Some physicians recommend cone biopsy, a procedure that surgically removes a chunk of the diseased tissue. It is a little more complicated than cryosurgery or laser surgery, and a bit more aggressive in that more tissue is removed. A cone biopsy can be done either with a cutting tool — a scalpel or a laser — or with an electrical wire. The choice depends on the condition of your cervix and your gynecologist’s preference. Either procedure can be done in an office setting, though most are performed in a surgicenter using a little sedation. Usually the sedation is a local anesthetic such as Novocain for your cervix and something like intravenous Valium to calm your nerves. Some women elect to have general anesthesia. Using a scalpel (a “cold-knife conization”) or a laser, the surgeon removes a small, cone-shaped wedge of cervical tissue and puts a few stitches around the area where the tissue was removed.

The newest technique, one that physicians are increasingly choosing, is a loop electrical excision procedure, or Loop electrical excision procedure. A very hot tungsten wire with electric current passing through it is used to take out a cone-shaped wedge of tissue. The wire cuts through the tissue easily and cauterizes the blood vessels at the same time, thereby controlling bleeding. Unlike a laser, the hot wire does not char the edges of the incision.

What are the risks of cone biopsy?

These different procedures for cone biopsy are all comparable in terms of cure rates or complications after surgery. As with any surgery, make sure your operation is performed by someone who has done it many times. The risk of infection or bleeding is always present in surgery; but with cone biopsies, that risk is slight.

Many women have a cervical or vaginal discharge for days or even a few weeks after a cone biopsy. The amount of discharge and the time it lasts differ from woman to woman, rather than from one type of procedure to another. The most significant discharge, however, does seem to occur after cryosurgery.

How long does it take to recover from a cone biopsy or Loop electrical excision procedure?

Since these procedures are minor enough to be done in a surgicenter or doctor’s office, the recovery period is short — aside from the vaginal discharge. You can continue all your usual activities, except that you should abstain from intercourse while your cervix is healing, a period of two to three weeks. Usually your physician will check you after this time to be sure you are healing well. A Pap smear will not give any useful diagnostic information until your cervix is fully healed.

Will a cone biopsy affect my fertility?

A cone biopsy will not affect your fertility or harm your cervix so that it is unable to sustain a pregnancy. Women who have had a cone biopsy rarely have problems giving birth.

When should you have another Pap smear after a cone biopsy?

Most physicians recommend waiting about three months, but even then your cervix may not be completely healed and the Pap smear will not be readable by the pathologist. The first accurate postoperative Pap smear generally shows that the abnormal cells are gone. After that, most physicians recommend a repeat Pap test more frequently than once a year, perhaps every six months for a year or two; thereafter, if nothing abnormal turns up, it is common to space the Pap smears further apart again.

Is a hysterectomy ever done because of cervical abnormalities?

Some old-time physicians do not believe in cone biopsies and prescribe hysterectomy instead. If your doctor recommends a hysterectomy for precancerous cervical disease, get a second opinion. If you have symptoms in addition to your cervical dysplasia, a hysterectomy, which removes the entire uterus including the cervix, may be a better choice than a cone biopsy.

Daisy has menstrual periods that last ten days, with heavy flow and clotting. She doesn’t want more children, and she is really incapacitated with her periods. She is not particularly reliable about following instructions or taking medication. Her last Pap smear showed that Daisy also has cervical dysplasia.

A hysterectomy for Daisy would solve several problems at once. Instead of removing part of her cervix and letting her cope with the heavy periods and birth control, a hysterectomy would give her permanent sterilization and solve her bleeding problems as well.

A hysterectomy may also be necessary if cervical changes have progressed beyond carcinoma in situ. If you prefer conservative therapy — a cone biopsy, for example — you need to follow up and be reliable about coming in for examinations. If you do not want to take that responsibility, then conservative therapy is not right for you.

Can you get a tubal ligation while you are having a cone biopsy?

Some women who need a cone biopsy ask for a tubal ligation at the same time. They would prefer not to have a hysterectomy, a personal preference that should be respected, but they would like sterilization. Fifteen years ago I seldom did a cone/tubal, because these two very different procedures achieve the same result as a hysterectomy. Today I do perform them together. The procedures are simple enough that doing both at the same time is not a problem. In general, recuperation from a cone/tubal is rapid. A hysterectomy is major surgery and requires a much longer recovery time.

What are the therapies for more advanced stages of cervical cancer?

Most women with cervical cancer are diagnosed early through Pap smears or because they have unexplained vaginal bleeding. There are two options for treatment of stage I cervical cancer. One is radiation therapy, which is quite effective. The other is radical pelvic surgery, which involves removing the uterus and taking out the lymph nodes next to it.

Surgery as a treatment for cervical cancer has the advantage that it does not interfere with the ovaries, because they are not involved with the disease; estrogen, made by the ovaries, does not stimulate cervical cancer. Most women who get the disease are fairly young and have functioning ovaries, which can continue to work normally after the surgery. Radiation therapy, on the other hand, will shut down the ovaries forever and cause artificial menopause, which is not desirable in younger women. The surgical approach can usually maintain normal sexual function by keeping the top of the vagina intact and unscarred.

Many physicians recommend some radiation therapy in addition to surgery, because of the risk of involvement of lymph nodes that have not been taken out. And some new approaches involve chemotherapy.

What are the survival rates for stage I cervical cancer?

Ninety percent of women treated for stage I cervical cancer (when the disease is still localized) will be alive five years later. In fact, if you have lived five years beyond your treatment, you are likely to live a great deal longer because cervical cancer, unlike some other cancers, generally recurs quickly if it recurs at all. human immunodeficiency virus-positive women have less reassuring survival rates.

What kind of physician should treat someone with cervical abnormalities?

Any board-certified gynecologist should be able to treat cervical dysplasia and do a cone biopsy or other appropriate therapy. If the cancer has spread beyond the cervix, it is wise to consult a specialist — a gynecological oncologist or someone who works with one. Obviously, radiation therapy should be directed by a specialist in this field. Surgery for invasive cancer should be performed by a specialist with considerable experience in cancer surgery — not necessarily someone board-certified in gynecological oncology, but someone skilled in radical pelvic surgery. The kind of radical hysterectomy appropriate for invasive cervical cancer is technically more difficult than a simple hysterectomy for fibroids or for early endometrial cancer.

Tagged with:  
Share →