A-Z

Cervical abnormalities: CIN3 and CGIN

Cone biopsy

A cone biopsy involves removing a slightly larger part of the cervix than with a LLETZ biopsy. With a LLETZ, the cells at the edges of the specimen are not always seen as clearly through a microscope as those taken by a cone biopsy.

A cone biopsy is usually done under a general anaesthetic, though very small cone biopsies can be performed under local anaesthetic. A vaginal pack is sometimes put in place in the operating theatre while the woman is under anaesthetic. This is like a long bandage that puts pressure on the biopsy site and so helps to stop any bleeding, a bit like putting pressure on a cut to stop it bleeding. Some women feel a deep ache and / or tenderness in their pelvis after surgery so it can help to have painkillers at home. Many women feel tired for a few days or even a week or so after having general anaesthetic.

Some of the women we interviewed were told at colposcopy that they would need to have a cone biopsy. Several found waiting for the appointment difficult and worrying. A few women were worried that they might have cervical cancer.

 

Michelle was extremely anxious because she didn’t know whether she had cervical cancer as well as...

Michelle was extremely anxious because she didn’t know whether she had cervical cancer as well as...

Age at interview: 31
Sex: Female
Age at diagnosis: 30
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When I first went to see him [GP], I was having such bad panic attacks, I mean you know I’m not talking about kind of, because again CIN3 and cancer are completely different things. And I’m not saying that what I went through was probably even in any way comparable to the ladies that are obviously going through that, but being told that you’ve got quite a serious health problem is very distressing.

So my doctor suggested for a short term problem that the valium would be the best solution. It would calm me down. I mean just to give you an idea of how bad it was, you know I was out driving one day and I thought I had to phone NHS direct because I thought I was having a heart attack, because the panic attacks were that bad.

I was having very bad palpitations. I felt my throat was constricting. I was shaking. And I was nearly passing out when I went out. I think it’s all just a complete process of going through it all, but the adrenaline’s constantly there. Your mind’s constantly on it. I couldn’t work and I didn’t go into work for around two weeks.

I found it very difficult actually to be around my husband and my daughter, which probably sounds quite strange but the reason was is because it kind of brought everything home emotionally as to, you know, what you could be facing and facing up to really.

 

Maria read a book about complementary approaches to cancer and changed her diet before surgery....

Maria read a book about complementary approaches to cancer and changed her diet before surgery....

Age at interview: 34
Sex: Female
Age at diagnosis: 33
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So in the three weeks leading up to the cone biopsy did you change your diet?

Yeah.

In that three weeks?

Because then I realised I knew nothing about cancer and I knew nothing. I mean I didn’t even know, I mean I knew my mind because I was a bit pessimistic. I thought, “Oh maybe I already have cancer. Or maybe…” So I was reading all these books and I realised, I mean there’s a really good book about this French doctor called David Servan Schreiber about cancer. And he’s had brain cancer as well, so he goes through all the things, which are not conventional medicine, that you can do to help yourself like nutrition, meditation, exercise. I can’t remember now but like a few other things, and it’s really, really interesting. And it explains what cancer is, which I had no idea.

And he also explains that there is an epidemic and that there are reasons for it, like maybe not to drink tap water. Or, you know, just start to be aware of what the toxin is and how it can affect your body and all that. So I found that a really, really interesting book.

Obviously the three weeks leading up to that [cone biopsy] weren’t the best of my life. But I was really well looked after and the operation went really smoothly. Afterward, I mean my mum came here to look after me, which was nice. But I, you know, I hardly had any bleeding or anything disturbing, so just a bit weak. So now I’m waiting, I’m waiting now for the next colposcopy, which is meant to be in October.

And hopefully, oh yeah and then the results came. And they were CGIN, which had already been diagnosed, plus CIN3, which was something new. So I mean it was getting worse. But I mean the good news was that it was clear, the margins were clear. So there was good news I guess.

For some, the thought of having a general anaesthetic caused anxiety and several looked for more information.

 

A doctor explains that, these days, general anaesthesia is completely safe.

A doctor explains that, these days, general anaesthesia is completely safe.

