The Ministry of Health recommends a Pap test for all women ages 24-65 every three years or every year. This recommendation is intended to detect changes in cervical cells before they develop into cervical cancer, thus preventing cancer development. In most cases, the PAP test results will turn out normal, but there may be cases in which the test will detect suspicious changes or precancerous activity in the cervix. These cases will require a more thorough examination to diagnose the cells accurately and treat them accordingly.
To accurately diagnose the condition of the cells from the PAP test, when suspected of being precancerous, a colposcopy (cervical exam) must be performed. During this test, the cervix can be visually seen by an advanced microscope called a colposcope, which allows the doctor to enlarge the desired area up to 60 times.
If the area examined is abnormal, the doctor will take a tissue sample (biopsy) from the site and send it to a lab for a pathological examination.
If clear precancerous findings have been found on PAP and colposcopy, the infected tissue should be removed, and one way to do this is through a procedure called conization.
What is conization and what is it used for?
“Cervical Conization” is a short surgical procedure with minimal invasiveness, known in Hebrew as a “cone biopsy,” because of the shape of the cone through which the infected tissue is removed.
Conization has two purposes:
Treatment – If cells have been identified in previous tests as precancerous, the infected tissue can be excised by conization.
Diagnosis – The conization can be used as a biopsy when an accurate diagnosis is not obtained from the PAP tests and the colposcopy. When conization is used for diagnosis, suspicious tissues from the cervix are sampled and sent for histological examinations to clarify their nature further.
Today, the conization procedure is most commonly utilized to diagnose and treat suspected precancerous cells in the cervix. It is a short, highly effective procedure usually performed without complications. In addition, this procedure has been shown to make a significant contribution to preventing the development of cervical cancer.
How is the procedure performed?
The conization procedure is usually performed in gynecological clinics and can be achieved only at the end of your menstrual bleeding. The process does not require a special fast; however, it is recommended to eat only a light meal and take some painkillers before starting.
The conization procedure is performed with local anesthesia only. It is a short procedure during which a sample of the abnormal cervical cells is taken using an electric loop. The patient may experience discomfort and slight pain in the lower abdomen during the process, similar to menstrual cramps.
(In some rare cases, it will be necessary to perform the procedure under general anesthesia, leaving the patient under medical supervision in a day hospital at the physician’s discretion.)
After completing the treatment, it is recommended to stay for a short time in the clinic to be supervised. If everything seems fine, the patient will be released. However, there may be bloody discharge and pain reminiscent of menstrual cramps during a month-long recovery. Painkillers can be taken to relieve them.
In sporadic cases, heavy bleeding accompanied by blood clots may occur, but in this case, immediate referral to a doctor or emergency room is advised!
After a month, the patient will go to the clinic for an updated examination. During this time, it is advisable to avoid having sex and using a tampon and to avoid strenuous exercise for the first ten days.
What do the conization results mean?
If the conization is performed as a biopsy, it will usually provide specific results, and the doctor will use this information to decide if the tissue needs to be excised.
If the procedure were performed as a treatment– during which the problematic tissue was removed, the team would need to make sure that the cervix is completely healed and that no further treatment is necessary after the procedure, other than performing a routine PAP test.
Future implications of treatment
Conization does not impair fertility but may lead to the weakening of the cervix and thus increase the risk of miscarriage or premature birth. In addition, conization may narrow the cervical canal, which may cause menstrual cramps or lack of menstrual bleeding. Both of these possible problems can be treated effortlessly, and if they do occur, the attending physician can be consulted.