A cone biopsy can:

* Remove a thin or a thick cone of tissue from the cervix, depending on how much tissue is needed for examination.
* Be used to diagnose and sometimes to treat abnormal cervical tissue. The abnormal tissue is removed and sent to a lab for examination.

A sample of tissue can be removed for a cone biopsy using:

* A surgical knife (scalpel).
* A carbon dioxide (CO2) laser.
* Loop electrosurgical excision procedure (LEEP).

How it is done

A cone biopsy is usually done as an outpatient procedure (you do not have to spend a night in the hospital).

The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups). Your health professional will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

Medication that makes you unconscious (general anesthetic) or that makes the entire genital area numb (regional anesthesia, such as a spinal or epidural) may be used.

A cone biopsy using LEEP may be done in your health professional’s office with an injected medication that numbs the cervix (cervical block). If a cervical block is used, an oral pain medication or pain medication given into a vein (intravenous, or IV) may be used in addition to the local anesthetic.

What To Expect After Surgery

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. Usually you will stay in the recovery area for 1 to 4 hours, and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will usually go home with a sheet of care instructions and who to contact if a problem arises.

Most women are able to return to their normal activity level in 1 week.

After a cone biopsy

* Some vaginal bleeding is normal for up to 1 week.
* Some vaginal spotting or discharge (bloody or dark brown) may occur for about 3 weeks.
* Sanitary napkins should be used instead of tampons for about 3 weeks.
* Sexual intercourse should be avoided for about 3 weeks.
* Douching should not be done.

When to call your health professional

Call your health professional for any of these symptoms:

* A fever
* Moderate to heavy bleeding (more than you would usually have during a menstrual period)
* Increasing pelvic pain
* Bad-smelling or yellowish vaginal discharge, which may indicate an infection

Why It Is Done

A cone biopsy may be done after a Pap test indicates moderate to severe cell changes and:

* The abnormal tissue cannot be seen with colposcopy but was found in cells collected from a biopsy of the cervical canal, or the abnormal tissue seen with colposcopy extends high into the cervical canal. A cone biopsy is done to remove and examine the abnormal tissue.
* The abnormal cells found on a Pap test cannot be seen with colposcopy or found in cells collected from a cervical biopsy. The cone biopsy may be used to diagnose the cause of the abnormal cell changes and remove the abnormal tissue at the same time.
* Cervical cancer is suspected based on Pap test results, colposcopy, and cervical biopsy. A cone biopsy can determine the extent, depth, and severity of the cancerous tissue and can guide treatment decisions.

How Well It Works

The cone biopsy may remove all of the abnormal tissue. This would mean that no further treatment is needed other than follow-up Pap tests.

The edges of the cervical tissue removed by a cone biopsy may contain abnormal cells, meaning that abnormal tissue may be left in the cervix. The cone biopsy may be repeated to remove the remaining abnormal cells. If follow-up tests show normal cells, then no further treatment may be needed. If abnormal cells remain, you and your health professional may discuss other treatments, such as removal of the uterus (hysterectomy).

The cone biopsy may show cancer that has grown deep into the cervical tissue (cervical cancer). Further treatment, such as surgery, radiation, or chemotherapy, will be recommended.
Risks

A cone biopsy is a surgical treatment with some risks.

* After surgery, a small number of women (less than 10%) may have bleeding that requires vaginal packing or a blood transfusion.1
* Narrowing of the cervix (cervical stenosis) that causes infertility may occur (rare).
* Inability of the cervix to remain closed during pregnancy (incompetent cervix) may occur, causing pregnancies to end in miscarriage or premature labor (rare).

What To Think About

Cone biopsy (conization) can be done using a carbon dioxide laser or loop electrosurgical excision procedure (LEEP). One possible disadvantage of these methods is that the abnormal tissue at the margin with the normal tissue can be changed by the heat from the laser beam or the wire loop. This may make the laboratory study of the biopsied tissue more difficult.

If you have a cone biopsy, you need regular follow-up Pap tests and colposcopic examinations. A Pap test should be repeated every 4 to 6 months or as recommended by your health professional. Once several Pap test results are normal, you and your health professional can decide how often to schedule future Pap tests.

The healing and scarring process after a cone biopsy may make it difficult to identify abnormal tissue in the future.

Cone biopsy (conization) for abnormal cervical cell changes – Yahoo! Health

The findings were published in The Lancet Oncology, and researchers said it could help pave the way for effective screening to prevent cervical cancer in rural and resource-poor settings.

The rapid test, careHPV, is a product of Qiagen NV and was designed to detect 14 high-risk types of HPV in about 2.5 hours. It can be operated by staff with minimal training and without any running water.

“If women 30 years and older could be screened at least once in their lifetimes with such a test, and appropriate treatment administered at the same visit, public health programmes would be affordable and deaths from cervical cancer would be reduced by a third,” said one of the researchers, John Sellors, professor of family medicine at the McMaster University in Canada.

Cervical cancer is the second most common cancer affecting women worldwide. It causes 300,000 deaths a year, with 85 percent of these occurring in the developing world.

Screening using pap smear is routinely done in the United States and Europe, where it has led to a 50 percent reduction in mortality. But implementing such tests in developing countries is not as easy, where taking smears and reading them can be problematic.

Although there are now vaccines against HPV, they are useless in women already exposed to the virus. For these older women, screening and early detection remain the best hope.

The trial involved 2,388 women in Shanxi in eastern China who were given instruments and instructions to collect specimens themselves. Midwives also collected other swab samples from the women. These were all run through careHPV tests.

Results were then compared against digital colposcopies done by a gynecologist at the site. Colposcopy examines the cervix and surrounding tissues for precancerous lesions.

