Leep or Cone Biopsy
Your cervix is the lower part of your uterus (womb). It links the vagina to the part of the uterus where periods come from and where pregnancies are contained. The opening of the cervix at the top of the vagina leads into a canal that goes into the uterus. The surface of the cervix is where most abnormalities occur. The surface can be seen through the vagina. The canal is not visible. The cervix is made up of layers of cells that slowly change as they move towards the surface. At the surface, the cells form a protective, skin-like covering. When all of the cells in your cervix are normal, your cervical smear test (Pap test) result is normal.
Problems that can develop
Some cells in the cervix may not change normally. If this is the case, your test results will not be normal. This can happen at any point in a woman’s life. Abnormal changes may occur in the cells on the surface of the cervix. This is sometimes called dysplasia. Abnormal cells may also spread beyond the surface of the cervix into the endocervical canal. Cells in either location can become cancer of the cervix if they are not found and treated.
What is a smear?
A smear is a screening test. It involves scraping cells from the surface of the cervix. These cells are placed on a glass slide and are then examined in the laboratory. The appearance of the cells can give an idea of whether the lining of the cervix is normal and healthy or whether it has changes that, if left untreated, might lead to cancer on the surface of the cervix or in the deeper tissues making up the cervix.
If your smear is not normal, it may need to be repeated, or a further examination of the cervix using an instrument like a pair of binoculars (a colposcope) may be advised. If there are changes in the lining of the cervix when this is done, a cervical biopsy may be necessary.
What is a biopsy?
A biopsy is a way of taking a very small piece of tissue from the cervix so that it can be studied in the laboratory under the microscope. This is the only way to be sure whether the changes seen in your earlier tests are a cancer or not. There are a several ways of doing biopsies. A number of factors will determine what is the best type of biopsy for you to have. Some biopsies can be done in the office, others need you to come to the hospital, usually for outpatient surgery.
What is a LEEP or cone biopsy?
A cone biopsy is a surgical procedure to find and treat a problem in the cervix, particularly if the abnormality extends into the endocervical canal. LEEP refers to a specific technique for doing the cone biopsy. Your doctor may do a LEEP or cone biopsy if one or more smear tests and a colposcopy (microscope) exam show abnormal cells on your cervix. During the procedure, tissue is removed from the cervix while you are anesthetized and sent to the laboratory to be studied. Cutting away the tissue also removes the abnormal cells. The tissue that grows back is likely to be normal, in which case no more treatment is needed. A cone biopsy usually takes less than half an hour to perform.
Preparing for the procedure
To help prevent problems with anaesthesia, do not eat or drink anything after midnight on the night before the biopsy. You will also need to have someone drive you home afterwards, as you may be too drowsy to drive safely. On the day of the biopsy, be sure to arrive at the hospital or office in plenty of time to sign in and get ready for your procedure.
What happens during a cone biopsy?
You will be given anesthesia before your biopsy to keep you comfortable during surgery. The doctor then puts a speculum into the vagina to hold it open. This allows your doctor to see the cervix. A cone-shaped piece of tissue is then removed from the cervix. The tissue is cut from the opening up into the canal. This may be done with a small knife, an electric wire (LEEP), or with a laser. The removed tissue is then sent to the laboratory. The laboratory studies the tissue and makes sure the abnormal cells have been cut away. New tissue grows back in the cervix in four to six weeks.
You will be able to rest in the recovery area until you are awake. Virtually all patients go home within an hour or two. If you do go home the same day you should plan to rest at home for a day or two. You may have some bleeding or discharge and mild cramping for a few days after surgery. Use sanitary pads, not tampons, for at least the three weeks after biopsy. Usually over the counter medication such as Aleve or Advil will relieve any discomfort. Call your health care provider if you have a fever, chills or heavy bleeding (such as soaking a pad ever thirty minutes to an hour. Do not have sexual intercourse or play active sports for four weeks after your biopsy. Until the cervix has fully healed, the tissue could be injured and cause bleeding. Other daily activities are not a problem.
Risks and complications
Your health care provider will discuss the risks and possible complications of cone biopsy with you. These include:
- incomplete removal of abnormal tissue
- severe bleeding
- weakening or scarring of the cervix
Your doctor will get the biopsy results and discuss them with you in about a week, and examine you in about three weeks to be sure the tissue is healing well. Once you have had a problem in your cervix, you are at a higher risk for future problems in your cervix. You will need to have a smear test and pelvic examination more often than before, once every four months for the first year and then generally every year once you have been cleared after the biopsy. Be sure to make an appointment as often as your health care provider recommends.