Cervical biopsy (cone biopsy)

A cone biopsy is a small operation to remove a cone shaped piece of tissue from your cervix.

You usually have it under general anaesthetic, which means you are asleep. The operation takes about 20 to 30 minutes. You will probably stay in hospital overnight. 

Why you might have a cone biopsy

You might have a cone biopsy if you have symptoms that could be caused by cervical cancer.

It's also a treatment for abnormal cervical cells picked up through cervical screening. The abnormal cells might be on the outer surface of the cervix (ectocervix) or the inner part of the cervix (endocervix). If left untreated, abnormal cervical cells might develop into cervical cancer.

Preparing for the cone biopsy

• Your specialist will check that you are fit and well enough for a general anaesthetic.
• Let them know if you are taking blood thinning medication or have a condition that affects your blood.
• Do not stop taking any contraceptives before the operation. If you think you might be pregnant before the procedure, let the doctor or nursing staff on the ward know. They will do a test to check.
• Having a general anaesthetic means you won’t be able to eat or drink for several hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your appointment letter will give you instructions about this.
• Remove any jewellery below the waist, such as a belly button or vaginal piercing at home.

What happens?

You have an anaesthetic so that you can’t feel anything during the operation. You have this in the anaesthetic room, next to the operating theatre.

All the doctors and nurses wear theatre gowns, hats and masks. This reduces your chance of getting an infection.

The anaesthetist puts a small tube (cannula) into a vein in your arm. You have any fluids and medicines you need through the cannula, including the general anaesthetic. This sends you into a deep sleep. When you wake up, the procedure will be over.

During the operation, your doctor puts a speculum into your vagina so that they can see the cervix. This is similar to when you have cervical screening or a colposcopy. Your doctor removes a cone shaped wedge of tissue from your cervix.

They send the piece of tissue to the laboratory where a pathologist looks at it closely under a microscope. They can check that all the abnormal cells have been taken away, or can check for cancer cells.

Your doctor might pack your vagina with some gauze. This is to put pressure on your cervix to help stop any bleeding. They may also put a tube into your bladder (catheter) to drain urine while the pack is in place.

After your cone biopsy

After the operation, you go back to the ward. Your nurse checks your blood pressure, pulse and temperature, and looks for signs of bleeding.

You will probably have period type pain when you wake up. Tell your nurse if you have any pain. They can give you some painkillers. You can take painkillers home with you if you need to, but the pain usually only lasts a couple of hours.

Once you are fully awake you can eat and drink.

Your nurse or doctor will take the gauze pack out before you leave hospital. You need to rest on the bed for a couple of hours afterwards to make sure there isn't any heavy bleeding.

It is normal to have some bleeding for up to 6 weeks after a cone biopsy. Your doctor may prescribe a drug called vasopressin or tranexamic acid that can reduce the bleeding.

At home

Try to rest as much as you can for the first week or so. You do not have to stay in bed. But you shouldn't be too active either.

Don't do any heavy housework or carry heavy loads. It will help if you can arrange for a relative or friend to help you for a few days, particularly if you have children to look after. Most women are able to go back to work within 1 or 2 weeks.

You shouldn't do any vigorous exercise or have sexual intercourse for 4 to 6 weeks after your cone biopsy. By that time your cervix will have healed.

Possible risks

Cone biopsy is normally a safe procedure but your nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a cone biopsy outweigh any possible risks.

Bleeding

There is a small risk of heavy bleeding. Your nurse will check you regularly after your operation for signs of bleeding.

Contact your GP or go to accident and emergency (A&E) if you start to bleed heavily or pass blood clots once you are at home. You may need treatment to stop the bleeding.

Infection

There is a small risk of infection after the biopsy. See your GP if you have:

• vaginal discharge that smells
• pain in your lower tummy (abdomen) that doesn't go away
• a high temperature (fever) 

You may need antibiotics.

To reduce infection during this time and for the next 4 weeks, you shouldn't:

• use tampons or menstrual cups
• have penetrative sex, including using fingers, tongues or any other objects
• do heavy exercise such as running or gym workouts that cause you to sweat
• swim
• take long baths – you may shower

 Pain

You may have pain lasting between 2 days and up to 4 weeks after treatment. Pain should not be too severe. It might feel like a cramping pain, similar to having a period. Ask the colposcopist about what pain medication you can take.

If you are in a lot of pain or if it lasts longer than 3 months, contact your GP.

Narrowing of the cervix

After a cone biopsy there is a very small risk that the cervix may narrow. You might need surgery to stretch (dilate) the cervical opening.

Pregnancy

Your doctor will not suggest a cone biopsy if you are pregnant unless they suspect there is a cervical cancer.

A cone biopsy can weaken the cervix. This can increase the risk of miscarriage or early labour in future pregnancies.

Getting your results

Before you leave hospital, make sure you know how you will be given the results. You might go back to the hospital for an outpatient appointment to get the results. Or the results may be sent in the post.

If you had a cone biopsy for abnormal cells, you usually have a follow up appointment about 6 months afterwards. This might be at the colposcopy clinic or GP surgery. The cone biopsy usually removes all of the abnormal cells so you don't need any further treatment. You continue with regular cervical screening tests to make sure your cervix remains healthy.

If you are diagnosed with cervical cancer, your doctor will arrange for further tests. You will meet a specialist cancer nurse to help support you.