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Gynaecology > Gestational trophoblastic disease > Flashcards

Gestational trophoblastic disease Flashcards

1
Q

What are the 4 types of gestational trophoblastic disease?

A
  1. Hydatidiform mole(partial or complete)
  2. Invasive mole
  3. Choriocarcinoma
  4. placental site trophoblastic tumour
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2
Q

Which types of gestational trophoblastic disease are benign?

A
  1. Hydatidiform mole
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3
Q

Which types of gestational trophoblastic disease are malignant?

A
  1. Invasive -these were benign hydatidiform then became malignant and spread to other areas
  2. Choriocarcinoma-occurs 15 years after previous pregnancy
  3. Placental site tumour-Rare and occurs years after previous pregnancy
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4
Q

Describe complete hydatidiform Moles?

A

The egg does not have chromosomes and does not have maternal DNA
No embryo or foetus

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5
Q

Describe partial hydatidiform moles?

A

The egg is fertilized by two sperms and has too much paternal DNA
Can have fetal parts, umbilical cord but usually congenital and chromosomal abnormalities

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6
Q

What are the risk factors for developing gestational trophoblastic disease?

A
  1. Age >40 years or too young
  2. Smoking cigarettes
  3. Blood group B
  4. Asian
  5. Previous molar pregnancy
  6. Previous asbestos exposure
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7
Q

What are the clinical features of GTD?

A
  1. PV bleeding with grape-like vesicles
  2. Because of excessive HCG-hyperemesis, early onset pre-eclampsia
  3. Hyperthyroidism
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8
Q

What blood tests would you do on this patient?

A
  1. FBC, U&E
  2. INR and PTT
  3. Thyroid tests
  4. B-HcG
  5. Crossmatch
  6. Rhesus
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9
Q

What imaging would you want to do in this patient?

A
  1. Chest X-ray
  2. Ultrasound of the abdomen
  3. Doppler-to exclude invasive moles
  4. CT/MRI-
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10
Q

What do we find On examination of these patients?

A
  1. Larger than expected uterus
  2. Adnexal tenderness
  3. Fetal parts if it is a partial hydatidiform mole
  4. Vaginal metabolites
  5. Metastatic disease to the brain, lungs and liver
  6. Vaginal Mets-grape-like vesicles
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11
Q

What is the pathophysiology of GTD?

A
  1. Trophoblasts produce HCG(specifically syncotrophoblast)

2. Mole-trophoblastic proliferation and abnormality which presents without viable fetus/fertilisation

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12
Q

When it comes to one of the clinical signs of HTD, thyrotoxicosis is included
How does thyrotoxicosis present?

A
  1. Tachycardia

2. Tremor

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13
Q

What is the management of non-invasive molar pregnancy?

A
  1. Resus the patient(fluids and blood transfusion for anaemia, correction of coagulopathy, treat the hyperthyroidism with propanol and carbamazepine )
  2. Suction curettage
    3, send the curettage for histological review
  3. Monitor the patients B-HcG- weekly over 3 months to pick up gestational trophoblastic neoplasm
  4. Offer low dose oral contraceptives to prevent conception for at least 12 months
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14
Q

What does GTN stand for?

A

Gestational trophoblastic neoplasm

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15
Q

How do we diagnose GTN?

A
  1. Plateau of HCG 4 times-over a period of 3 weeks or longer[1,7,14,21]
  2. If the HCG is increased for 3 consecutive measurement
  3. HCG elevated for 6 months or more
  4. Histological evidence of choriocarcinoma
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16
Q

What is the figo score based on?

A
  1. Age
  2. Level of hCG before treatment
  3. Tumour size
  4. Site and size of mets
  5. Previous pregnancy
  6. Number of months from pregnancy
17
Q

What is the chemotherapy we give for a score of <6 (low risk)

A

Single chemo-methotrexate

18
Q

What is the chemotherapy we give to patients with >7 (high risk)

A

Combination chemotherapy

  • etoposide
  • methotrexate
  • actinomycetes D
  • cyclophosphamide
  • oncovin (EMACO)
19
Q

What is the treatment for haemorrhage for patients with metastatic vaginal nodules?

A
  1. Insert urinary catheter
  2. Pack the vagina with gauze
  3. Resus the patient-fluids, blood transfusion
  4. Selective embolisation of pelvic vessels
  5. Ligation of internal iliac artery if it all fails
  6. Last option is hysterectomy

Gynaecology (18 decks)

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