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?