Surgery for cervical cancer -- LEEP versus cone biopsy

If you are told you need surgery for cervical cancer or dysplasia, which is better: LEEP or cone biopsy? They are similar but the techniques are different.


LEEP, or loop electrosurgical excision procedure, is less precise than a cone biopsy. And more gynecologists can do LEEPs than cone biopsies, which is the reason it is often the treatment recommended first for moderate to severe dysplasia or suspected cervical cancer.

During a LEEP, the doctor swipes the electrified loop over the cervix, removing a slice of tissue. At the same time, that loop burns the edge which stops the bleeding, which is why the doctors don't have to put in any stitches. They call it "cauterization."

Because the tissue has been burned, during the next few weeks, you will have brown discharge as the dead tissue flakes off. It's completely painless. I'll tell you right now (sorry if this is TMI!) that there can be a weird odor to the discharge, and that's because the tissue was burned during the surgery. You may even see what looks like scabs coming out.

Cone biopsy

A cone biopsy is more exact, and the surgeon precisely cuts out a cone shaped piece of the cervix. Because they use a knife, the doctors have to put in stitches to stop the bleeding. While you're healing, you shouldn't really have any unusual discharge, and the stitches don't have to be removed--they dissolve gradually on their own.

A cone biopsy can also go deeper into the cervix, so that may be done after an initial LEEP or even another cone biopsy if more tissue has to be removed. Another difference between the two surgeries is that during a cone biopsy, the surgeon can cut more from the canal of the cervix than is possible with a LEEP.

Either way, the tissue is sent to a lab where a pathologist looks at it for tumors or dysplasia. If you have a tumor and there is a margin of normal tissue around it, you may be done with treatment. If you have dysplasia, you may also be done, and you will go for more frequent followup Pap smears. 

If you have a tumor, and there is not a good margin of normal tissue around it, then you will need more surgery, like another cone biopsy or, if the tumor if larger, perhaps even a trachelectomy

Either surgery for cervical cancer or dysplasia removes tissue that is not normal, whether it is dysplasia or an actual tumor. Both are done under anesthesia, and recovery is painless. 

Often your regular gynecologist will recommend a LEEP first, hoping that's all you need. If a tumor is discovered without a good margin, then you may be sent to a surgeon for a cone biopsy. 

Sometimes you might read about laser surgery for cervical cancer, but my gynecologist told me that that causes more stenosis than LEEP or cone biopsy, so it isn't really done much anymore.