Gestational Trophoblastic Disease 4 Flashcards
Define gestational trophoblastic neoplasia.
1
Q
What patients are at the highest risk for postmolar gestational trophoblastic neoplasia?
A
- Uterine size > dates or >20 week size
- Theca-lutein cysts
- Age > 40
- Very high hCG levels
- Medical complications: toxemia, hyperthyroidism, trophoblastic embolization
- Repeat hydatidiform mole
2
Q
What are the important factors in regards to the clinical evaluation of patients with gestational trophoblastic neoplasia?
A
- History
- Physical examination
- CXR (chest CT if negative)
- Abdominal-pelvic CT scan
- Brain CT scan or MRI
- CBC and platelets
- Serum chemistries
- hCG level
3
Q
What are the features of low risk metastatic gestational trophoblastic neoplasias?
A
- hCG < 40,000 mIU/mL serum
- Sx present for < 4 months
- No brain or liver metastases
- No prior chemotherapy
- Pregnancy event not term delivery
- Nonmetastatic disease
- Metastatic disease (Stage II-III)
- WHO/FIGO score < 7
- Not FIGO stage IV
4
Q
What are the features of a high risk gestational trophoblastic neoplasia?
A
- hCG >100,000 IU/24-hr urine or > 40,000 mIU/mL serum
- Sx present for > 4 months
- Brain or liver metastases
- Prior chemotherapy failure
- Antecedent term pregnancy
- FIGO stages II & III, risk score >7
- FIGO stage IV
5
Q
Describe the FIGO clinical staging of gestational trophoblastic neoplasia?
A
- Stage I - Tumor strictly contained to the uterine corpus
- Stage II - Tumor extends outside the uterus, but is limited
- to the genital structures
- Stage III - Tumor extends to the lungs with or without
- genital tract involvement
- Stage IV - Tumor metastatic to any other site