Large loop excision/cone biopsy for cervical cancer

Large loop excision and a cone biopsy are not usually used to treat cervical cancer but occasionally they may be used if very early stage cancer is found during treatments for suspected abnormal cervical cells. These treatments are only performed if the cancerous cells have spread only slightly beyond the surface cells of the cervix.

Cone biopsy is also used as a way of diagnosing cervical cancer (see ‘Symptoms and tests’).

Large loop excision (LLETZ)

Large loop excision is also referred to as LLETZ (large loop excision of the transformation zone). After injection of an anaesthetic, a thin wire which is heated electrically is used to remove the affected cells.

One of the women we interviewed had had a large loop excision done under general anaesthetic as a day patient which cured her cancer. One year after her large loop excision, this woman chose to have a hysterectomy for her own peace of mind and because she had found regular colposcopy examinations traumatic.

Cone biopsy

A cone biopsy involves an inpatient stay and an operation under general anaesthetic where a small conical or cylindrical piece of the cervix which contains the cancer cells is removed. This is correctly called a knife cone biopsy. If there is a very slight growth of cancer cells (microinvasive cancer), the cone biopsy may remove it all so that no further treatment is needed.

Three of the women we interviewed had experienced a cone biopsy as a treatment for cervical cancer. One woman did not need any further treatment. Another had a radical trachelectomy because a large cone biopsy did not remove all the cancerous cells.

A third woman had a cone biopsy to treat her cancer, but a reanalysis of her biopsy results led her to having a Wertheim’s hysterectomy (where the uterus, ovaries, lymph nodes and upper part of the vagina are removed) 3 months later.

After a cone biopsy most women experience some light bleeding and some mild discomfort for a short while.

She describes the side effects from her large cone biopsy.

Age at interview 39

Gender Female

Age at diagnosis 31

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They thought they might be able to treat the tumour with a large cone biopsy. Normally they just take a small cone but he tried to be fairly adventourous and take a big cone biopsy and hoped that he would be able to get clear enough margins around the tumour. But it was borderline. He said it wasn’t safe to leave it like that, so that’s why we had to go on for more treatment.

And after the cone biopsy did you have any side effects from that?

No just a bit of soreness and a bit of bleeding for a few days. But then apart from that it was okay and it just took a few days to recover from that, mostly from the anaesthetic really. I think I was off work for just a week after that.

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For more information see Cervical abnormalities: CIN3 and CGIN: LLETZ and Cervical abnormalities: CIN3 and CGIN: cone biopsy.