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Old 08-26-2008, 07:30 PM   #1
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Severe Dysplasia...following up with Cone biopsy

I had an abnormal pap over a year ago...followed by a Colposcopy which showed up "ungradeable". I was supposed to have a follow-up Colpo done in February, but didn't end up getting in for it until this month. Well, it came back showing Severe Dysplasia. She had taken 3 different samples. They called and said I would need to come back in for a Cone Biopsy on the 22nd of Sept. From all the research I have done...it sounds like a LEEP procedure would be the next step. It doesn't even sound like the cone biopsy is common. Why would they want to do this rather than the LEEP? I'm pretty scared right now. I have already battled another type of cancer about 6 years ago and really don't want to go through another one.
Also, what can I expect from the Cone biopsy? They said I wouldn't be put under General...and they made it sound like a pretty simple procedure. I'm just wondering what to expect if any of you have had one.

Thanks so much~
Cor

 
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Old 08-27-2008, 04:59 PM   #2
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Re: Severe Dysplasia...following up with Cone biopsy

Hi Cor. I totally understand your confusion over Cone vs. LEEP. I had the same confusion back in March and April.

The way I understand it is that they both remove a cone shaped portion of the cervix which is then biopsied to determine if there are lesions and if there are then how large are they. Cones and LEEPs could be diagnostic AND treatment, or, if margins are not good then it might be just diagnostic requiring further tests/procedures.

The difference is that the LEEP cuts the cervix with a wire loop. As the LEEP cuts, it also singes or cauterizes the edges of the biopsied tissue and the intact tissue. This reduces bleeding of the intact tissue. The LEEP can be done under local or general anesthesia.

The cone biopsy uses a knife to cut the sample. Some doctors (mine did) go back over the intact tissue with the LEEP tool to singe the edges to reduce bleeding. This allows the biopsied tissue to have a clean, cut edge. This allows the pathologist to determine if a lesion has clear margins or not. The LEEP can burn the edges so it might not be clear if a lesion has clear margins. I have never heard of a cone biopsy being done with local anesthesia. Mine was done under general. The "sleep" wasn't very deep because the procedure only took about 20-30 minutes. I was awake within 20-30 minutes of being wheeled out of OR and was home with in 1.5 hours.

I don't know why some patients have a LEEP and others have a cone. I suspect part of it has to do with the doctor's knowledge and experience with either or both. I also suspect it has to do with charges (which one pays more - but that is the cynical side of me talking). Another reason a doctor might pick a cone over a LEEP (and this is just my thoughts based on experience) might be if the doctor things the dysplasia is more than CIN II.

My colposcopy didn't require any biopsies so my doctor did an ECC at the time. That came back adenocarcinoma in situ. Based on my history (26 years of good paps, never missing a pap, positive for high risk HPV, clear colposcopy) she might have suspected something in the endocervical canal. When the AIS (adenocarcinoma in situ) came back, she might have suspected my lesions were actually cancer so she chose the cone biopsy over the LEEP. But I don't know that for sure. All I know is I had a cone and not a LEEP and I had cancer.

The good news (and really, there IS good news) is that the cancer was found at stage Ia1. The only treatment I needed was a hysterectomy to remove my cervix and uterus. I don't need chemo or radiation. My gyn/oncologist said that within 1 year I would most likely have been at a stage 2 requiring chemo and/or radiation. I believe I am fortunate for my cancer to have been found so early by the HPV test, the ECC, and the cone biopsy. If I could change anything, it would be for me to have been tested for HPV earlier, but since it was approved only 4 years ago that wasn't very likely to have happened. I'm glad I went through the steps I went through.

Now, that is my story. It doesn't mean your story is like mine. It is entirely possible (and very likely) that the cone is diagnostic and treatment. My situation was very atypical . . . but then I tend to be the odd one out in a crowd!

Take care and write back, ok?

 
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Old 09-21-2008, 03:13 PM   #3
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Re: Severe Dysplasia...following up with Cone biopsy/Leep

Wow...thank you so much for all the info and for sharing your story. I really appreciate it. I'm so glad they were able to catch it early and that you are doing well now!

Well, tomorrow is THE day. They are going to be doing the LEEP procedure afterall. After reading several posts on here...I have a few concerns. My main concern is the injection given to numb the cervix prior to the procedure. I have a heart condition called SVT ...which is an arrhthmia which causes my heart to beat up to 230/240 bpm. I have these episodes very often (almost weekly lately)...and usually end up needing to be cardioverted. From what I've read the numbing injection contains a combination of a form of lidocaine along with epinephrine. I know that my heart will go absolutely crazy if given epinephrine...is this necessary?? I can't even take sinus meds due to my SVT. Can they do the procedure without the injection or possibly only using the numbing agent without epinephrine? That is my main concern.

Also, the only thing my Gyn told me is that my Colpo results came back showing "Severe Dysplasia". If there were any cells that had turned cancerous...would the Colpo have showed that? I'm hoping the LEEP will remove the areas of Dysplasia and that will be it. I'm dealing with this along with my heart issues all alone right now. My husband is deployed and it's just myself and my 2 girls. I have no family nearby and very few friends (as we haven't lived in the area long). So, I'm hoping the LEEP is the last thing I will need done regarding my cervical issues.

 
Old 09-21-2008, 05:58 PM   #4
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Re: Severe Dysplasia...following up with Cone biopsy/Leep

Oh goodness! Make absolutley CERTAIN the doctor knows that before they start the procedure (or giving you any meds). I assume, by your description that you are having the procedure in-office and not as an out patient. I think many doctors do it in-office which involves the injections you were talking about. If you get it done at an out patient center, then they'll put you under (but a light sleep, not heavy sedation) to do the procedure.

I don't know the extent of what a colpo can show. I don't know if it can diagnose cancer. My ECC (which was done when I had the colpo) showed adenocarcinoma in situ (highest level of precancer or Stage 0 cancer). After my cone biopsy I was diagnosed with adenocarcinoma. I don't know if the ECC didn't read cancer or if the cone biopsy just found an actual lesion.

I wish you the best of outcomes with your LEEP. Please check in and let us know how you are doing! You are in my prayers!

 
Old 09-22-2008, 10:26 AM   #5
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Re: Severe Dysplasia...following up with Cone biopsy

Thank you again...you are always so helpful to everyone!

Well, I had my procedure this morning and am back home resting now. I will be honest...it was horrible. They decided not to give me the epinephrine due to my SVT...so I only received the xylocaine injections to numb the area. Well, it felt as if they hadn't numbed me at all. She even waited a little bit hoping it would kick in. She ended up removing 2 large pieces. The 2 assistants in the room had to hold my hips down because the pain was so excruciating I couldn't help but jump each time. It felt like she was taking a razor and just slicing me up inside and then I would feel really deep knife like pains (she said this was pain from my uterus). My whole body was shaking so bad...they kept me there for quite awhile afterwards to make sure I would be ok. I did have quite a bit of bleeding during the procedure...she made the comment "You're definitely a bleeder". So, I'm supposed to watch that closely for the next few days. I'm still feeling pretty dizzy. So, now it's the waiting game. She said since it is Monday...they should have my results in my Friday. I'm hoping for the best!

Thanks again Pickle Eyes!

 
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Old 09-22-2008, 09:31 PM   #6
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Re: Severe Dysplasia...following up with Cone biopsy

I am so sad to hear it was so painful! (((hugs))) Hopefully you are not in so much pain now! Please take it easy. Don't lift heavy stuff, don't bend/stoop a lot. Lay in bed. Pamper yourself.

And of course, let us know how your report reads!

 
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