer – the removed tissue can be sent for testing to see if there are cancer cells
  • you have an early stage cancer (stage 1A1) – which means the cancer is very small.

Read about staging and grading cervical cancer >

Making decisions about treatment

A team of healthcare professionals, called a multidisciplinary team or MDT, will discuss your test results, diagnosis and medical history to help decide which treatments are best for you.

It is important that you are involved in any decisions about your treatment. You need to know and understand all the information about the treatment, including the benefits and risks.

You may also want to think about how having the treatment might impact on your life, including:

  • being able to have a child or more children (fertility)
  • being able to keep working (employment)
  • your finances, for any support you might need
  • other commitments or responsibilities you have. 

Read about making treatment decisions >

You should still be able to have children after a cone biopsy. It’s a smaller surgery, so you will still have:

  • most of your cervix 
  • your womb 
  • your ovaries.

Understanding the risk

After a cone biopsy there is a slightly higher risk of miscarriage and premature birth, as well as complications if the baby is very premature. This can be very distressing to think about.

If you have had a cone biopsy, the risk of giving birth before 37 weeks is about 11 in 100 (11%). If you have not had treatment, this risk is about 7 out of 100 (7%).

Getting support

If you get pregnant in future, it is important to tell your midwife that you have had LLETZ. They may offer to do an ultrasound scan of your cervix. If they think it is short and there is a risk you may have the baby a bit early, they may offer you a cervical stitch (cervical cerclage). This is an operation where a stitch is placed around the cervix. It is usually done between 12 and 24 weeks of pregnancy, although it may be done later.

Speak to your healthcare team to find out your individual risks and what can help. The charity Tommy’s also provides information about having a safe and healthy pregnancy.

Read about pregnancy on the Tommy’s website >

Your immune system protects the body from infection by finding and killing germs, bacteria or viruses. Surgery doesn’t usually have a big impact on your immune system.

Your hospital is doing as much as possible to reduce this risk. When your healthcare team are supporting you to make treatment decisions, they will consider the risk of COVID-19 as part of this. In most hospitals we have spoken to, surgeries are continuing as usual for cervical cancer patients. But your healthcare team may talk to you about: 

  • delaying your treatment
  • changing to a different treatment
  • using telephone calls and video calls to avoid face-to-face appointments where possible
  • having a test to check for COVID-19 before your surgery. 

Read about COVID-19 and healthcare >

Before a cone biopsy

It can help to prepare for a cone biopsy emotionally, physically and practically.

Read about preparing for treatment >

How long does a cone biopsy take?

A cone biopsy takes about 15 minutes. You are usually able to go home the same day or the day after.  

Having a general anaesthetic

A cone biopsy is usually done under general anaesthetic. This means you will be asleep during the surgery and won’t feel anything.

Cone biopsies are occasionally done under local anaesthetic if a very small area needs to be removed. This is where the part of your body is numbed so you can’t feel anything, but you are still awake. 

Some people feel worried about having a general anaesthetic. If you feel this way, you could speak to your healthcare team and anaesthetist before, to find more about what will happen and talk through any concerns. You can also speak to your healthcare team about which type of anaesthetic you would prefer.

When it’s time to have the surgery, you will be taken to a room next door to the operating theatre in a hospital bed. An anaesthetist will give you injections – one to make you fall asleep and one to make your body numb. Once you are asleep, you will be wheeled into the operating room. 

The anaesthetist will ask you to count to 10 and before you reach 7, you will drift off to sleep. You will wake up in the recovery room, once the surgery is done. 

During a cone biopsy

A cone biopsy is done vaginally, like cervical screening and colposcopy.

Your surgeon will use a speculum (plastic tube) to open your vagina. They will then remove a small, cone-shaped piece of tissue from your cervix. It is usually about 1cm wide. 

A cone biopsy is normally done with a scalpel. This is known as a surgical knife or cold knife cone biopsy.

After your surgeon has removed the tissue, they will place some gauze inside your vagina to stop any bleeding. This is called a vaginal pack and looks a bit like a large tampon or rolled-up bandage.

You might also have a thin tube put into your bladder. It might be done through the tube you wee from (urethra) or a small opening in your lower stomach. The catheter helps to drain your wee. It can be removed once the vaginal pack is removed.

Read about catheters on the NHS website >

During a cone biopsy

A cone biopsy is done vaginally, like cervical screening and colposcopy.

Your surgeon will use a speculum (plastic tube) to open your vagina. They will then remove a small, cone-shaped piece of tissue from your cervix. It is usually about 1cm wide. 

A cone biopsy is normally done with a scalpel. This is known as a surgical knife or cold knife cone biopsy.

After your surgeon has removed the tissue, they will place some gauze inside your vagina to stop any bleeding. This is called a vaginal pack and looks a bit like a large tampon or rolled-up bandage.

You might also have a thin tube put into your bladder. It might be done through the tube you wee from (urethra) or a small opening in your lower stomach. The catheter helps to drain your wee. It can be removed once the vaginal pack is removed.

Read about catheters on the NHS website >

A cone biopsy

An illustration showing the cervix. A cone-shaped piece of the cervix has been removed.

After a cone biopsy  

After the operation, you go back to the outpatient clinic or a ward to recover.

A nurse will make sure you are recovering from the general anaesthetic by checking your:

  • blood pressure
  • pulse 
  • temperature
  • breathing.

They will also check that the vaginal pack is in place and for any bleeding. 

