Conization of cervix is a surgical procedure which is popularly used to detect and treat cervical abnormalities. It may also be called cervical conization or cone biopsy. The process comprises the entailing the resection of a conical or wedge-shaped piece of tissue from the cervix for histopathological analysis. Conization is done in cases where the cervical screening tests such as Pap smear or HPV testing detected changes such as cervical dysplasia, carcinoma in situ, or stage I cervical cancer.
The practice of conization is closely connected with the medicine’s history that started in the 20th century when it came as a diagnostic and therapeutic technique for cervical lesions. Since the introduction of this surgical method, many discoveries of cervical fibers and tools have contributed to the refinement of conization operation as a very helpful procedure in the treatment of cervical diseases.
One of the most used devices for conization is a scalpel which cuts out the affected area layer by layer. Cold knife conization is performed for clean margins specimen prior to histological evaluation, however it requires general anesthesia. Laser treatments can be very accurate but expensive and interfere with histological examination of the tissue. Among the merits of LEEP, there are such as the speed of the procedure, protection of the boundaries, and a minimal amount of bleeding. It is also possible to do this procedure in the outdoor clinic.
Epidemiology
The general frequency of conizations depends on the number of cervical cancer cases, which is approximately within the range of 10 to 20 million. HPV infection can be the cause of cervical cancer, more than 80% of which will probably get better on their own. The American Cancer Society estimates that the US will have 13,820 newly diagnosed individuals with cancer and a toll of 4,360 in 2024. The diagnosis age is the mean of 35 to 44 years old. Black and native American woman are looking at 65 percent higher mortality mean rate than white women.
Anatomy
Pathophysiology
Cervical precancerous lesions (PBL) are the termination of normal cervix cells that become abnormal because of Human Papilloma Virus (HPV) infection. Although CINs may be equally looked at with pre-cancerous lesions, they are usually diagnosed and treated by a surgical intervention using a technique called conization. If therapy is not provided, such lesions may degenerate into invasion cervical cancer that turns into aggressive type. The transformation zone is the place where the endocervix columnar epithelium joins the ectocervix squamous epithelium, and in this area precancerous changes are more developed. The goal of conization is to remove the area’s most likely affected and any other abnormal tissue as a measure to stop invasive cancer from progressing. Conization could be followed by tissue removal or not because of the specific surgical procedure. The histopathological examination of the removed material should be done to confirm diagnostic accuracy, as well as for planning further management and identifying the completeness of surgical excision.
Etiology
The virus called Human papillomavirus infection at the increased danger leads to the development of cervical intraepithelial neoplasia. 16 and 18 types of p53 mutations are known to be in more than 90% of aggressive cancers and 50 to 80% squamous intraepithelial lesion (SIL).
Genetics
Prognostic Factors
Examination of excised cervical tissue by means of pathohistology is crucial for assessing prognosis and factors such as cervical intraepithelial neoplasma (CIN) and invasive carcinoma will determine the risk categories of the patient. The grade of the lesions and invasive cancer are factors to the prediction of outcomes with poor prognoses. Disease-free margin status, whether is a reliable predictor of residual or recurrent disease which is an important prognostic factor in this context with clear margins being an indicator of the lowest risk of residual disease.
Clinical History
Conization is the main operation of choice carried out in women aged between 30 and 5 years who suffer from abnormal cervical screening tests or symptoms suspicious of cervical pathology. The uterine abnormality in young women may lead to the progression of menstrual irregularities or incidence of symptoms. For women aged 30-50 years who received an abnormal Pap test or positive HPV test result, low-grade cancers are the most common types of cervical cancer treated with conization.
Physical Examination
Colposcopy
Cervical Mapping
Bimanual Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Cervical Intraepithelial Neoplasia
Cervical Polyps
Cervical Cancer
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment process involves the excision of abnormal or precancerous cervix cells through a small cone-shaped cone removing a small wedge of surrounding normal tissues. Most of the time these procedures are done under a general anesthesia and however some individuals may desire a local one. The sample tissue will be subject to an inspection in a lab by a pathologist whose objective includes ascertaining the type of the cells (normal, pre-cancerous or cancerous) and whether further treatment is required.
