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Cervical Conization


Medical editor Gunnar B. Kristensen MD
Gynecological Oncologist
Oslo University Hospital

General

During cervical conization, a small part of the cervix is removed. Conization is a diagnostic procedure used when biopsies show microinvasion but cancer is not visible. Cervical conization is sufficient treatment for stage Ia1 without vessel invasion. For stage Ia1 with vessel invasion, it is recommended to supplement with pelvic lymph node dissection. Conization is performed as day surgery.

Indications

  • Treatment for CIN 2–3 or AIS.
  • Microinvasive cervical cancer.

Goal

  • Determine final histological diagnosis for CIN 2–3 and microinvasive cervical cancer. 
  • Curative treatment of CIN 2–3.
  • Curative treatment of cervical cancer in stage Ia1 in patients desiring future fertility.

Preparation

The procedure is usually done under local anesthesia, but at Oslo University Hospital/Norwegian Radium Hospital, it is usually performed under general anesthesia. This is because most patients treated at The Norwegian Radium Hospital have microinvasive cervical cancer or other complicating conditions. General anesthesia then provides better conditions for the procedure and therefore greater confidence for an optimal result. 

The patient is prepared for the procedure by:

  • being informed about the procedure
  • having an enema the day before the procedure
  • fasting

Implementation

  • The patient lies in the lithotomy position.
  • The legs are covered to avoid nerve injury.
  • The environment should be sterile.
  • The procedure begins with colposcopy to identify the boundary of the transformation zone.
  • Each quadrant of cervical stroma is injected with 5 ml xylocain with adrenalin 10 mg/ml to reduce bleeding during the procedure.
  • The line where the mucosa will be incised is marked with laser.
  • A cone is cut out. It is important that the entire transformation zone is included, but as small amount of cervical stroma as possible should be removed.  
  • At the end, hemostasis is performed. Supplementary laser evaporation can be done, but with caution not to destruct more tissue than necessary. It may be appropriate to place a suture around larger vessels that bleed.
  • There is no reason to do additional laser evaporation of the mucosa after the cone is removed. This leads to unnecessary destruction of normal tissue.

Follow-up

Post-op care

It is normal to have light bleeding or bloody discharge during the first 2-3 weeks after the procedure. If there is bleeding that is more than normal menstruation, the patient should contact their doctor.  A compress is usually enough to stop the bleeding but a suture may be needed in some cases. Tranexamic acid treatment can reduce small bleeding but not serious arterial bleeding.

Precautionary measures

While the cervix is healing (about 3 weeks) the patient should not bathe in a bathtub or salt water, have sexual intercourse, or use a tampon. 


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