Cervical conization is both a diagnostic and treatment tool used to detect and treat abnormalities of the cervix. It is also known as a cone biopsy or cold knife cone biopsy.
Purpose
Cervical conization is performed if the results of a cervical biopsy have found a precancerous condition in the cervix. The cervix is the small cylindrical organ at the lower part of the uterus, which separates the uterus from the vagina. Cervical conization also may be performed if there is an abnormal cervical smear test (PAP test). A biopsy is a diagnostic test in which tissue or cells are removed from the body and examined under a microscope, primarily to look for cancer or other abnormalities.
Precautions
As with any operation that is performed under general anesthesia, the patient must not eat or drink anything for six to eight hours before surgery.
Description
The patient lies on the table with her legs raised in stirrups, similar to the position when having a PAP test. The patient is given general anesthesia, and the vagina is held open with an instrument called a speculum. Using a scalpel or laser the doctor removes a cone-shaped piece of the cervix containing the area with abnormal cells. The resulting crater is repaired by stitching flaps of tissue over the wound. Alternatively, the wound may be left open, and heat or freezing is used to stop bleeding.
Once the tissue has been removed, it is examined under a microscope for signs of cancer. If cancer is present, other tests will be needed. Surgery will be performed to remove the cervix and uterus (hysterectomy) and other treatments may be used as well. If the abnormal cells are precancerous, a laser can be used to destroy them.
Cold knife cone biopsy used to be the preferred treatment for removing abnormal cells in the cervix. Now, most cone biopsies are performed using laser surgery. Cold knife cone biopsy is generally used only for special situations. For example, if a biopsy did not remove all the abnormal cells, the cold knife cone procedure allows the physician to remove what's left.
Aftercare
An overnight stay in the hospital may be required. After the test, the patient may feel some cramps or discomfort for about a week. Women should not have sex, use tampons, or douche until after seeing their physician for a follow up appointment (a week or more after the procedure).
Risks
Because cone biopsies carry risks such as bleeding and problems with subsequent pregnancies, they have been replaced with newer technologies except in a few circumstances.
About one in 10 women experience bleeding from the vagina about two weeks after the biopsy. There is also a slight risk of infection or perforation of the uterus. In a few women, the cervical canal becomes narrowed or completely blocked, which can later interfere with the movement of sperm. This can impair a woman's fertility.
If too much muscle tissue has been removed, the procedure can lead to an incompetent cervix, which can be a problem with subsequent pregnancies. An incompetent cervix cannot seal properly to maintain a pregnancy. If untreated, the condition increases the odds of miscarriage or premature labor.
Cervical conization also may temporarily alter cervical cells, which can make a Pap smear test hard to interpret accurately for three or four months.
Normal results
This procedure is only performed if an abnormality is known or suspected.
Abnormal results
The presence of precancerous or cancerous cells in the cervix.
BOOKS
Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.
PERIODICALS
Clifford, Catherine. "Cervical Cancer: Smart Way to Protect Yourself." Redbook 189 (Oct. 1997): 124-28.
Israeloff, Roberta. "Your Pap Test is Abnormal: What Does it Mean?" Cosmopolitan, Apr. 1995, 120-22.
Biopsy—The removal of a small piece of living tissue for examination under a microscope.
PAP test—The short term for Papanicolaou test, this procedure tests a smear of cellular material scraped from the cervix and examined under a microscope to detect abnormal cells.
