Cervical Biopsy Contents Procedure Overview by wuyunqing


									                                                                                             The content provided here is for
                                                                                             informational purposes only, and was
                                                                                             not designed to diagnose or treat a
                                    Cervical Biopsy                                          health problem or disease, or replace
                                                                                             the professional medical advice you
                                                                                             receive when you are with your
 (Biopsy-Cervix, Cervical Punch Biopsy, Cone Biopsy, Conization)                             physician. Please consult your
                                                                                             physician with any questions or
                                                                                             concerns you may have regarding your
                                                                                             condition. The content has been
                                        Contents                                             compiled from various resources and
                                                                                             due to the general nature of the
                                                                                             content of the document due citation
Procedure Overview .....................................................................1    and references has not been made.

Reasons for the Procedure ...........................................................2       Please contact us if you would like to
                                                                                             see graphic or visual images of the
Risks of the Procedure..................................................................2
                                                                                             procedures. This pdf has been only
Before the Procedure ...................................................................3    designed with content to give you
                                                                                             know-how of the treatment or
During the Procedure ...................................................................4    procedure.

After the Procedure......................................................................4

Procedure Overview

What is a cervical biopsy?
A cervical biopsy is a procedure performed to remove tissue from the cervix to
test for abnormal or precancerous conditions, or cervical cancer.
The cervix is the lower, narrow part of the uterus (womb) located between the
bladder and the rectum. It forms a canal that opens into the vagina, which
leads to the outside of the body.

Types of cervical biopsies:
There are several types of cervical biopsies. In addition to removing tissue for
testing, some of these procedures may be used to completely remove areas of
abnormal tissue and may also be used for treatment of precancerous lesions.                  DB/MMO/TP/cervical biopsy

Types of cervical biopsies include:                                                          Doc: ver1.0

     •     punch biopsy - a surgical procedure to remove a small piece of tissue             Updated 4th Dec 2010
           from the cervix. One or more punch biopsies may be performed on
                                                                                             If you would like to add further
           different areas of the cervix.                                                    information to this document or
     •     cone biopsy or conization - a surgical procedure that uses a laser or             amend it and support our knowledge
                                                                                             base please email us on
           scalpel to remove a large cone-shaped piece of tissue from the cervix
     •     endocervical curettage (ECC) - a surgical procedure in which a narrow
           instrument called a curette is used to scrape the lining of the

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        endocervical canal, an area that cannot be seen from the outside of the cervix
Other related procedures that may be used to help diagnose and treat abnormal or cancerous cervical cells include loop
electrosurgical excision procedure (LEEP), colposcopy, and Pap test. Please see these procedures for additional information.

What are female pelvic organs?
The organs and structures of the female pelvis are:
    •   endometrium - the lining of the uterus
    •   uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen,
        between the bladder and the rectum. The uterus sheds it’s lining each month during menstruation, unless a
        fertilized egg (ovum) becomes implanted and pregnancy follows.
    •   ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and
        where the female sex hormones estrogen and progesterone are produced
    •   cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that
        opens into the vagina, which leads to the outside of the body
    •   vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the
        "birth canal," the vagina connects the cervix and the vulva (the external genitalia)
    •   vulva - the external portion of the female genital organs

Reasons for the Procedure
A cervical biopsy may be performed when cervical abnormalities are found during a pelvic examination, or abnormal cells
are found during a Pap test. A positive test for human papillomavirus (HPV), a sexually transmitted infection, may also be a
reason for cervical biopsy. Certain types of HPV can cause cervical cancer and other less common types of genital cancers. A
cervical biopsy is often performed as part of a colposcopy procedure, also called a colposcopy-guided cervical biopsy. A
colposcopy is a procedure that uses a colposcope, an instrument with a special lens to magnify the cervical tissues.
A cervical biopsy may be performed to detect cancer of the cervix or precancerous lesions of the cervix. Cells that appear to
be abnormal, but are not cancerous at the present time, are identified as precancerous. The appearance of these abnormal
cells may be the first evidence of cancer that may develop years later.
A cervical biopsy may also be used to diagnose and assist in the treatment of the following conditions:
    •   polyps (benign growths) on the cervix
    •   genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical
    •   diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases
        the risk for cancer of the reproductive system
There may be other reasons for your physician to recommend a cervical biopsy.

