Cone Biopsy / Leep of the Cervix / Laser Treatment

What Is A Cone Biopsy?

A cone biopsy or LEEP is a minor surgical procedure. It involves the removal of a cylindrical or cone-shaped piece of the cervix in which the abnormal cells are located. Pathological examination will then confirm the diagnosis and ensure that all the abnormal cells have been removed.

Why Is It Performed?

A cone biopsy or LEEP is performed when:

• There are precancerous changes of the cervix.
• The entire abnormal area cannot be fully seen at colposcopy. This may occur when the abnormality extends into the cervical canal. This is the canal that leads from the vagina through the cervix and into the uterus.
• The PAP smear repeatedly shows abnormal cells although the colposcopy reveals normal results. This may mean that the abnormal cells are from the endocervical canal.
• The doctor is concerned that the abnormal cells show signs of a very early cancer.

How Is It Performed?

You will be positioned as for a gynaecological examination.

For pain relief, a local anaesthetic (during which you will remain awake) or a general anaesthetic (during which you would be asleep for the entire procedure) will be administered.

In general, the procedure is performed via one of 3 methods:

• With a heated electrical loop wire - This is known as LLETZ (large loop excision of the transformation zone) or LEEP (loop electrosurgical excision)
• With a surgical knife
• With a laser

There is usually some mild discomfort after the procedure. A brown-coloured paste (Monsel's solution) may be applied to arrest the bleeding.

A vaginal pack may also be inserted temporarily to stop any bleeding and a tube (catheter) may be placed in the bladder to ensure that it remains empty until the gauze is removed. Painkillers and antibiotics may be prescribed after the procedure.

Where Is It Performed?

This may be performed at:

• The Colposcopy Clinic at the Gynaecological Cancer Center (GCC) (Level 1)
• The Day Surgery Centre (Basement 1)
• The Operating Theatres (Level 2)

What Can I Expect After The Procedure?

After surgery, you may experience:

• Mild abdominal cramps similar to menstrual cramps. This may last for a few hours and is easily relieved with painkillers which your doctor may prescribe.
• Vaginal discharge which may last for up to 6 weeks. This is typically a yellow / brown discharge and may be blood stained. You are advised to wear a liner or sanitary pads.
• The timing of your next menstrual period should not be affected.

What Special Precautions Will I Need To Take?

1. Activities
   • You may want to rest after the procedure.
   • You may return to work or your normal activities the following day.
   • Avoid strenuous activities.
   • Avoid swimming for a month.
2. Diet
   You may continue with a normal diet.
3. Medication
   Your doctor may prescribe a course of antibiotics.
4. Sexual activity
   You are advised to abstain from sexual intercourse for a month following the procedure.
5. Hygiene
   • Avoid tub baths, take showers instead.
   • Avoid douching or using vaginal medications unless otherwise specified by your doctor.
   • Do use sanitary pads until the bleeding stops. Avoid tampons.

It is normal to have slight bleeding or brownish vaginal discharge for 2- 3 weeks following the procedure. Consult your doctor if you experience:

• Heavy bright red vaginal bleeding (similar to your period) within the first 3 weeks of the operation - such bleeding typically occurs within the first 48 hours of the procedure or 10-14 days after the surgery. It may of course be due to your period. It would however be safer to consult your doctor to exclude bleeding from the wound site.
• Foul-smelling vaginal discharge within the first 3 weeks of the surgery as this may be due to an infection.
• Fever
• Severe abdominal cramps not relieved by painkillers.

You can seek consultation at the Gynaecological Cancer Centre (Level 1) or at our 24-Hour O&G Clinic (Basement 1).

What About Follow-Up Visits?

After treatment, follow-up visits are necessary to ensure that all the abnormal areas have been treated and that the cervix has healed well. To ensure that you remain well, regular visits are advised.