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
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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
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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
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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
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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
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