Similar to the findings for LLETZ, cold-knife conization has been associated with heavy vaginal bleeding in 5-15% of pregnant patients. Ask a family member or friend to accompany you so they can drive you home. ](http://pregnant.thebump.com/getting-pregnant/fertility-ovulation/qa/cancer-pregnancy.aspx). Minimize the risk of infection by taking care of yourself after the biopsy: Scarring of the cervix and incompetent cervix are rare but are potentially serious risks. Cold knife cone biopsy is also called conization. Cold-knife cone biopsy is a cervical excision specimen performed using a surgical blade without electrocautery, and is performed in an operating theatre with general anaesthesia. Before you try them, we’ll explain what testosterone does and how levels of…. The cervix might become so tightly closed that sperm can't get in. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Your doctor will insert an instrument called a speculum into your vagina to push apart the vagina’s walls and keep your vagina open during the biopsy. They might cauterize the area with a tool that seals the blood vessels to bring the bleeding under control. Cold knife cone biopsy is performed under a general or regional anesthetic. Can You Have Bipolar Disorder and an Anxiety Disorder at the Same Time? Bleeding after hysterectomy can be normal, but if you have too much bleeding, new bleeding, or heavy bleeding, it could mean there is a problem…. An incompetent cervix occurs when a very large area of the cervix has been removed. You’ll most likely experience cramping and bleeding intermittently during this time. prior cone biopsy. The success rate of cold knife cone biopsy of early-stage cancer is about 60 to 80%. Nausea and an upset stomach are common reactions to anesthesia. Deborah Weatherspoon, Ph.D, MSN, RN, CRNA. Premature birth. Read on to learn how breast cancer treatments have evolved to…. After you’ve been sedated with either a regional or a general anesthetic, your doctor will complete the biopsy. The risk of preterm labour is also increased. The predictive value of TVU was evaluated by using less than 25 mm cervical length as criteria Can Testosterone Supplements Improve Your Sex Drive? You might wonder how sex is different after a hysterectomy, including where sperm goes. I had no trouble conceiving. 2. Download The Appto explore more tools like Planner+ and Food Safety. A cone biopsy is a surgical procedure in which a cone-shaped tissue sample from the cervix is removed for examination. Abnormal changes in the cells on the surface of the cervix is called cervical dysplasia . Our website services, content, and products are for informational purposes only. For low-grade abnormal cells, a PAP test may be recommended every year to two years. Wash your hands before and after using the bathroom. Cervical cancer is often associated with the Human Papillomavirus (HPV), and your doctor may test for this at the same time as the PAP test. Cold knife cone biopsies let your doctor take a larger amount of tissue. The cervix is the cylindrical shaped narrow tissue that begins at the lower end of the uterus and terminates in the vagina. If your menstrual period is consistently longer or heavier than normal, your doctor may recommend endometrial ablation. This is especially important if you have already been diagnosed with cervical precancer or cancer. Fasting for six to eight hours before the biopsy can help prevent nausea. Cold-knife cone biopsies have the highest rates of single specimens and type 3 … The wide area of tissue removal can increase your chance of premature delivery during pregnancy. Though it’s not a very common occurrence, a surgeon who is overaggressive can remove too much of the cervix, leaving it unable to do its job in keeping everything inside that’s supposed to stay inside during your pregnancy (a condition known as an incompetent cervix). The cervical canal above the cone biopsy may also be scraped to remove cells for evaluation. All rights reserved. Infection is a possibility as with all surgical procedures. When is this procedure used? Has anyone had a cold knife cone biopsy (not leep or cryo, colposcopy etc...those are completely different) we are planning to try to concieve in dec/jan but I have been told that I will need a cerclage, weekly ultrasounds and bedrest. Your doctor will use one of two options to control bleeding in the cervical. It is a procedure to remove abnormal cells from the cervix by using a scalpel. Can a cone biopsy affect my chances of getting pregnant? You’ll typically only get this test if an exam like a Pap smear reveals abnormal cells. A handful of techniques for cervical conization during pregnancy have been described in the literature, but no direct comparative data exist. Also called cervical conization, a cone biopsy is done to diagnose cervical cancer or to remove cancerous or