Re: cone biopsy to determine hysterectomy procedure?
Hi Inforforme62, Welcome to the boards. I know it is a scary thing to be facing, but please know you have others in the army who are facing this same monster. You are NOT a lone!
I want to share my (very similar) story with you. With it, it might answer some of your questions. Here goes . . .
I went for my Pap in Decmeber, the results came back in Janauary. My pap, as usual (for 20+ years) came back fine. This is the first time the doctor did the HPV/DNA test. It came back high risk HPV (hrHPV). I was so freaked out she decided to go ahead and send me to a gynecologist, instead of waiting 3 or 6 months and retesting.
I went to an ob/gyn. She scheduled a colposcopy with possible biopsy. While there, she said the colposcopy looked GREAT! She didn't need to take any biopsies. She decided to do an ECC (endocervical curettage - scraping of the endocervical canal) because I am 44, have positive hrHPV, and the colposcopy didn't show anything. It came back adenocarcinoma in situ (highest level of precancer). Two weeks later, I was scheduled for a cone biopsy.
She chose the cone biopsy over the LEEP because she said the LEEP singes the margins on the biopsy and she wanted to make sure the edges could be read. The cone was day-surgery and I was home by noon. The cone biopsy came back endocervical adenocarcinoma Ia1, one of the lowest stages of cervical cancer. Actually, it is microinvasive. She said the margins were clear, but just barely. I think she isn't totally confident that all of the lesion(s) was taken.
I then went to a gyn/oncologist. She said I will be having a hysterectomy, it is just a matter of how/when and what will happen prior to the hysterectomy. I was given 3 (+/-) choices:
1) radical hysterectomy
2) another conization, depending on the depth of any further lesions then have the hysterectomy the next day. (microinvasive or no lesions = hyst (uterus and cervix only) (greater than 3mm invasion = radical hyst)
3) wait 3 months (so prior cone could heal) do another ECC, if it comes back without lesions then the simple hyst (uterus and cervix only). If it comes back with any lesions, then I'd have another cone (with the same options as above) and then the hysterectomy the next day.
My doctor said she'd pick option 3 because there is a chance of only having 1 round of anesthesia. Because I didn't want to wait 3 months for the hysterectomy, I chose option 2. I am having my second cone on June 17th and my hysterectomy of June 18. I am having a LAVH (laparoscopically assited vaginal hyst). I was so relieve to know it wouldn't be an abdominal cut.
What I've gathered is the second cone helps decide if the lesions are growing back in the time period since the first cone and it tells them if there are more/larger lesions they didn't get the first time around.
She said the hysterectomy has to occur within 48 hours of the cone or there is too much swelling to get in and do the hyst. Then she'd have to wait 6 more weeks or so.
I'm a bit anxious at having anesthesia 2 days in a row, but I'm sure the anesthesiologists do it often enough that they know what to look for. Besides, the anesthesia for the cone is a lighter sedation than the one for the hysterectomy.
There you have it. I *think* I addressed many of your concerns, but I'm not positive. Ask whatever quesitons you have. Someone here will most likely know an answer or be able to tell you to look for it.
Hugs and peace to you!