Pre-operative counseling with education can prepare patients by writing about the medical procedure, risks provided, benefits and the expected results.
Psychological supports systems will allow the patients with cervical abnormalities to break the emotional stress and anxiety barriers on their way to recovery.
Non-medicinal methods in pain management such as relaxation, deep breathing, guided imagery, and distraction lower anxiety and pain levels. It is critical in physical therapy and rehabilitation of pelvic floor muscles where patients can experience improved muscle strength and relief from pain as well as optimized postoperative recovery.
Nutritional counseling and lifestyle changes, e.g., balancing diet with exercise, sufficient water intake, and quitting smoking are all beneficial for general health as well as an aid to the fast and proper healing after the surgery.
Role of Hemostatic agents in the treatment of Conization of Cervix
Cervical conization leads to bleeding from the surgical site, and hemostatic agents making it stop by reducing bleeding and promote haemostasis are necessary for treating cervical conization. They are useful in operating room by preventing postoperative haemorrhage risks, maintaining stability of haemorrhage, and insuring the best possible wound healing.
One of the topical hemostatic agents is the Monsel’s solution – Ferric subsulfate – which causes coagulation and helps the formation of a scab over the wound and in turn stops the tissue’s bleeding. The agent is directly applied onto the cervical tones after conization to have hemostasis.
The Silver Nitrate is another topical hemostatic agent which is effectively used to stop bleeding from mucous membranes, including the cervix or mucous membranes of the mouth. It changes the structure of proteins as well as causes clumping of the red blood cells that further leads to the formation of a clot. It is used by directly applying on to the bleeding surface as a solution or sticks of silver nitrate. The use of hemostatic preparations mitigates blood flow, keeping the patient from having to take in too many red blood cells and consequently reducing the incidence of complications brought about by excessive blood loss.
Colposcopy: It is an investigation technique that displays inside the cervix from a colposcope, which is a sort of microscope with a big magnifying glass. It is the imaging modality that permits visualization of the cells in the cervix clearly, thus allowing sampling of suspected zones aimed at the histopathological diagnosis. Colposcopy, if carried out in the past, may be used for identification of the size and the state of lesions cervix and high-risk areas which are biopsied, for selection of the best types of therapy.
Endocervical Curettage (ECC): It’s a procedure that includes epithelial cells removal of the cervical canal’s end lining, specifically for a tissue sample to be analyzed using histopathological examination. It is usually performed during colposcopy or conization to assess the abnormal cells that may possibly extend to the endocervical canal (the dead end area of the cervix). ECC provides the evaluation of the whole cervix at ease, helping detect the abnormalities that cannot be seen on colposcopy or biopsy tests when using them alone.
LLETZ (Large Loop Excision of the Transformation Zone): It is an alternative to knife that involves tissue removal by using a loop electrode which reaches to the transformation zone and other abnormal cervical tissue. It is usually performed as an alternative to the cold knife conization techniques which is formally used for diagnosis of cervical precancerous cells. It facilitates precise tissue excision, immediate hemostasis, and saves the ecto-cervical margins, conditions that lead to high success rates on treating and diagnosing the affected person.
use-of-phases-in-managing-conization-of-cervix
Preoperative Phase: In this stage, the patient is prepared for conization (biopsy) that is part of this process. Various aspects of the surgical process could be addressed such as dialogues organized with the healthcare team about the procedure, collecting the informed consent, and one’s necessary which include diagnostic tests or evaluations.
Intraoperative Phase: This part involves the actual conization process, when a hysteroscopic knife is used to remove the abnormal portion of the endometrium. The surgeon proceeds by royally amputating a small cone that is abnormal tissue from the cervix plus the area of the surrounding tissue that is healthy. Finally, the piece is sent to a pathology lab for the testing to be done.
Postoperative Phase: Then after completion of the conization process the patient enters the postoperative stage which includes close monitoring few hours before discharge. At the weeks following procedure, post-procedure patients may see vaginal bleeding.
Recovery Phase: This stage then switches to the patient’s healing process that follows the conization procedure. The instruction for the patients is to do downplay the sexual penetration and use pads if menstruating for the next three weeks. The other part of the recovery also consists of regularly checking for any symptoms of complication, as an example danger bleeding or infection.