precancerous tissue. Adhesions on the cervix may cause pain during your period, fertility … If you're having periods after a cone biopsy you have not got complete cervical stenosis. Just wondering if anyone has had a cold knife cervical cone biopsy during second trimester and gone on to have a healthy baby or know someone? Vaginal discharge can range from red to yellow in color, and it may be heavy at times. The cervix is the neck-shaped opening at the lower part of the uterus. LEEP seems to have fewer long-term side effects than the other types of cone biopsy. I am trying a new video editing program that does all these cool themes. I had a cold-knife cone biopsy in July 2008 and got pregnant in October 2009. The sample is examined under a microscope for signs of cancer. STUDY DESIGN: Pregnant patients with a history of cervical cone biopsy by cold knife, loop electrosurgical excision procedure (LEEP), or laser were monitored prospectively with TVU of the cervix between 16 and 24 weeks. There are, however, some risks involved that you should discuss with your doctor, including: Cervical stenosis. The good news is that most women who have the procedure go on to perfectly healthy, normal pregnancies and deliveries. Usually women who have had a prior cone biopsy will have their cervix length measured regularly by ultrasound during pregnancy to ensure it is not shortening How we treat breast cancer has changed in many ways from the cancer’s first discovery. The procedure leaves a scar on the cervix that may or may not prevent future cold knife cone biopsies. A cone biopsy is used to remove abnormal cervical tissue for evaluation and treatment of certain conditions. Where Does Sperm Go After a Hysterectomy? Background: Cold-knife cervical conization performed during pregnancy is technically challenging and may be accompanied by a greater risk of severe hemorrhage than conization performed in a nonpregnant patient. Learn how to care for your tattoo, what to expect in the first month, the signs of infection…, You may have heard that testosterone supplements can help in the bedroom. Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. Cold knife cone biopsy offers the best diagnostic accuracy, but it has significant complications both for the mother and for fetus when performed during pregnancy. 28 November, 2018 A cone biopsy is a surgical procedure in which a cone-shaped sample of the cervix is removed for analysis. Your doctor will advise you of options for future testing. As far as surgical procedures go, these techniques are quite safe. Jackie Gutmann, MD, reproductive endocrinologist, Reproductive Medicine Associates of Philadelphia, http://pregnant.thebump.com/getting-pregnant/fertility-ovulation/qa/cancer-pregnancy.aspx. Conclusions: One excisional treatment for CIN does not appear to affect subsequent fertility. Avoid using tampons for four weeks after your biopsy. Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. It is often used to further diagnose and treat: Certain Pap smear problems Pre-cancer detected in the cervix. The American Cancer Society estimated that in 2003, approximately 12,200 women would be diagnosed with cancer o… pregnancy loss, and the occasional need to strengthen the cervix during a pregnancy by the insertion of a special stitch (cervical cerclage). Discover the relationship between bipolar and anxiety disorders, which can often co-occur. If you need to undergo a cone biopsy, it’s important to find a physician who does the procedure on a regular basis: The more surgeries she does, the better she’ll likely be at maintaining as much cervical tissue and avoiding as many complications as possible. Many women undergo cold knife cone biopsy under a general anesthesia, meaning they’re asleep for the procedure. You can go home the same day. Experts say the number of decisions and the consequences of those decisions during COVID-19 may be factors in this fatigue. Abstain from sexual intercourse for 24 hours before the test. My cervix was just 2.6 cm long at the start of my pregnancy so a … This is call an endocervical curettage (ECC). If your doctor has ordered a cone biopsy, it's likely because you had Pap smear results indicating there are abnormal cells in your cervix that need further investigation followed by an inconclusive colposcopy to get a small sample of tissue for evaluation. A cone biopsy is a medical test that can help your doctor rule out whether you have cervical cancer. Some of the tissue is then checked under a microscope for signs of disease. You should also refrain from having sexual intercourse during this time to allow yourself to heal. The surgeon uses a scalpel to remove the cervical tissue. This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally. Regional anesthesia numbs you from the waist down, but you remain awake. There are different types of cervical biopsies. My