Cervical Conization

Cervical Conization in Turkey: Expert Treatment for Pre-Cancerous Lesions

What is cervical conization? Why is it performed? Learn about the removal of CIN 2-3 lesions, recovery process, and impact on fertility. Expert care in Istanbul with Dr. Cengiz Andan.

Prevent Cancer Before It Starts: Diagnosis and Cure in One Step

Receiving a “high-grade abnormality” (CIN 2 or CIN 3) result from a Pap smear or biopsy can be alarming. However, this is not cancer—it is a warning sign. To prevent these cells from developing into cancer, the diseased area must be completely removed.

This is where Cervical Conization (Cone Biopsy) comes in. It is a surgical procedure that removes a cone-shaped wedge of tissue from the cervix. It serves a dual purpose: it provides a definitive diagnosis and, in most cases, cures the condition by removing the abnormal tissue entirely.

Known as “cervical surgery,” this procedure does not involve removing the uterus. At Dr. Cengiz Andan’s Clinic in Istanbul, we prioritize organ-preserving techniques. We often prefer Cold Knife Conization over LEEP for cases where the lesion is deeper or its boundaries are unclear, ensuring a more thorough cleaning and precise diagnosis.

1. What is Conization? How Does it Differ from LEEP?

Conization involves removing a cone-shaped piece of tissue from the cervix, including the transformation zone where abnormal cells are most likely to be found.

Conization vs. LEEP:

• LEEP (Loop Electrosurgical Excision Procedure): Uses an electrical wire loop to shave off tissue. It is excellent for superficial lesions but uses heat, which can sometimes affect the tissue edges for pathology analysis.
• Cold Knife Conization: Uses a scalpel (surgical knife). Because it doesn’t use heat, the tissue margins are preserved perfectly for the pathologist. It also allows the surgeon to remove a deeper, larger sample if the lesion extends further into the cervical canal. This is why it is preferred for higher-risk cases.

2. When is Conization Recommended?

• High-Grade Lesions: When a biopsy confirms CIN 2 or CIN 3 (moderate to severe dysplasia).
• Hidden Lesions: When abnormal cells are suspected to be growing deep inside the cervical canal (Endocervical involvement).
• Discrepancy: When a Pap smear shows severe changes (HSIL) but the colposcopy biopsy does not find them (suggesting the problem is hidden deeper).
• Microinvasive Cancer: To determine if very early-stage cancer has been completely removed or if further surgery is needed.

3. The Procedure: Step-by-Step

Conization is typically performed in an operating room setting under light general anesthesia to ensure the patient feels absolutely no pain.

1. Preparation: You will be asleep and positioned for a gynecological exam.
2. Excision: The doctor uses a scalpel or laser to precisely cut a cone-shaped wedge of tissue from the cervix.
3. Repair: The surgical site is treated to stop bleeding, often with dissolvable stitches or cautery.
4. ECC (Endocervical Curettage): Usually, a scraping of the remaining cervical canal is done to ensure no abnormal cells are left higher up.
5. Duration: The procedure takes approximately 15 to 30 minutes.

4. Recovery and Aftercare

Patients are usually discharged the same day after a few hours of observation.

• Pain: Mild cramping, similar to menstrual pain, is common and easily managed with painkillers.
• Bleeding: Light spotting is normal for the first few days. Around 10-15 days later, you may experience a heavier flow or spotting as the scab from the cervix heals and falls off.
• Restrictions: To prevent infection and ensure proper healing, you must avoid sexual intercourse, swimming, baths (shower only), and tampons for 4 to 6 weeks.

5. Conization and Fertility: Can I Still Have a Baby?

This is the most common concern for our patients.

• Does not cause infertility: Conization does not affect your ability to get pregnant. Your ovaries and uterus remain untouched.
• Pregnancy Risks: Because a portion of the cervix is removed, there is a slightly increased risk of “cervical incompetence” (premature opening of the cervix) or preterm birth in future pregnancies. However, this is manageable. During pregnancy, your doctor will monitor your cervical length, and a simple stitch (cerclage) can be placed if needed to keep the cervix closed.

6. Understanding Your Results

The removed tissue is sent to a pathology lab for detailed analysis.

• Negative Margins (Clear): The abnormal tissue was completely removed. No further treatment is needed, just regular follow-up smears.
• Positive Margins: Abnormal cells were found at the edge of the cut, meaning some might still be left behind. Depending on the severity, a repeat conization or, in rare cases, a hysterectomy might be recommended.
• Invasive Cancer: If deeper cancer is found, a more extensive cancer surgery (Radical Hysterectomy) will be planned.

Frequently Asked Questions (FAQ)

1. Will conization change my periods?No. The procedure is performed only on the cervix and does not affect your hormones or menstrual cycle. Your periods will continue as normal, though the first one after surgery might be slightly heavier or more painful.
2. What if I bleed heavily after surgery?Mild bleeding is expected. However, if you soak more than one pad an hour, pass large clots, or have a fever/foul-smelling discharge, you should contact your doctor immediately. This could indicate an infection or bleeding vessel.
3. Is this a permanent cure?In 95% of cases, conization completely removes the abnormal cells and cures the lesion. However, since HPV causes these changes, there is a risk of recurrence if the virus remains active. Boosting your immune system and quitting smoking are vital to prevent the disease from coming back.
4. When can I shower?You can take a shower the same day or the next day. Avoid baths, swimming pools, or sitting in water, as this can introduce bacteria to the healing cervix.
5. Why did my doctor choose Conization over LEEP?Your doctor likely chose Cold Knife Conization because they suspect the abnormal cells are deeper in the canal or need a cleaner tissue sample for the pathologist to rule out cancer definitively. This ensures a safer and more accurate diagnosis.

Dr. Cengiz Andan eliminates the risk of “incomplete treatment” in cervical pathologies by choosing the most precise surgical method, ensuring your health is never left to chance.