What Is a Cone Biopsy?

Medically Reviewed by Dany Paul Baby, MD on April 07, 2022
5 min read

Your cervix is the small opening at the bottom part of your uterus, or womb, that connects your vagina and your womb.

A cone biopsy is a minor surgery to remove a cone-shaped piece of your cervix. 

A cone biopsy can refer to both diagnosis and treatment. Your doctor might remove only a sample of irregular tissue to test and diagnose cancer or precancerous changes on the outer part of your cervix or inside the cervical canal. They may also remove tissue to treat cancer and prevent it from spreading. 

You might have a biopsy to diagnose or treat:

  • Cervical dysplasia: the presence of precancerous cells on your cervix or in your vaginal canal
  • Carcinoma in situ, also called stage 0 disease, where cancer abnormal cells are present but haven’t spread
  • Stage 1A1 cervical cancer, where the cancer is so small you can only see it under a microscope

A cone biopsy procedure is usually an outpatient surgery. It takes less than an hour to do, and you can usually go home on the same day. You’ll receive anesthesia so you won’t feel any pain, but the type of anesthetic depends on how much tissue they need to remove. 

You might be given a:

  • Local anesthetic, which numbs the area and helps you to relax
  • Regional anesthetic, injected into your spine
  • General anesthetic, which puts you to sleep for the procedure 

The procedure is much like a Pap smear. You lay on your back with your feet in stirrups, and your doctor inserts an instrument into your vagina to keep it open. Then, they place a magnifying instrument called a colposcope near your vulva (the outer part of your genitals) and shine a light into your vagina so they can see your cervix and guide their tools.

Next, your doctor removes a cone-shaped piece of tissue. There are 3 different ways to perform the actual biopsy: cold-knife excision, laser surgery, and LEEP.  

Cold-knife excision. For this procedure, they use a small surgery knife to cut out the tissue. 

Laser surgery. This procedure uses a focused beam of light to remove the tissue. The procedure is sometimes referred to as a laser excision. 

LEEP. LEEP stands for loop electrosurgical excision procedure. For this method, they heat a thin wire loop with electricity and use it to remove the tissue. It’s the most common method and is also called a loop biopsy or loop excision. 

Once the tissue is removed, they send the sample to the lab for testing. They might then apply a cream to your cervix to control bleeding or pack your vagina with gauze to help with bleeding and insert a tube called a catheter to drain your urine. 

You’ll be sent to a recovery room to be monitored until you’re ready to go home. 

Your care providers will take out the catheter before you leave, and they will either take out the packing or let it fall out on its own. Sometimes, they will use a natural product that your body absorbs. If the product or gauze falls out, it might look bloody or black, but this is normal.

It takes 4 to 6 weeks to recover and for cervical tissue to grow back. In the first few days, you might experience:

  • Cramping 
  • Pain
  • Some bleeding 
  • Dark brown blood or small amounts of blood called spotting, which can be observed for up to 3 weeks
  • Pink discharge 

Some mild pain is normal, and you can treat this with extra-strength acetaminophen. Your doctor might prescribe a different pain medication that will help, too. 

You’ll need to rest as much as possible for the first few days and up to the first week. Too much activity can make you bleed, so it’s important to avoid things like housework, lifting heavy loads, and being overly active. 

Most people can return to work within one week of a cone biopsy. 

You also need, however, to give your cervix time to heal without irritating it. For four to six weeks after the procedure, this will mean:

  • No vaginal sex
  • No tampons or menstrual cups
  • No douching
  • No baths, hot tubs, or pools

Take showers instead of soaking in a bath and use sanitary pads for any bleeding. Lingering blood and discharge will slowly go away over the next few weeks and will turn from red or pink to watery and clear. Your next period might be late, and you might experience heavier bleeding than usual. 

Schedule a follow-up with your doctor for a date about four weeks after your biopsy. They will conduct an exam and look at your cervix to make sure it’s healed. They might also go over your results and give you the OK to have vaginal sex and use tampons again. 

Before you leave the clinic, check with your doctor about how you’ll receive your results. Sometimes, you’ll get a report in the mail, but sometimes, the results will go to your doctor. Either way, it’s a good idea to go over what the results mean with your doctor.

The information in your results can depend on whether you have a cone biopsy for a diagnosis or treatment. Results might be:

  • Normal, which means your cervical tissue shows no sign of irregular or cancerous cells. 
  • Abnormal, which means your tissue shows irregular cells. Your doctor will usually describe the type of cells.

Results might also include:

  • Negative margins, which means the edges of your cone-shaped tissue don’t have cancer cells.
  • Positive margins, which means the edges have cancer cells, and there might be some cancer left behind.

You’ll need follow-up care based on your results. If your doctor removed all of the cancerous cells during the surgery, you might not need any other treatment. They might recommend receiving regular pap smears to monitor the situation, though.

A cone biopsy is usually very safe, but there are some potential risks, including:

  • Heavy bleeding
  • Infection
  • Cervical scars 
  • A weakened cervix that causes early delivery and pregnancy loss

Call your doctor if you have:

  • Large blood clots or severe bleeding that soaks a pad every 1 to 2 hours
  • A fever
  • Chills 
  • Foul-smelling discharge 
  • Severe pain