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General anaesthesia is completely safe now. And I mean these are fit young women who have no other health problems generally speaking. And there is really very little to worry about. The important thing, of course, is to tell the anaesthetist about their fears and they’ll be able to calm them down.

 

Colleen had never been in hospital before. The thought of having general anaesthetic frightened...

Colleen had never been in hospital before. The thought of having general anaesthetic frightened...

Age at interview: 25
Sex: Female
Age at diagnosis: 25
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They confirmed CIN3, and then I got booked in for a loop cone biopsy. And my biggest concern with that, because I’m a relatively healthy person. I’ve never, apart from being born, I’ve never been in hospital like. I’ve never even had things with my teeth or anything. I’ve had no symptoms. I’ve always played loads of sport, and I don’t really drink, I don’t smoke.

And so just the thought of having general anaesthetic, for me that was just like the most terrifying. I was more scared about the general anaesthetic than I was about the actual procedure. That kind of dominated everything. And I was really worried about that.

When I came round, I was pretty chipper. I am like the most dramatic person, but I was just like so relieved I was alive. It wasn’t the surgery that bothered me, it was the general anaesthetic. And I was so convinced that was how I was going to go. So convinced. So convinced. But then I was fine for the rest of the day, like I literally felt if I could’ve gone for a run, I felt so fine. But that probably would have been a bad idea because I probably only felt that way because they’d pumped me full of drips and stuff.

So you went for surgery, did you go by yourself, or was your mum…?

No, my mum came with me again. I don’t think I could’ve gone by myself; I would have been a mess. So yeah, she came with me for the surgery, which was quite good.

And you had the general anaesthetic, were you in for a few days, or just one?


No I was in and out in a day. I went in, I had to go in for 12, and I think I left at about 5. So it was really quick. And I had it on the Friday and I was back at work on the Monday.

Several women described what happened on the day of treatment. Although some were worried beforehand, most said it went well and they felt fine when they came round. Marjory, who’d been treated by cone biopsy over twenty years ago, remembers little about her treatment.

 

Katie was a bit tearful before surgery, but the next thing she knew the operation was over. She...

Katie was a bit tearful before surgery, but the next thing she knew the operation was over. She...

Age at interview: 28
Sex: Female
Age at diagnosis: 28
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The nurse came round and just sort of explained what was going to happen. They was going to, like the consultant would be round in a bit, and the anaesthetist would be round to talk me through what each of them would be doing.

Then she gave me these big, measured me up to put these stockings. And she came back and put these stockings on. Then I had to get changed. I was a bit nervous, because I was actually just starting my period this day. And I’d e-mailed him a couple of days before saying I might be starting my period soon, is that a problem? And he said as long as it’s not a problem for me, and it wasn’t because I’d thought, I would rather, although it’s not ideal, I’d rather get it over and done with than have to wait another week.
 
So yeah, then he came round to see me, just explained I had to sign some paperwork and stuff. And then the anaesthetist came round to introduce himself. And then a little while later, then they gave me the gown and stuff that I had to get changed into. My mum stayed with me and a little while later they came back and said, “Right, we’re taking you down.” So my mum went and said my boyfriend was going to come back, asked roughly what time they’d, I’d be finished. They said it doesn’t take very long, so she said she was going to ring my boyfriend and tell him to bring me back, to come up.
 
Then they took me down. As I was in the room though, there was the anaesthetist and another lady talking to me. They were lovely. But I was getting a bit teary, and they’d asked me these questions and stuff. It wasn’t how I remember being knocked out actually. It was like feeling a bit drunk first of all and then lasted a few minutes and then the next thing I know, I remember someone trying to wake me up, and then I was going back to sleep again.

And then the next thing I remember there was them then passing me from the bed that they were carrying me on to my bed, and me thinking “Is my boyfriend here yet?” And he wasn’t, because it wasn’t that long after, but it seemed like quite a long time. And then he got there and he was talking to me, and I was like, “Don’t talk to me, I’m tired.” And that was it really. And then eventually I sort of woke up and then my mum come back, and she come with my daughter as well, to pick me up. And then they took me home and we just came here and I just zonked out on the sofa.

 

Gillian didn’t know she’d had a cone biopsy until later. The appointment felt rushed and, because...

