A cone biopsy is a procedure in which surgeons remove a cone-shaped wedge of abnormal tissue from the cervix. The tissue is sent to a laboratory to be tested for the presence of precancerous or cancerous cells. It is often performed after an abnormal Pap test. Cone biopsy – also known as conization or cold knife biopsy – is a surgical procedure to remove abnormal tissue from the cervix. The procedure can detect cervical cancer or changes in some of the cells of the cervix, commonly called cervical dysplasia, that can lead to cervical malignancy. It’s called a cone biopsy because the surgeon cuts a cone-shaped piece of irregular tissue from the cervix. This type of biopsy allows them to reach the deeper layers (or inner parts) of the cervix. The tissue is then sent to a laboratory for further testing. Cone biopsy is a treatment option to remove abnormal and precancerous cells from the cervix. It also diagnoses precancerous and cancerous cells in the cervix. Recovery after the procedure takes place in the hospital or surgical center a few hours after it is performed. The attending physician monitors the blood pressure, pulse, bleeding and pain to make sure that the recovery is going well and the patient can go home. After the procedure, patients report period-like pain for several days. These symptoms can be helped by steroid anti-inflammatory medications. Most women can return to their daily activities after about a week. Cramping and bleeding are normal for the first week after the procedure. It is normal for vaginal discharge to change from red or pink to light brown. Some doctors provide a list of activities that need to be avoided until the follow-up appointment. Some of the items on this list may include: Abstaining from intercourse for the first four weeks after the procedure, as well as avoiding the use of tampons and vaginal douches; It is necessary to avoid lifting weights and heavy physical exercises; Avoiding swimming in pools or hot tubs. A follow-up examination is necessary four to six weeks after conization. After the cone biopsy, the attending physician may recommend a Pap test every six months. After several consecutive Pap smear results return to normal, move to a more typical pap smear schedule (once a year). This schedule varies based on age and prior medical history. The procedure is safe, but carries its own risks. Some of the complications associated with cone biopsy are:Bleeding; Formation of blood clots; Infection; Narrowing of the cervix (cervical stenosis); Increasing the risk of premature birth in future pregnancies; Damage to nearby organs such as the bladder or rectum. After the procedure is performed, connective tissue forms, which can make it difficult to identify abnormal cells during future smear tests. The most common side effects of cone biopsy include: Menstrual cramps; Discomfort or slight pain; Bleeding or spotting. References: 1. Canadian Cancer Society. Cone biopsy (https://cancer.ca/en/treatments/tests-and-procedures/cone-biopsy). 2. Cancer Research UK. Cone biopsy (https://www.cancerresearchuk.org/about-cancer/cervical-cancer/getting-diagnosed/tests-diagnose/cone-biopsy). 3. Cooper DB, Carugno J, Menefee GW. Conization Of Cervix (https://www.ncbi.nlm.nih.gov/books/NBK441845/). [Updated 2021 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 4. Kim ML, Hahn HS, Lim KT, et al. The safety of conization in the management of adenocarcinoma in situ of the uterine cervix (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097330/). J Gynecol Oncol.