Cervical conization is a surgical procedure, it is performed for diagnostic and / or therapeutic indications. Cervical conization, like all surgical procedures, can carry some risk of complications. Check how the conization procedure works, when it is indicated and what complications may occur.
Cervical conizationis a surgical procedure involving the excision of a cone-shaped fragment of the cervix (from Latinconus- cone). Conization is performed for diagnostic and / or therapeutic indications. The purpose of diagnostic conization is to collect tissue fragments for further histopathological examination.
Therapeutic conization is a method of treating precancerous lesions or low-stage neoplasms. The conization procedure usually takes less than an hour, and in most cases patients can leave the hospital the same day.
Structure of the cervix
The cervix is the lowest part of this organ, which "protrudes" towards the vagina. Its length is usually 2-3 cm.
From the point of view of microscopic structure, the epithelium covering the cervix is of the greatest importance. From the inside (in the so-called cervical canal) it is lined with a cylindrical epithelium, made of one layer of tall cells. In turn, the vaginal part of the cervix is covered with a different type of epithelium - the so-called multilayer flat, i.e. composed of several layers of flat cells.
The cervix is therefore the place where two types of epithelial tissue meet. The place where one epithelium passes into another, also called the transformation zone, is a special location. It is here that changes in the structure of cells most often begin, which are the nucleus of the neoplastic processes that later develop.
Cervical cancer. Pre-cancerous conditions
Cervical cancer is the most common cancer of the reproductive system in women. In the context of the prevention and treatment of cervical cancer, it is very important to know the process of its formation. He althy cells do not turn into cancer cells "overnight".
Cervical cancer develops from precursor changes - the so-called precancerous conditions. In medicine, they are referred to ascervical dysplasia or intraepithelial neoplasia (CIN). These conditions are characterized by the presence of abnormal cells, however, confined to the epithelium and not yet capable of aggressive and invasive growth.
The advancement of cell structure changes is determined on the three-level CIN 1/2/3 scale, which means low, medium and high degree of dysplasia, respectively.
Knowledge of the developmental stages of cervical cancer is of great importance in the prevention of this disease. Cells with an abnormal structure can be detected in a cytological examination before the development of an invasive form of cancer. Regular preventive examinations are therefore essential for early diagnosis. The sooner cervical dysplasia is detected, the greater the chance of timely treatment and full recovery.
When is cervical conization indicated?
Cervical conization is a surgical procedure involving the excision of the cervical tissues in the shape of a cone. The indications for conization are the diagnosis and treatment of precancerous conditions and the early stages of cervical cancer.
Diagnostic conization is usually preceded by other tests, such as cytology and colposcopy. In a cytological examination, a cervical smear is taken and the obtained material is viewed under a microscope. The presence of abnormal cells is usually an indication for a colposcopic examination, in which the doctor has the opportunity to carefully examine the cervix and take specimens from it for histopathological examination.
If the results of the above tests are still inconsistent, conization is indicated. Taking a larger volume of tissue enables a better assessment of the type and severity of changes in the cervix.
Apart from the great usefulness of conization as a diagnostic method, this procedure can also be a form of treatment. In this case, the indications include precancerous conditions of the cervix (especially moderate and high degree dysplasia), as well as very early stages of development of cervical cancer. If conization successfully removes all abnormal cells, no further treatment is usually needed.
Cervical conization - the course of the procedure
The conization procedure is performed under local or general anesthesia. The decision is made by the anaesthesiologist after talking to the patient. The procedure is usually preceded by the insertion of a catheter into the urinary bladder.
After anesthesia, special specula and tools are inserted into the vagina, thanks to which the cervix is well visualized.The very excision of the cone is performed with a scalpel, laser or so-called electrosurgical loop.
Cervical conization can be combined with curettage of the uterine cavity - thanks to this, it is possible to extend the diagnosis to possible changes in the endometrium. At the end of the procedure, the doctor stops all sources of bleeding.
If needed, he can also apply self-absorbable sutures around the cervix. After waking up, the patient remains under observation for several hours. In the absence of complications, you can return home on the same day.
Cervical conization - contraindications
Due to the risk of postoperative bleeding, conization is avoided during pregnancy, unless there are compelling indications.
As with other surgical procedures, any infections that may be a source of postoperative infections should be treated before surgery. This is especially true of inflammation in the reproductive system.
Conization may also be impossible for anatomical reasons (for example, in the case of an extremely short cervix). Before the cervical conization treatment, it is also necessary to discontinue (after consulting a doctor) drugs that inhibit blood clotting.
Complications after cervical conization
It may take several weeks for the conization wound to heal completely. In the first days after the treatment, spotting from the genital tract and minor pain are common. The most serious complication of conization is intense bleeding that may occur during surgery or in the postoperative period. In most cases, the doctor performing the conization protects the potential sources of bleeding with a laser or appropriate sutures.
Another complication of cervical conization is postoperative infection. In the event of an increased risk of infection, the doctor may prescribe prophylactic antibiotic therapy. Symptoms of infection include persistent vaginal discharge and an increase in temperature. In the event of their occurrence, it is necessary to consult a doctor. After the conization treatment, it is also advisable to refrain from sexual intercourse for 3-4 weeks.
Patients after conization and removal of dysplastic changes should undergo regular preventive examinations - cytology and colposcopy. Despite successful treatment, abnormal cells may reappear in the cervix and require further treatment.
The last problem that bothers the patients are issues related to the maintenance of pregnancy after the conization treatment. It is believed to have passed through the conizationCarries a small risk of cervical insufficiency and the resulting premature birth. This risk may be increased by the depth of the procedure performed. Unfortunately, scientific research does not give a clear answer to these issues. Many of them show no relationship between the history of conization and an increased risk of cervical failure.
About the author
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.
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