Gillian didn’t know she’d had a cone biopsy until later. The appointment felt rushed and, because...

Age at interview: 30
Sex: Female
Age at diagnosis: 27
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You mentioned that you wish you’d known what treatment you were having. You didn’t know it was a cone biopsy…

Yes. I think, for me, the biggest thing would be the choice had been taken away. I’d had the treatment and I had an operation before I even knew that, or consent had been given to have that. And for me what would be, but even then I wouldn’t have known what to do because I think if they’d stopped and said, “We can take a little bit of, your cells are looking like this, we can take a little bit away, or you can come back next week once we’ve got the results of this.” I think I maybe even then, at the time, if I’m honest, would have said, “Oh no, just go ahead with it now.” But I think I’d like, I would have liked the choice, and had maybe the two or three days away on my own to think about it. Whereas I think the fact, and then you can make that decision to say and go through with it then. But I think it was that I wasn’t given, explained what was happening properly and you sort of find these things out afterwards.

And it was all just done quickly on that one day, you were in and out within…?

I was in about half an hour, by the time I arrived in the queue, and then it’s all over and you don’t really know what’s gone on. It’s just very much like a meat market.

Many women feel tired for a few days or even a week or so after having a general anaesthetic (see ‘Healing after a LLETZ or cone biopsy’ for women’s experiences of their recovery).

A few women who had small cone biopsies had them under a local anaesthetic. Two would have liked more information because they didn’t know they’d had a cone biopsy until they received their results letter. Gillian also found the procedure painful.

 

Debbie said her questions weren’t answered and she was given very little information. She is...

Debbie said her questions weren’t answered and she was given very little information. She is...

Age at interview: 36
Sex: Female
Age at diagnosis: 24
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I was listening to what they were talking about. When I was trying to ask questions about what they were talking about when he said, the doctor said , “Oh no, I don’t see anything.” They started having a conversation about that; I said “Oh sorry, what does that mean? You don’t see anything? What? Why?” And he said, “Oh I’m just going to go ahead and do the treatment.” I said, “Wait a minute, why are you going to go ahead and do the treatment if you can’t see anything?” But I wasn’t really spoken to about it.

And did he say what treatment he was going to do?

No. No, he didn’t. He just said that he’d have to remove it and the only time he stopped was when he said, “Right, we’re going to go ahead and do the treatment.” And he said, “Now you won’t be able to fly for four weeks,” as he was about to do the treatment. And I said, “Wait a minute, wait a minute, I fly for a living.” I said, you know, “Are you telling me now…?” Because I was under the impression that perhaps I’d have to have a few days off work, and then I’d be okay, and this is what I’d told work. I’d said there’s a chance I’m going to be off for a few days, not a month. I hadn’t warned them that it might be a month.

And he said, “Oh do you want me to stop then? Do you not want me to do the treatment?” But at that point with your legs in stirrups, and nurses everywhere, it’s a bit difficult to say, “Oh well I need time to think about this.” So I said, “Well no, if it needs to be done then just go ahead.” But that was it, there was, afterwards he basically just told me the results would be available in a couple of weeks, and that they would write to me. I said, “Well, is that what I do then, do I just wait for you to contact me?” And he said, “Yes, yes we’ll be in touch.”

Did you know at this point what treatment he was…?

No. No I never, I still don’t know now. I still don’t know because when I phoned the, I spoke to the receptionist initially, who said, “Oh no, your results won’t be in yet.” And she phoned me back about five minutes later and said, “Oh, no they are in.” She said, “They are here.” She said, “I’ll read them out to you.” But all she said was the treatment had been successful, that it was CIN3, and that they have clear margins. And that I’d have to see my GP for a smear in six months.

But when the letter actually came through it was entitled Loop Cone Biopsy. And I still really don’t understand that. But I’m not terribly concerned that I don’t understand it because they’ve obviously got it all. But I still am a bit confused at the difference between what the cone biopsy is, and what the LLETZ treatment is. Because this seems to be an amalgamation of both of them. So I don’t know, and I’ll just leave it now.

 

Gillian found the procedure very painful even after being given more local anaesthetic. Her body...

Gillian found the procedure very painful even after being given more local anaesthetic. Her body...