“The ability of the careHPV test to detect precancerous cells was found to be 90 percent; 84.2 percent of the women without precancerous disease were identified as negative by the test,” the researchers said in a statement.

New virus test may stop cervical cancer in rural women on Yahoo! Health

Consumers, doctors and others have raised questions about Gardasil’s safety but the Food and Drug Administration and the Centers for Disease Control and Prevention said the most serious adverse events did not appear linked to the vaccine.

“Based on the review of available information by FDA and CDC, Gardasil continues to be safe and effective, and its benefits continue to outweigh its risks,” a statement said.

The agencies said they reviewed more than 9,700 reports of health problems following Gardasil injections.

Six percent of the cases were deemed serious events. They included 20 deaths reported as of June 30.

“There was not a common pattern to the deaths that would suggest they were caused by the vaccine,” the FDA and CDC statement said.

In cases where autopsy or other records were available, ”the cause of death was explained by factors other than the vaccine,” the agencies said.

Other serious problems that were reported included a rare neurological disorder called Guillain-Barre Syndrome. Data “do not currently suggest an association” between Gardasil and the condition, the FDA and CDC said.

Gardasil targets four strains of the human papillomavirus (HPV), a common sexually transmitted virus that causes genital warts and most cases of cervical cancer. It is approved for women and girls ages 9 to 26.

The vaccine is one of Merck’s top-selling products but its sales have been under pressure. On Monday, Merck projected 2008 Gardasil sales of between $1.4 billion and $1.6 billion. That was down from its prior view of $1.9 billion to $2.1 billion.

The lowered forecast was due in part to Merck’s failure earlier this year to win U.S. approval to market the vaccine to an older group of women.

Merck has distributed more than 16 million Gardasil doses in the United States.

Merck spokeswoman Amy Rose referred to a July 8 statement in which the company said it was confident of Gardasil’s safety.

Routine vaccinations against HPV are already being offered to schoolgirls aged 12 to 13 from next month despite claims from some parents it will "sexualise" them at a young age.

The virus is primarily passed on through sexual contact, meaning it must be administered before girls become sexually active to provide optimum protection. However, critics fear it could lead to sexual promiscuity among teenagers who believe they are protected.

Another 300,000 more girls aged 17 and 18 will also be offered the jab for the first time this September, while a catch-up programme for 14 to 18-year-olds starts next year.

A possible further extension to older women flies in the face of Government advisors’ recommendations it would not be cost-effective and has surprised experts.

Older women only gain limited protection from the vaccine because they are likely to be sexually active and therefore may have already been exposed to the virus.

Professor Margaret Stanley, an adviser to the HPV sub-group of the Joint Committee for Vaccination and Immunisation, described the move as a "remarkable volte-face".

"Vaccinating older girls and women who have active sexual lives will have an effect but it will be much less than immunising the virgins," she said.

"There is the real anxiety that these older girls and women may think that they had had a magic bullet, are protected, don’t go for their smears and the cancers aren’t picked up at an early stage."

Ministers at the Department of Health were said to have chosen the cheaper Cervarix vaccine over the more expensive Gardasil to avoid any extra expense.

A DoH spokeswoman confirmed ministers were considering a possible extension: "We are looking at the most effective uses for the vaccine and are currently assessing the strengths and weaknesses of offering it to over 18s, including cost effectiveness."

But she added: "There is no evidence that extending the vaccination to over 18s would deter women from having smear tests. Receiving the vaccine could in fact provide an opportunity to remind women of the need for screening."

HPV is held responsible for around 70 per cent of all cases of cervical cancer, which kills more than 1,000 women in the UK each year.

It is thought the £300 vaccination, which is given in three injections over six months, could save hundreds of lives.

Big Brother star Jade Goody, 27, was informed last week that she had tested positive for the disease.

Young women could be offered a vaccine against one of the most common causes of cervical cancer, under an extension of a controversial programme to immunise teenage girls.

The vaccine against the HPV virus was licensed in 2006 for use in girls and women ages 9 to 26. Health officials recommend it for girls at age 11 or 12, and some doctors offer it to women in their 20s in “catch-up” vaccination campaigns.

The maker of the Gardasil vaccine, Merck & Co., also wants to market it to women ages 27 to 45, but so far the U.S. Food and Drug Administration has denied that request.

The government-funded study found the HPV vaccine is very cost-effective when given to girls at age 12, but raises questions about the value of pushing for vaccinating adults.

Two researchers at the Harvard School of Public Health did the study, one of the most sophisticated analyses of the issue so far. Results are in Thursday’s New England Journal of Medicine.

Gardasil is given in three doses over six months and costs about $375. It targets the two types of HPV, or human papillomavirus, believed to be responsible for about 70 percent of cervical cancer cases, and two other types that cause most genital warts. The virus spreads through sex.

Health officials say it’s best to give the shots to girls at age 11 or 12, before they begin having sex. Some parents think that age is too young for a vaccination campaign against a sexually transmitted disease.

But that is when the shots make the most economic sense, the researchers found.

They used computer models to predict the health outcomes of girls and women who get the vaccination as well as Pap tests or other screenings, which are still recommended for vaccine recipients. Their calculation included the cost of the vaccine, screenings and treating cervical cancer and other illnesses targeted by the vaccine.

To determine cost-effectiveness, the researchers used widely accepted economic measures of how much society is willing to pay to extend the life of a person by a year. They set a figure of $43,600 per year for the Gardasil vaccination of each 12-year-old girl, well below the $100,000 mark seen as an upper range for cost-effectiveness.

That assumes the vaccine gives lifetime protection — something doctors don’t know is true, because the shot is too new.

“Their base-case assumptions are quite optimistic,” wrote Dr. Charlotte Haug, a Norwegian physician, in an editorial that accompanies the study.