Gestational trophoblastic disease

Question 1

Define gestational trophoblastic disease.

Answer 1

GTD with local invasion and metastasis. Include invasive mole, choriocarcinoma, placental site trophoblastic tumor.

Question 2

Explain the aetiology of gestational trophoblastic disease.

Answer 2

Abnormal chromosomal material of placental tissue.

Invasive moles always form from hyatidiform nuclei.

Choriocarcinoma often after molar pregnancy, viable, miscarriage or ectopic.

Question 3

What are the risk factors for gestational trophoblastic disease?

Answer 3

Extreme of age, ethnicity (Asian), previous GTD, diet (low fat, low B carotene).

Question 4

What are the the different types of gestational trophoblastic disease.

Answer 4

Invasive mole: characteristic of hyatidiform mole, with invasion into myometrium, necrosis and haemorrage.

Choriocarcinoma: Cytotrophoblast and syncitiotrophoblast without formed choronic villi invade myometrium.

Placental site trophoblastic tumor: intermetidate trophoblasts infiltrate myometrium without causing tissue distruction. Contains HPL.

All metastasize promptly, especially to lungs, pelvis and brain.

Question 5

Summarise the epidemiology of gestational trophoblastic disease.

Answer 5

Follows 25% complete and 2% partial moles. 1/20k pregnancies.

Question 6

Recognise the presenting symptoms of gestational trophoblastic disease.

Answer 6

Persistent PV bleed, HEMG, lower abdo pain.

Symptoms of lung, brain and bladder/bowel mets.

Question 7

Recognise the signs of gestational trophoblastic disease on physical examination.

Answer 7

Excessive uterine size for gestation.

Question 8

Identify appropriate investigations for gestational trophoblastic disease and interpret the results.

Answer 8

Blood: serum BHCG (high, persistently high after EPRC)

CT CAP, MRI brain

Question 9

Generate a management plan for gestational trophoblastic disease.

Answer 9

Manage in specialist centres. Chemotherapy with MTX. Hysterectomy for placental site trophoblastic tumor.

Question 10

Identify the possible complications of gestational trophoblastic disease and its management.

Answer 10

Metastasis, side effects of chemotherapy.

Question 11

Summarise the prognosis for patients with gestational trophoblastic disease.

Answer 11

Non metastatic and low risk metastatic disease: 100% cure rate with chemo.

High risk metastatic disease: 75% cure rate with chemo.