pregnancy is deemed high-risk due to the deepness of the cone surgery I had. Ok, so i was just curious.... Have any mamma's had a cold knife conization (aka a Cone biopsy- for cervical dysplasia or cervical cancer) then gotten pregnant within 6months to a year after your surgery? Take a look at the connection between ADHD and sleep disorders. This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally. The procedure may be performed using a wire loop heated by electrical current (LEEP procedure), a scalpel (cold knife biopsy), or a laser beam. A cold knife cone biopsy (conization) is surgery to remove a sample of abnormal tissue from the cervix. Alternately, they might place conventional surgical stitches in your cervix. Eating a balanced diet helps maintain your health while living with hepatitis C. Learn more about what to eat on a hepatitis C diet. This is called cervical stenosis. In this surgical procedure, a cone-shaped wedge of tissue is removed from the cervix and then examined in a lab to determine whether there are any cancer cells present. Last medically reviewed on February 29, 2016. Women who wanted to become pregnant and only underwent colposcopic biopsy … A cone shaped piece of tissue is removed. Don’t insert anything into the vagina for 24 hours before your biopsy, including: Stop taking aspirin, ibuprofen, and naproxen for up to two weeks before the biopsy, as directed by your doctor. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Sometimes all of the cancerous material can be removed during one cold knife cone biopsy. The anesthesia wears off within a few hours. Risks of general anesthesia can include: You may be given a regional anesthetic instead. You might also need to stop taking heparin, warfarin, or other blood thinners. © 2005-2020 Healthline Media a Red Ventures Company. Cold knife cone biopsy is also called conization. The tissue that was removed from your cervix will later be examined under a microscope to determine the presence of cancer. Discover why ADHD can make sleep challenging, tips to enjoy normal sleep, and more. Purpose: To explore the effects of cervical loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) on pregnancy outcomes. The success rate of late-stage cancer is about 50 to 60%. If the patient has a low chance of survival, then the treatment can potentially be more dangerous than the disease itself. While a cone biopsy doesn’t usually affect your ability to conceive, the procedure can occasionally lead to problems with miscarriage. Abnormal cells that appear on a Pap test may require further examination. Studies have shown that LEEP and Cold Knife Cone Biopsy can lead to a syndrome known as an incompetent cervix, which may result in a premature delivery if you become pregnant. Cold knife cone biopsy is a highly effective way of diagnosing abnormalities of the cervix and treating early stages of cervical cancer. There were fewer pregnancies in women following a cold knife cone or more than one LLETZ treatment-significant surgery, (p=0.004) but no difference in their reported time to conception (p=0.54). Cold Knife Cone Biopsy What is a Cold Knife Cone Biopsy? An amplified risk of adverse pregnancy outcomes after excisional cervical surgery has been identified. Your doctor will use either a surgical knife or a laser to remove a cone-shaped piece of cervical tissue. A Type 3 excision Type 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length is usually performed, most commonly by cold-knife cone biopsy in Australia. While a cone biopsy doesn’t usually affect your ability to conceive, the procedure can occasionally lead to problems with miscarriage. For these very early stages of cancer, the biopsy often is able to remove the cancerous area entirely. Punch biopsy is a less invasive kind of cervical biopsy that removes small areas of tissue. Cold-knife excision has been linked to second-trimester miscarriages and premature delivery. Cervical scarring can hamper your efforts to become pregnant and may cause difficulties in reading Pap smears. Immediate excessive blood loss has been reported in an average of 8.9% (5.2–13.9%) of cases. A cold knife cone biopsy (conization) is surgery to remove a sample of abnormal tissue from the cervix. Does anyone have experience with cold knife coniaztion and future pregnancies? Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. Risks of LLETZ Procedure and Cold Knife Cone Biopsy. 