Conization of cervix is a surgical procedure which is popularly used to detect and treat cervical abnormalities. It may also be called cervical conization or cone biopsy. The process comprises the entailing the resection of a conical or wedge-shaped piece of tissue from the cervix for histopathological analysis. Conization is done in cases where the cervical screening tests such as Pap smear or HPV testing detected changes such as cervical dysplasia, carcinoma in situ, or stage I cervical cancer.
The practice of conization is closely connected with the medicine’s history that started in the 20th century when it came as a diagnostic and therapeutic technique for cervical lesions. Since the introduction of this surgical method, many discoveries of cervical fibers and tools have contributed to the refinement of conization operation as a very helpful procedure in the treatment of cervical diseases.
One of the most used devices for conization is a scalpel which cuts out the affected area layer by layer. Cold knife conization is performed for clean margins specimen prior to histological evaluation, however it requires general anesthesia. Laser treatments can be very accurate but expensive and interfere with histological examination of the tissue. Among the merits of LEEP, there are such as the speed of the procedure, protection of the boundaries, and a minimal amount of bleeding. It is also possible to do this procedure in the outdoor clinic.
The general frequency of conizations depends on the number of cervical cancer cases, which is approximately within the range of 10 to 20 million. HPV infection can be the cause of cervical cancer, more than 80% of which will probably get better on their own. The American Cancer Society estimates that the US will have 13,820 newly diagnosed individuals with cancer and a toll of 4,360 in 2024. The diagnosis age is the mean of 35 to 44 years old. Black and native American woman are looking at 65 percent higher mortality mean rate than white women.
Cervical precancerous lesions (PBL) are the termination of normal cervix cells that become abnormal because of Human Papilloma Virus (HPV) infection. Although CINs may be equally looked at with pre-cancerous lesions, they are usually diagnosed and treated by a surgical intervention using a technique called conization. If therapy is not provided, such lesions may degenerate into invasion cervical cancer that turns into aggressive type. The transformation zone is the place where the endocervix columnar epithelium joins the ectocervix squamous epithelium, and in this area precancerous changes are more developed. The goal of conization is to remove the area’s most likely affected and any other abnormal tissue as a measure to stop invasive cancer from progressing. Conization could be followed by tissue removal or not because of the specific surgical procedure. The histopathological examination of the removed material should be done to confirm diagnostic accuracy, as well as for planning further management and identifying the completeness of surgical excision.
The virus called Human papillomavirus infection at the increased danger leads to the development of cervical intraepithelial neoplasia. 16 and 18 types of p53 mutations are known to be in more than 90% of aggressive cancers and 50 to 80% squamous intraepithelial lesion (SIL).
Examination of excised cervical tissue by means of pathohistology is crucial for assessing prognosis and factors such as cervical intraepithelial neoplasma (CIN) and invasive carcinoma will determine the risk categories of the patient. The grade of the lesions and invasive cancer are factors to the prediction of outcomes with poor prognoses. Disease-free margin status, whether is a reliable predictor of residual or recurrent disease which is an important prognostic factor in this context with clear margins being an indicator of the lowest risk of residual disease.
Conization is the main operation of choice carried out in women aged between 30 and 5 years who suffer from abnormal cervical screening tests or symptoms suspicious of cervical pathology. The uterine abnormality in young women may lead to the progression of menstrual irregularities or incidence of symptoms. For women aged 30-50 years who received an abnormal Pap test or positive HPV test result, low-grade cancers are the most common types of cervical cancer treated with conization.
Colposcopy
Cervical Mapping
Bimanual Examination
Cervical Intraepithelial Neoplasia
Cervical Polyps
Cervical Cancer
The treatment process involves the excision of abnormal or precancerous cervix cells through a small cone-shaped cone removing a small wedge of surrounding normal tissues. Most of the time these procedures are done under a general anesthesia and however some individuals may desire a local one. The sample tissue will be subject to an inspection in a lab by a pathologist whose objective includes ascertaining the type of the cells (normal, pre-cancerous or cancerous) and whether further treatment is required.