Age at interview: 30
Sex: Female
Age at diagnosis: 27
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I think then she [doctor] said she could see the presence of the cells, and she was going to do treatment there and then. So she then gave me four local anaesthetics, which you were told that your body might react uncomfortably to these anaesthetics. And my body went into shock. So what that meant was my body, the nurses were there at the same time with my hand, but my body just went into shaking, shaking, shaking. So I found that very distressing because I had no, it didn’t last long, it lasted about a minute or two minutes but it was very distressing.

Did you feel like you had no control?


I had no control over my body, and it just went into shock. And I hadn’t, and wasn’t able to stop that. Then she gave me the local anaesthetics, which were very painful. And then she said that that would stop me feeling any pain during the colposcopy. And that wasn’t the case at all. So I did feel a lot of pain. So she gave me another local anaesthetic, and they didn’t work either. So then she did the procedure, and she had a television beside me. But I remember thinking that was, but she must’ve been looking in the television at what she could see when she was doing the operation. And she removed the tissue and I remember at the time she said there was quite a large affected area. But it was very painful and then that was it, over really after that.

 

Marjory had a cone biopsy in 1984 and has been clear ever since.

Marjory had a cone biopsy in 1984 and has been clear ever since.

Age at interview: 64
Sex: Female
Age at diagnosis: 39
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They made an appointment for me to have this cone biopsy. Apparently it was a very long thin one, whatever that meant. But I think it was quite deep. It didn’t cover a large area, but it was, you know, quite penetrative.

So you had the treatment and then you went back every year, and every two years eventually, for cervical screening?

Yes.

Were there any more problems after that?

No absolutely none, there were none.

So you had treatment once, and that was it?

That was it yeah. Yeah, I was very fortunate.

So that was in 84, we’re now in 2009,

Yeah.

And you’ve had absolutely no problems since?

No nothing, nothing.

So that’s very good.

Is it?

Yeah.

Yeah. He did a good job.


Well a lot of people, if they watch this interview, and they’ve recently been treated, would find it quite…

Encouraging.

…encouraging.

Well I hope so.

To have treatment once, and…

Yes and...

…20 years later, over 20 years later, you’re fine.

The trouble with this interview is that because it’s so long ago, there are things that I do remember obviously, and things obviously I can’t. The little things that have gone now and I can’t remember.

Women were pleased to hear that their results showed the abnormal cells had all been removed. One woman, though, felt unsure whether this was the case or whether she’d need more treatment at her first follow-up appointment.

 

When Katie saw the doctor about her results, she was unsure whether all the abnormal cells had...

When Katie saw the doctor about her results, she was unsure whether all the abnormal cells had...

Age at interview: 28
Sex: Female
Age at diagnosis: 28
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The consultant said that he would call me by Thursday or Friday, once the pathology come back, and he would know then if there was any cancer. He e-mailed me Friday morning and said there was no evidence of there being cancer. So I thought, “Oh that’s great.” So I had to go back for my follow up the following Friday just to make sure that everything was okay. And then I was a little bit shocked then because I thought it was just going to be a formality. He’d say, “Right, okay great. Come back in four months,” you know, “And then we’ll check you,” you know, “make sure that everything’s still as it is.”

But then he started talking about that one side of it, the pathology was fine. But the other side was quite close. The language I don’t really understand it too thoroughly. But then he also said that I might, there may be some more cells further up the canal, like leading up to the womb.

And so when I come back in four months he’s going to have to look there. Now I’m still not really sure if that is something they do for everyone or if it’s based on the results of the pathology. I’m not too sure, and then he was then showing me that I could have some more cells in the lining of the womb, and worst case scenario means that I might have to have a hysterectomy.

So, I mean, and that really is as far as it’s got so far, everything. It’s fine. Every now and again I’ll have a bad day and I’ll start feeling sorry for myself, and thinking, “Oh my God.” You think the worst case scenario. But no, I mean I don’t, I’m alright I think overall about it really.

Many women felt that the emotional side of having CIN / CGIN and a cone biopsy was more difficult than the physical (see ‘Emotional effects’).

More experiences of cone biopsy can be found on our - Cervical Screening site.


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Last reviewed July 2017.
Last updated July 2017.
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