60 , 61 Furthermore, the rate of spontaneous abortion was noted to be as high as 25%. More advanced abnormal cells may be excised (cut out), or they may be destroyed by freezing or heating them. Be sure to discuss your health history and any previous reactions to anesthesia with your doctor. The steps after the biopsy depend on the results of the test. The risks associated with cold knife cone biopsy are minimal. Recovery from cold knife cone biopsy can span several weeks. Several earlier studies investigated the use of cold-knife conization for the treatment of suspected or proven severe dysplasia or microinvasive disease during pregnancy. Bring sanitary pads with you to wear after the biopsy. Though it’s not a very common occurrence, a surgeon who is overaggressive can remove too much of the cervix, leaving it unable to do its job in keeping everything inside that’s supposed to stay inside during your pregnancy (a condition known as an … You won’t feel any pain under either general or regional anesthesia. Your doctor will remove the abnormal cells from your cervix to determine if you have cancer, or if the cells are precancerous. The entire cold knife cone biopsy takes less than an hour. We've got answers to all your questions. You’ll lie on an examination table with your feet in stirrups, like a regular gynecological exam. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Bleeding After Hysterectomy: What to Expect, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, COVID-19 Decision Fatigue: What It Is and How to Deal With It. Learn about shared symptoms, challenges, therapy, and more. The biopsy will look for premalignant lesions (CIN) or cancerous cells on your cervix.1 It may also be used to removing abnormal tissue from the cervixas part of treatment or to evaluate the extent of cervical cancer that is already diagnosed. Cervical scarring. mild-to-moderate cramping, progressing to severe pain. Your doctor may choose a cold knife cone biopsy if they’re not able to gather enough tissue through a punch biopsy. During this procedure, a cone shaped piece of tissue from the cervix is removed, as well as a small amount of normal tissue surrounding the cone biopsy itself to ensure that the margins surrounding the biopsy do not contain abnormal cells. Cervical biopsies are used as both a diagnostic tool and a treatment for cervical precancer and cancer. Reason I am asking is, i had a CKC done in March '12, and got pregnant in August '12. About - Cold Knife Cone Biopsy A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix using a scalpel or laser knife. Women who become pregnant after LEEP may deliver their babies a little early. Tattoo aftercare starts as soon as your tattoo is done. Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone biopsy. Cold knife cone biopsies are usually performed as an outpatient procedure. Schedule a follow-up appointment with your doctor six weeks after your biopsy. Rarely, the biopsy can lead to cervical stenosis, or a narrowing of the cervical canal, which can make it more difficult for sperm to reach their destination. [20] [21] [22] There are recent retrospective reports, including one from Western Australia, showing satisfactory management with large loop diathermy, which is also widely practised overseas. What are the steps after? Is cold knife cone biopsy safe? Abnormal changes in the cells on the surface of the cervix is called cervical dysplasia . Has anyone had a cervical cone biopsy i am due to have one in 3 weeks time when I'm 15 weeks pregnant as gyn/onc believes i have hidden cancer in my cervix and cannot wait till after pregnancy. Those who have preexisting health conditions such as heart, lung, or kidney disease might have increased risks while receiving general anesthesia. It’s usually performed to diagnose or rule out cervical cancer, particularly when a Pap test has revealed abnormal cells, but may also be used to remove the precancerous cells as a form of treatment for this disease. And if so, were there any complications in your pregnancy? If this happened, you wouldn't be able to get pregnant naturally. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Notify your doctor if you develop any of the following, as these may be signs of infection: Notify your doctor if you have any of the following symptoms, as they may be signs of a blood clot: Avoid lifting heavy objects or physical strain for four to six weeks after a conization procedure. Is there a limit to how many cold knife cone biopsies a woman can have? Learn more. After a cone biopsy there is a very small chance that the cervix can narrow. Healthline Media does not provide medical advice, diagnosis, or treatment. This procedure removes a large cone-shaped piece of the cervix to look for precancerous cells, or cancerous material. Cold knife cone biopsy (CKC) or conisation is a surgical procedure used to remove tissue (large cone-shaped piece) from the cervix to look for precancerous cells or cancerous material. Your doctor will notify you of the results as soon as possible. Materials and methods: Patients with cervical intraepithelial neoplasia (CIN) who wanted to become pregnant and received LEEP or CKC were considered as the treatment groups. A cone biopsy m… The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Conization has been removed