Surgery, General
Pre-operative counseling with education can prepare patients by writing about the medical procedure, risks provided, benefits and the expected results.
Psychological supports systems will allow the patients with cervical abnormalities to break the emotional stress and anxiety barriers on their way to recovery.
Non-medicinal methods in pain management such as relaxation, deep breathing, guided imagery, and distraction lower anxiety and pain levels. It is critical in physical therapy and rehabilitation of pelvic floor muscles where patients can experience improved muscle strength and relief from pain as well as optimized postoperative recovery.
Nutritional counseling and lifestyle changes, e.g., balancing diet with exercise, sufficient water intake, and quitting smoking are all beneficial for general health as well as an aid to the fast and proper healing after the surgery.
Surgery, General
Cervical conization leads to bleeding from the surgical site, and hemostatic agents making it stop by reducing bleeding and promote haemostasis are necessary for treating cervical conization. They are useful in operating room by preventing postoperative haemorrhage risks, maintaining stability of haemorrhage, and insuring the best possible wound healing.
One of the topical hemostatic agents is the Monsel’s solution – Ferric subsulfate – which causes coagulation and helps the formation of a scab over the wound and in turn stops the tissue’s bleeding. The agent is directly applied onto the cervical tones after conization to have hemostasis.
The Silver Nitrate is another topical hemostatic agent which is effectively used to stop bleeding from mucous membranes, including the cervix or mucous membranes of the mouth. It changes the structure of proteins as well as causes clumping of the red blood cells that further leads to the formation of a clot. It is used by directly applying on to the bleeding surface as a solution or sticks of silver nitrate. The use of hemostatic preparations mitigates blood flow, keeping the patient from having to take in too many red blood cells and consequently reducing the incidence of complications brought about by excessive blood loss.
Surgery, General
Colposcopy: It is an investigation technique that displays inside the cervix from a colposcope, which is a sort of microscope with a big magnifying glass. It is the imaging modality that permits visualization of the cells in the cervix clearly, thus allowing sampling of suspected zones aimed at the histopathological diagnosis. Colposcopy, if carried out in the past, may be used for identification of the size and the state of lesions cervix and high-risk areas which are biopsied, for selection of the best types of therapy.
Endocervical Curettage (ECC): It’s a procedure that includes epithelial cells removal of the cervical canal’s end lining, specifically for a tissue sample to be analyzed using histopathological examination. It is usually performed during colposcopy or conization to assess the abnormal cells that may possibly extend to the endocervical canal (the dead end area of the cervix). ECC provides the evaluation of the whole cervix at ease, helping detect the abnormalities that cannot be seen on colposcopy or biopsy tests when using them alone.
LLETZ (Large Loop Excision of the Transformation Zone): It is an alternative to knife that involves tissue removal by using a loop electrode which reaches to the transformation zone and other abnormal cervical tissue. It is usually performed as an alternative to the cold knife conization techniques which is formally used for diagnosis of cervical precancerous cells. It facilitates precise tissue excision, immediate hemostasis, and saves the ecto-cervical margins, conditions that lead to high success rates on treating and diagnosing the affected person.
Surgery, General
Preoperative Phase: In this stage, the patient is prepared for conization (biopsy) that is part of this process. Various aspects of the surgical process could be addressed such as dialogues organized with the healthcare team about the procedure, collecting the informed consent, and one’s necessary which include diagnostic tests or evaluations.
Intraoperative Phase: This part involves the actual conization process, when a hysteroscopic knife is used to remove the abnormal portion of the endometrium. The surgeon proceeds by royally amputating a small cone that is abnormal tissue from the cervix plus the area of the surrounding tissue that is healthy. Finally, the piece is sent to a pathology lab for the testing to be done.
Postoperative Phase: Then after completion of the conization process the patient enters the postoperative stage which includes close monitoring few hours before discharge. At the weeks following procedure, post-procedure patients may see vaginal bleeding.
Recovery Phase: This stage then switches to the patient’s healing process that follows the conization procedure. The instruction for the patients is to do downplay the sexual penetration and use pads if menstruating for the next three weeks. The other part of the recovery also consists of regularly checking for any symptoms of complication, as an example danger bleeding or infection.