Risks of the Procedure
As with any surgical procedure, complications may occur. Some possible complications may include, but are not limited to,
the following:
    •   infection
    •   bleeding

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In addition, cone biopsies may increase the risk for infertility (the inability to become pregnant) and miscarriage because of
the changes and scarring in the cervix that may occur as a result of the procedure.
Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.
If you are pregnant or suspect that you may be pregnant, you should notify your physician. Some types of cervical biopsies
can be done during pregnancy, while others cannot.
If possible, a cervical biopsy will be scheduled approximately one week after your menstrual period.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your
physician prior to the procedure.
Certain factors or conditions may interfere with a cervical biopsy. These factors include, but are not limited to, the
    •    menstruation
    •    acute pelvic inflammatory disease
    •    acute inflammation of the cervix

Before the Procedure
    •    Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might
         have about the procedure.
    •    You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully
         and ask questions if something is not clear.
    •    Generally, no prior preparation, such as fasting or sedation, is required for a simple cervical biopsy. If your biopsy
         requires regional or general anesthesia, you may need to fast for a certain number of hours before the procedure,
         generally after midnight.
    •    If you are pregnant or suspect that you are pregnant, you should notify your physician.
    •    Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic
         agents (local and general).
    •    Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are
    •    Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-
         thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop
         these medications prior to the procedure.
    •    You should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before
         the procedure.
    •    Your physician may recommend that you take a pain reliever 30 minutes before the procedure, or you may be
         given a sedative before the anesthesia is started. You will need someone to drive you home afterwards.
    •    You may want to bring a sanitary napkin to wear home after the procedure.
    •    Based upon your medical condition, your physician may request other specific preparation.

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During the Procedure
A cervical biopsy may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Some
biopsy procedures only require local anesthesia, while others require a regional or general anesthesia. Procedures may vary
depending on your condition and your physician’s practices.
Generally, a cervical biopsy follows this process:
    1.   You will be asked to undress completely or from the waist down and put on a hospital gown.
    2.   You will be instructed to empty your bladder prior to the procedure.
    3.   You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
    4.   Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart
         to expose the cervix.
    5.   Often, the physician will use a colposcope, an instrument with a special lens similar to a microscope, to magnify
         the cervical tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina.
    6.   Your physician will look through the colposcope to locate any problem areas on the cervix or in the vagina.
         Photographs with the colposcope or sketches of the areas on your cervix may be made for your healthcare record.
    7.   Your cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution
         helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An
         iodine solution may be used to coat the cervix, called the Schiller test.
    8.   The type of biopsy performed will be determined by the size, shape, location, and other characteristics of the
    9.   The physician may numb the area using a small needle to inject medication.
    10. A type of forceps called a tenaculum may be used to hold the cervix steady for the biopsy. You may feel some
        cramping when the tenaculum is applied.
    11. The amount and location of tissue removed depends on the type of biopsy. For a simple cervical biopsy,
        sometimes called a punch biopsy, one or more small samples of tissue will be removed using a special type of
        forceps. When this is performed, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal
        may be sampled with a special instrument called an endocervical curette or an endocervical brush. This may also
        cause some cramping.
    12. For a cone biopsy, in which a larger cone-shaped piece of tissue is removed from the cervix, the loop
        electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure may be used. With the cold knife
        cone biopsy, a laser or a surgical scalpel may be used to remove tissue. This procedure requires the use of regional
        or general anesthesia.
    13. Bleeding from the biopsy site may be treated with a paste-like topical medication. Electrocauterization (use of a
        probe with high frequency electrical signals to stop bleeding) or sutures may be used in some cases.
    14. After a cone biopsy, the cervix may be packed with a pressure dressing. Your physician will instruct you on removal
        of this packing.
    15. The tissue will be sent to a lab for examination.

After the Procedure
The recovery process will vary depending upon the type of biopsy performed and if anesthesia was administered.

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If you received regional or general anesthesia, you will be taken to the recovery room for observation. Once your blood
pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your
home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.
After a simple biopsy, you may rest for a few minutes after the procedure before going home.
You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-
colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.
Take a pain reliever for cramping as recommended by your physician. Aspirin or certain other pain medications may
increase the chance of bleeding. Be sure to take only recommended medications.
You may be instructed not to douche, use tampons, or have intercourse for one week after a biopsy procedure, or for a
period of time recommended by your physician.
After a cone biopsy, you should not insert anything into your vagina until your cervix has healed, which may take several
weeks. You may also have other restrictions on your activity, including no heavy lifting.
You may resume your normal diet unless your physician advises you differently.
Your physician will advise you on when to return for further treatment or care. Generally, women who have had a cervical
biopsy will need more frequent Pap tests.
Notify your physician if you have any of the following:
    •    bleeding
    •    foul-smelling drainage from your vagina
    •    fever and/or chills
    •    severe lower abdominal pain
Your physician may give you additional or alternate instructions after the procedure, depending on your particular

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