cone biopsy to determine hysterectomy procedure? - Hysterectomy Message Board

infoforme62 · 05-28-2008, 02:37 PM

I'm at the border of CIN3 (severe dysplasia/CIS) & invasive cancer and scheduled for a cone biopsy on July 14 & that is going to determine what type of hysterectomy I need which will be performed on the 16th of July. Just had leep last week & now they want to do a hysto. Is it common to use cone to determine type of hysto I will have? All I've read was that cone can sometimes be done to get rid of it? Didn't know what questions to ask the doc so started searching on the internet about cone biopsy & that sounds like a treatment. He says we're still going to do a hysto?

mikayla19 · 05-28-2008, 03:46 PM

Hello,
I have a similar situation, except I haven't yet been told I need a hysterectomy immediately. I have CIN 3 and AIS. My gynecologist told me that I would have a cone biopsy for two reasons: partly to remove the early cancer cells and partly to determine the extent of the cancer cells up into the cervical canal. I'm not sure if you've seen the section that the biopsy removes, but go figure it's cone shaped. From what I've gathered the largest part of the cone is at the cervix and then it extends back into the cervical canal. I'm not sure if they use the cone biopsy to determine what type of hysterectomy....but maybe the type is dependent on how far into the cervical canal the CIN3 lies.
I'm 24 and don't have any immediate plans for a family. Otherwise, he would have recommended a hysterectomy. In fact, once I do have children he told me I should get a hysterectomy.
Hang in there and I hope this helps. I'll be going in for my cone biopsy within the next two weeks.....so i'll try and answer any other questions....if you've got em!

infoforme62 · 05-28-2008, 04:05 PM

Quote:

Originally Posted by mikayla19

Hello,
I have a similar situation, except I haven't yet been told I need a hysterectomy immediately. I have CIN 3 and AIS. My gynecologist told me that I would have a cone biopsy for two reasons: partly to remove the early cancer cells and partly to determine the extent of the cancer cells up into the cervical canal. I'm not sure if you've seen the section that the biopsy removes, but go figure it's cone shaped. From what I've gathered the largest part of the cone is at the cervix and then it extends back into the cervical canal. I'm not sure if they use the cone biopsy to determine what type of hysterectomy....but maybe the type is dependent on how far into the cervical canal the CIN3 lies.
I'm 24 and don't have any immediate plans for a family. Otherwise, he would have recommended a hysterectomy. In fact, once I do have children he told me I should get a hysterectomy.
Hang in there and I hope this helps. I'll be going in for my cone biopsy within the next two weeks.....so i'll try and answer any other questions....if you've got em!

infoforme62 · 05-28-2008, 04:10 PM

Thanks, I'm 45 & have two kids & don't plan on having any more. Just confused now that he said the cone would determine what type of hysto I will have. The doc said it's on the border of severe displasia/CIS & invasive cancer. Didn't know what questions to ask until I went on the internet & got really screwed up. The Leep was so painful!! How was yours. Please keep me informed with your procedure. We can kinda just be there for each other!

Pickle Eyes · 05-28-2008, 05:36 PM

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!