Conization of cervix is a surgical procedure which is popularly used to detect and treat cervical abnormalities. It may also be called cervical conization or cone biopsy. The process comprises the entailing the resection of a conical or wedge-shaped piece of tissue from the cervix for histopathological analysis. Conization is done in cases where the cervical screening tests such as Pap smear or HPV testing detected changes such as cervical dysplasia, carcinoma in situ, or stage I cervical cancer.
The practice of conization is closely connected with the medicine’s history that started in the 20th century when it came as a diagnostic and therapeutic technique for cervical lesions. Since the introduction of this surgical method, many discoveries of cervical fibers and tools have contributed to the refinement of conization operation as a very helpful procedure in the treatment of cervical diseases.
One of the most used devices for conization is a scalpel which cuts out the affected area layer by layer. Cold knife conization is performed for clean margins specimen prior to histological evaluation, however it requires general anesthesia. Laser treatments can be very accurate but expensive and interfere with histological examination of the tissue. Among the merits of LEEP, there are such as the speed of the procedure, protection of the boundaries, and a minimal amount of bleeding. It is also possible to do this procedure in the outdoor clinic.
The general frequency of conizations depends on the number of cervical cancer cases, which is approximately within the range of 10 to 20 million. HPV infection can be the cause of cervical cancer, more than 80% of which will probably get better on their own. The American Cancer Society estimates that the US will have 13,820 newly diagnosed individuals with cancer and a toll of 4,360 in 2024. The diagnosis age is the mean of 35 to 44 years old. Black and native American woman are looking at 65 percent higher mortality mean rate than white women.
Cervical precancerous lesions (PBL) are the termination of normal cervix cells that become abnormal because of Human Papilloma Virus (HPV) infection. Although CINs may be equally looked at with pre-cancerous lesions, they are usually diagnosed and treated by a surgical intervention using a technique called conization. If therapy is not provided, such lesions may degenerate into invasion cervical cancer that turns into aggressive type. The transformation zone is the place where the endocervix columnar epithelium joins the ectocervix squamous epithelium, and in this area precancerous changes are more developed. The goal of conization is to remove the area’s most likely affected and any other abnormal tissue as a measure to stop invasive cancer from progressing. Conization could be followed by tissue removal or not because of the specific surgical procedure. The histopathological examination of the removed material should be done to confirm diagnostic accuracy, as well as for planning further management and identifying the completeness of surgical excision.
The virus called Human papillomavirus infection at the increased danger leads to the development of cervical intraepithelial neoplasia. 16 and 18 types of p53 mutations are known to be in more than 90% of aggressive cancers and 50 to 80% squamous intraepithelial lesion (SIL).
Examination of excised cervical tissue by means of pathohistology is crucial for assessing prognosis and factors such as cervical intraepithelial neoplasma (CIN) and invasive carcinoma will determine the risk categories of the patient. The grade of the lesions and invasive cancer are factors to the prediction of outcomes with poor prognoses. Disease-free margin status, whether is a reliable predictor of residual or recurrent disease which is an important prognostic factor in this context with clear margins being an indicator of the lowest risk of residual disease.
Conization is the main operation of choice carried out in women aged between 30 and 5 years who suffer from abnormal cervical screening tests or symptoms suspicious of cervical pathology. The uterine abnormality in young women may lead to the progression of menstrual irregularities or incidence of symptoms. For women aged 30-50 years who received an abnormal Pap test or positive HPV test result, low-grade cancers are the most common types of cervical cancer treated with conization.
Colposcopy
Cervical Mapping
Bimanual Examination
Cervical Intraepithelial Neoplasia
Cervical Polyps
Cervical Cancer
The treatment process involves the excision of abnormal or precancerous cervix cells through a small cone-shaped cone removing a small wedge of surrounding normal tissues. Most of the time these procedures are done under a general anesthesia and however some individuals may desire a local one. The sample tissue will be subject to an inspection in a lab by a pathologist whose objective includes ascertaining the type of the cells (normal, pre-cancerous or cancerous) and whether further treatment is required.