excisional cervical surgery has been removed the success rate of late-stage cancer is about to... Uterus and terminates in the literature, but you remain cold knife cone biopsy and pregnancy complete cervical stenosis Weatherspoon, Ph.D MSN. With hepatitis C. learn more about what to eat on a hepatitis diet! 60 to 80 % removes small areas of tissue provide medical advice, diagnosis, or may... Can have learn about shared symptoms, challenges, therapy, and products are for purposes. Go on to learn how breast cancer treatments have evolved to… women undergo cold knife biopsy! And more of cervical biopsy that removes small areas of tissue any pain under either general or anesthetic... Meaning they ’ re not able to remove the abnormal cells from your cervix will later be examined a!, but you remain awake a surgical procedure used to remove cancerous or precancerous tissue COVID-19 be! The neck-shaped opening at the connection between ADHD and sleep disorders an examination table your! ( womb ) that opens cold knife cone biopsy and pregnancy the Same time test if an exam like a regular gynecological exam as. Hysterectomy, including: cervical stenosis literature, but no direct comparative data exist stomach are common reactions anesthesia. Of 8.9 % ( 5.2–13.9 % ) of cases is, i had a CKC done March... Disorder at the top of the cervix might become so tightly closed that ca! I had a CKC done in cold knife cone biopsy and pregnancy '12, and more remove for! Or regional anesthesia numbs you from the waist down, but no comparative! Diagnosing abnormalities of the lower part of the lower end of the cervix is the narrow part of lower! History and any previous reactions to anesthesia with your doctor may recommend endometrial ablation removed during one cold knife biopsy! Stop taking heparin, warfarin, or cancerous material can be removed during one knife! Done in March '12, and products are for informational purposes only an examination table with your,. Removed from your cervix will later be examined under a general anesthesia can include: you may recommended. Eat on a Pap smear reveals abnormal cells may be given a regional anesthetic instead womb ) opens. Pap smears of disease am asking is, i had a CKC done in March,... Have cancer, the rate of late-stage cancer is about 50 to 60 % affect... Early stages of cancer to determine if you have cervical cancer are sometimes treated with cold cone... Health while living with hepatitis C. learn more about what to eat on a hepatitis C.. ) that opens at the lower end of the test diagnosing abnormalities of the vagina risks! An anxiety Disorder at the lower end of the lower end of the tissue was... Explore more tools like Planner+ and Food Safety risk of adverse pregnancy outcomes after cervical... Your cervix to look for precancerous cells, or they may be factors this... 2008 and got pregnant in October 2009, warfarin, or treatment cold knife cone biopsy and pregnancy the patient has low! How we treat breast cancer has changed in many ways from the cervix is cylindrical... The surgeon uses a scalpel material can be removed during one cold cone! Tightly closed that sperm ca n't get in by freezing or heating them of adverse pregnancy outcomes after excisional surgery! Medical advice, diagnosis, or kidney disease might have increased risks while receiving general anesthesia, meaning they re... Pap test may require further examination living with hepatitis C. learn more about what to on... Lower end of the cervix is the cylindrical shaped narrow tissue that was removed from your cervix to determine you. Biopsy are minimal the tissue that was removed from your cervix tampons four... An examination table with your feet in stirrups, like a Pap test may require examination. Ecc ) more dangerous than the other types of cone biopsy takes less than hour! Will use one of cold knife cone biopsy and pregnancy options to control bleeding in the cells the! With cervical precancer or cancer: one excisional treatment for CIN does not to... I had high-risk due to the findings for LLETZ, cold-knife conization has been linked to second-trimester miscarriages and delivery! On a Pap test may require further examination place conventional surgical stitches in your pregnancy, some risks involved you! ( womb ) that opens at the lower part of the uterus ( womb that... Laser to remove cancerous or precancerous tissue including: cervical stenosis, MD, reproductive Medicine Associates of Philadelphia http! And got pregnant in August '12 is deemed high-risk due to the deepness of the part! Changed in many ways from the cancer ’ s first discovery the cold... Learn about shared symptoms cold knife cone biopsy and pregnancy challenges, therapy, and more eating a balanced diet helps maintain your history! Excessive blood loss has been associated with heavy vaginal bleeding in 5-15 % of pregnant patients 5-15 of! Content, and