Conization of Cervix - Indications, Contraindications, Procedure, and Risks Involved

What Is the Conization of Cervix?

A surgical procedure known as cold knife cone (CKC) or conization of the cervix is used to diagnose and manage cervical dysplasia or early cervical cancer. The cervix is the opening of the uterus into the vagina. A surgical operation known as conization or cone biopsy of the cervix involves the removal of a little wedge of tissue in the shape of a cone or cylinder (mouth of the uterus).

It is regarded as a comprehensive form of cervical biopsy (a procedure in which a small piece of abnormal tissue is removed from the cervix and sent for lab examination). The excised tissue is sent to a lab for testing to look for any disease symptoms. In addition, conization may be used to diagnose cervical cancer or to treat specific cervix-related medical issues. If a border of healthy tissue surrounds the aberrant tissue in the excised wedge, it implies that the cervix is cleared of the majority of the abnormal tissue. Conization can be carried out with a scalpel, a laser, or an electrosurgical tool, often known as a LEEP (loop electrosurgical excision procedure).

Why Is Conization of Cervix Done?

Cone biopsies are used to find cervical cancer or early cancer-precursor alterations. If a procedure called colposcopy cannot identify the reason for an abnormal Pap smear, a cone biopsy is performed.

Additionally, a cone biopsy may be utilized to treat,

• Aberrant cell alterations range from mild to severe (cervical intraepithelial neoplasia- CIN II or CIN III).

• Cervical cancer at a very early stage (stage 0 or IA1).

What Are the Indications of Conization of Cervix?

Conization of the cervix is indicated in the following cases,

• A surgeon should undertake a diagnostic excisional operation if a lesion indicates invasive cancer or adenocarcinoma in situ of the cervix.

• A diagnostic cone is advised if there is a histological discrepancy with the cytological screening test and the histology results are less severe.

• An excisional cone is required in cases of unsatisfactory colposcopic evaluation with signs of dysplasia present, unexplained high grade, or abnormal glandular cell cytology.

• If colposcopy fails to fully visualize the entire lesion.

• If the patient wants to preserve her fertility, these methods are also sufficient for treating stage 1A1 squamous cell cervical cancer and severe dysplasia.

What Are the Contraindications of Conization of Cervix?

The cone technique has few contraindications,

• A cold knife cone could not be an option if there is little cervix to remove due to prior excisions.

• An office procedure without general anesthesia is advised if a patient is not a good candidate for surgery.

• The cold knife cone should only be used during pregnancy if there is a very high probability that invasive malignancy is present.

• The cone should not be used if the patient has severe cervicitis or is taking anticoagulant medication.

What Is the Procedure for Conization of Cervix?

The procedure is described as follows,

• The usual setting for a conization procedure, particularly LEEP conization, is a doctor's office or another outpatient facility. Mostly, the patient can return home the same day.

• The patient will be informed of the procedure's risks by the doctor. A thorough medical history will be taken, a physical exam will be performed, and any necessary tests will be ordered.

• The patient will be instructed to remove all clothing below the waist and to drape themselves.

• Footrests or stirrups support the patient as they lie backward on the examination table (lithotomy position).

• The physician gives anesthesia (general, regional, or local). To lessen pain, IV (intravenous) medications may be administered.

• The doctor will next gently spread the patient's vaginal walls and examine the cervix using a lubricated instrument called a speculum.

• Cone biopsies include taking a wedge of tissue from the cervix and sending it to a lab for analysis.

• The patient is monitored in the recovery area once the treatment is over before being released to go home. They could require assistance getting back home.

• Returning to the regular activities will take around a week. The region will not entirely heal for roughly four weeks to six weeks. In six weeks, a check-up exam might be conducted.

What Are the Risks Associated With the Conization of Cervix?

The following are the risks of the conization procedure,

• Excessive pain.

• Cervical stenosis (abnormal narrowing of the cervix).

• Excessive bleeding.

• Infertility (occurs rarely).

• Infections.

• Cervical incompetence (the inability of the cervix to remain closed during pregnancy, which could raise the chance of abortion and preterm or early birth).

• Cervical scarring (which may cause painful periods, premature delivery, and difficulty getting pregnant).

• Damage to the bladder or rectum.

• Additionally, a cone biopsy may make it more challenging for the doctor to evaluate future abnormal Pap smear results.

In addition to concerns for the patient, laser conization may also present some risks for the medical professional. The smoke produced by laser conization and LEEP could harm the operator's breathing. This is because particles of the human papillomavirus (HPV) may be present in the smoke. Therefore, smoke evacuators must be used, and it is advised for the medical team to wear a mask while performing the treatment.

The patient must immediately contact the doctor in the following cases,

• Symptoms of infection like fever, chills, or a foul-smelling discharge from the vagina.

• Heavy vaginal bleeding (can happen a week after the procedure).

• Increasing pain in the pelvis or belly.

How Are the Results Interpreted After the Conization of Cervix?

The result can be,

• Normal - A normal result demonstrates that the cervix is free of precancerous or cancerous cells.

• Abnormal - Abnormal results typically indicate the presence of malignant or precancerous cells in the cervix. This condition is known as cervical intraepithelial neoplasia (CIN).

Three categories of modifications are identified:

• CIN I - Mild dysplasia.

• CIN II - Moderate to noticeable dysplasia.

• CIN III - Extreme dysplasia to in situ carcinoma

• Cervical cancer may also be the cause of anomalous outcomes.

Conclusion:

The removal of a portion of the cervix is known as cervical conization. The uterus's lower half is known as the cervix. Through the vagina, the cervix is accessed during this procedure. It is possible to use cervical conization for both diagnosis and treatment. A sample of the abnormal cervix tissue can be removed. After that, a lab will examine the sample for abnormal cells like cervical cancer. This procedure is frequently utilized following an abnormal pap smear. Moreover, conization can remove abnormal tissue. It might be carried out as part of treatment.