Surgery, General
Pre-operative counseling with education can prepare patients by writing about the medical procedure, risks provided, benefits and the expected results.
Psychological supports systems will allow the patients with cervical abnormalities to break the emotional stress and anxiety barriers on their way to recovery.
Non-medicinal methods in pain management such as relaxation, deep breathing, guided imagery, and distraction lower anxiety and pain levels. It is critical in physical therapy and rehabilitation of pelvic floor muscles where patients can experience improved muscle strength and relief from pain as well as optimized postoperative recovery.
Nutritional counseling and lifestyle changes, e.g., balancing diet with exercise, sufficient water intake, and quitting smoking are all beneficial for general health as well as an aid to the fast and proper healing after the surgery.
Surgery, General
Cervical conization leads to bleeding from the surgical site, and hemostatic agents making it stop by reducing bleeding and promote haemostasis are necessary for treating cervical conization. They are useful in operating room by preventing postoperative haemorrhage risks, maintaining stability of haemorrhage, and insuring the best possible wound healing.
One of the topical hemostatic agents is the Monsel’s solution – Ferric subsulfate – which causes coagulation and helps the formation of a scab over the wound and in turn stops the tissue’s bleeding. The agent is directly applied onto the cervical tones after conization to have hemostasis.
The Silver Nitrate is another topical hemostatic agent which is effectively used to stop bleeding from mucous membranes, including the cervix or mucous membranes of the mouth. It changes the structure of proteins as well as causes clumping of the red blood cells that further leads to the formation of a clot. It is used by directly applying on to the bleeding surface as a solution or sticks of silver nitrate. The use of hemostatic preparations mitigates blood flow, keeping the patient from having to take in too many red blood cells and consequently reducing the incidence of complications brought about by excessive blood loss.
Surgery, General
Colposcopy: It is an investigation technique that displays inside the cervix from a colposcope, which is a sort of microscope with a big magnifying glass. It is the imaging modality that permits visualization of the cells in the cervix clearly, thus allowing sampling of suspected zones aimed at the histopathological diagnosis. Colposcopy, if carried out in the past, may be used for identification of the size and the state of lesions cervix and high-risk areas which are biopsied, for selection of the best types of therapy.
Endocervical Curettage (ECC): It’s a procedure that includes epithelial cells removal of the cervical canal’s end lining, specifically for a tissue sample to be analyzed using histopathological examination. It is usually performed during colposcopy or conization to assess the abnormal cells that may possibly extend to the endocervical canal (the dead end area of the cervix). ECC provides the evaluation of the whole cervix at ease, helping detect the abnormalities that cannot be seen on colposcopy or biopsy tests when using them alone.
LLETZ (Large Loop Excision of the Transformation Zone): It is an alternative to knife that involves tissue removal by using a loop electrode which reaches to the transformation zone and other abnormal cervical tissue. It is usually performed as an alternative to the cold knife conization techniques which is formally used for diagnosis of cervical precancerous cells. It facilitates precise tissue excision, immediate hemostasis, and saves the ecto-cervical margins, conditions that lead to high success rates on treating and diagnosing the affected person.
Surgery, General
Preoperative Phase: In this stage, the patient is prepared for conization (biopsy) that is part of this process. Various aspects of the surgical process could be addressed such as dialogues organized with the healthcare team about the procedure, collecting the informed consent, and one’s necessary which include diagnostic tests or evaluations.
Intraoperative Phase: This part involves the actual conization process, when a hysteroscopic knife is used to remove the abnormal portion of the endometrium. The surgeon proceeds by royally amputating a small cone that is abnormal tissue from the cervix plus the area of the surrounding tissue that is healthy. Finally, the piece is sent to a pathology lab for the testing to be done.
Postoperative Phase: Then after completion of the conization process the patient enters the postoperative stage which includes close monitoring few hours before discharge. At the weeks following procedure, post-procedure patients may see vaginal bleeding.
Recovery Phase: This stage then switches to the patient’s healing process that follows the conization procedure. The instruction for the patients is to do downplay the sexual penetration and use pads if menstruating for the next three weeks. The other part of the recovery also consists of regularly checking for any symptoms of complication, as an example danger bleeding or infection.
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