You may be able to go home the same day. You usually need to be in hospital for about 6 hours so the general anaesthetic can wear off. In some cases, you might need to stay in hospital overnight or longer if your healthcare team want to do more checks.

Your healthcare team will usually take the pack out of your vagina, and remove the catheter within 24 hours after your cone biopsy. You may be monitored once the pack is removed, to check there is no heavy bleeding.

You will not be able to drive, so it is important to arrange transport home. This might be a friend or family member, or public transport.

Recovering from cone biopsy

Once you are home, it usually takes between 1 to 2 weeks to recover from a cone biopsy, although side effects can last longer.

Read about recovering from surgery >

Follow-up after a cone biopsy

After your cone biopsy, the tissue that was removed will be sent to laboratory. A specialist called a histopathologist will look at it under a microscope. They will check whether all the cancer cells have been removed.

You should get these results within 4 to 8 weeks. You can ask your healthcare team exactly how long you will have to wait.

If there are no cancer cells, you will be invited for a follow-up appointment at the hospital in 6 months. At this appointment, you will have cervical screening (a smear test). This tests for high-risk human papillomavirus (HPV) that causes almost all cervical cancer.

If your result is clear, you will be invited back for a follow-up appointment every year for 10 years. You will continue to have cervical screening at these appointments.

If you result shows you have high-risk HPV, the same sample will be tested for cell changes:

  • If there are no cell changes, your healthcare team may want you to come back for another cervical screening test in 6 or 12 months.
  • If there are cell changes but not cancer, your healthcare team may offer you another treatment to remove them.

If there are still cancer cells in your body, you will probably need more tests and treatment. Your healthcare team can explain what this process might look like for you.

Risks and side effects of cone biopsy

You may have some side effects after having a cone biopsy. Everyone’s recovery is different and not everyone gets all these side effects, but it is important to be prepared. Your healthcare team will explain potential side effects to you in more detail.

Cone biopsy removes a small part of your cervix, so it may take time to feel better before it heals. While it is healing, it can cause pain. This pain varies from person to person – sometimes it is described as a cramping pain, like a period. It can last between 2 days to up to 4 weeks, although you may experience pain for longer.

 

If you are in a lot of pain or find it is affecting your day-to-day life, talk to your healthcare team. They can advise on pain medication, offer reassurance based on your medical history and, if needed, will be able to check you are healing properly.

You will usually have some bleeding after a cone biopsy. The bleeding is usually like a period, but may be slightly heavier than your normal period. It can last between 2 days to up to 4 weeks after the surgery, although you may bleed for longer. 

About 10 days after a cone biopsy, the bleeding may get heavier. This is expected and is a sign that you are healing.

However, if the bleeding is soaking through a period pad every hour, you should phone your healthcare team at the hospital straight away. This is sometimes called delayed haemorrhaging. They can advise you and give you the right care. Out of hours, you can call 111.

If you are on blood thinning medication or you have a haematological condition, you must tell your healthcare team because you may have a higher risk of bleeding after cone biopsy.

The risk of having an infection after a cone biopsy is between 18 and 36 in 100 (18 to 36%). It is important to contact your healthcare team if you experience any of these symptoms:

  • Heavy bleeding – for example, if you are soaking through a period pad every hour.
  • Discharge that smells badly. 
  • Feeling unwell – for example, if you have a high temperature.

Your healthcare team will be able to treat an infection with antibiotics.

The opening of the cervix (the os) can narrow or close and become scarred after cone biopsy. This is called cervical stenosis. If this happens, the passage between the womb and vagina may become partly or fully blocked. After a cone biopsy, there is a between 2 to 14 in 100 (2% to 14%) risk of this happening.   

You may not have any symptoms of cervical stenosis. If you have periods, they might become irregular or painful. If you are trying to become pregnant, the sperm may not be able to get to the womb. It may also be harder for your healthcare professional to do cervical screening in the future, but you can be referred to colposcopy if this happens. Cervical stenosis is more likely if:

  • you are going through or have been through menopause 
  • you have had more than 1 treatment
  • treatment removes a large area of the cervix 
  • treatment removes cells from inside the cervical canal (endocervix). 

If you are worried about cervical stenosis or think you may have it, speak with your healthcare team. They can offer support and practical ways to help, like using a thin tube (dilator) with lubricant to help open the cervix.

You shouldn’t have sex for 4 to 6 weeks after your cone biopsy. This is to make sure any side effects are better and you are healed.  

You may find that your sex life is different after a cone biopsy. This can be because of the surgery and side effects, or the emotional impact of being diagnosed with cancer. It can take some time and to recover, but this does tend to gradually get better.

Read about sex after cervical cancer >

More information and support about cone biopsy

Even if you don’t need further treatment, having a cone biopsy can have an emotional impact on you. You may feel anxious, down or worried about the future. Your healthcare team, both at the hospital and at your GP surgery, are there to support you with any questions or worries you have. 

Remember that we are here for you too, whether you are waiting for surgery or years past it. Our trained volunteers can listen and help you understand what’s going on via our free Helpline on 0808 802 8000.

Check our Helpline opening hours >

 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

If you have general questions about cone biopsy, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.

References

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]

Read more about how we research and write our information >

Connect with others

Join our Forum to talk with others who have had a cone biopsy.

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Date last updated: 
03 Nov 2020
Date due for review: 
03 Nov 2023
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