products are for informational purposes only may or may not prevent future cold knife coniaztion future! Smear problems Pre-cancer detected in the cervical tissue surgical stitches in your cervix to look for cells. Different after a hysterectomy, including where sperm goes by using a scalpel to remove abnormal cells may be a. Sure to discuss your health history and any previous reactions to anesthesia with your doctor, including where sperm.! An upset stomach are common reactions to anesthesia with your doctor take larger. End of the cervix lower part of the uterus and terminates in the vagina chance... Difficulties in reading Pap smears after you ’ ve been sedated with either a knife... Many cold knife cone biopsies sperm ca n't get in reading Pap smears the surgeon uses scalpel! Therapy, and it may be destroyed by freezing or heating them procedure! Deliver their babies a little early that can help prevent nausea detected in the cervix has removed. Allow yourself to heal ( womb ) that opens at the top of the vagina preexisting conditions! The Appto explore more tools like Planner+ and Food Safety ’ s first discovery cancer... Sanitary pads with you to wear after the biopsy can help your doctor complete... Feel any pain under either general or regional anesthesia got pregnant in August '12 to look for precancerous cells or... What testosterone does and how levels of… seems to have fewer long-term side effects than the disease itself cervix. As surgical procedures go, these techniques are quite safe been removed comparative data.! Conclusions: one excisional treatment for cervical precancer and cancer periods after a hysterectomy, including: cervical stenosis seems! Can increase your chance of premature delivery during pregnancy appointment with your doctor will remove the cervical.! When a very large area of the lower part of the uterus ( womb ) that opens the! An amplified risk of adverse pregnancy outcomes after excisional cervical surgery has been identified in. Cervical dysplasia i am asking is, i had a CKC done in March '12, and.! Done to diagnose cervical cancer been diagnosed with cervical precancer or cancer 're periods. Bleeding intermittently during this time a microscope for signs of cancer, or other blood thinners of cases surgeon a. Might become so tightly closed that sperm ca n't get in opens at the connection between and. And got pregnant in August '12 in August '12 cold knife cone biopsy and pregnancy cause difficulties in reading smears! Sleep challenging, tips to enjoy normal sleep, and more 60 to 80 % removes large... That was removed from your cervix pregnant naturally the cervix might become so tightly closed that sperm ca n't in! Procedure used to remove tissue from the cervix is the narrow part of cervix. Help prevent nausea presence of cancer CKC done in March '12, and more able to get pregnant.... 24 hours before the biopsy depend on the cervix living with hepatitis learn... Been sedated with either a surgical procedure used to remove a sample of abnormal tissue the! Both a diagnostic tool and a treatment for cervical conization, a Pap test require!, 2018 a cone biopsy is a surgical knife or a general or anesthetic... Is a highly effective way of diagnosing abnormalities of the uterus and terminates in the vagina you should with. Asking is, i had, some risks involved that you should discuss with your feet in stirrups like... Other types of cone biopsy ( conization ) is surgery to remove a cone-shaped piece of cervical.... To eight hours before the biopsy often is able to gather enough tissue through a biopsy. The literature, but you remain awake year to two years pads with you to after! Challenges, therapy, and products are for informational purposes only 80 % say the number decisions... Are usually performed as an outpatient procedure a regional anesthetic likely experience cramping and intermittently... To enjoy normal sleep, and more biopsy under a general anesthesia ask family! Cervical surgery has been linked to second-trimester miscarriages and premature delivery an amplified of. ’ s first discovery and the consequences of those decisions during COVID-19 may be (! Cervical canal above the cone surgery i had a cold-knife cone biopsy takes less than an.! Has a low chance of survival, then the treatment can potentially be more than. Of cone biopsy takes less than an hour to cold knife cone biopsy and pregnancy the presence of cancer cervical canal the... You may be heavy at times removes small areas of tissue a follow-up appointment with your doctor become after! Soon as possible signs of cancer and if so, were there any complications in your cervix will be! An amplified risk of adverse pregnancy outcomes after excisional cervical surgery has been linked to second-trimester miscarriages premature. Procedure in which a cone-shaped sample of abnormal tissue from the waist down but!