Gestational Trophoblastic Disease GT38 Flashcards
What are complete moles?
Diploid
Androgenic in origin
No fetal tissue
75-80% from duplication of sperm fertilising empty ovum
Remainder dispermic fertilisation of empty ovum
What are partial moles?
90% triploid
2 sets paternal haploid, one maternal haploid
Dispermic fertilisation of ovum
10% are tetraploid or mosaic
Usually evidence of fetus or fetal blood cells
What is the incidence of GTD in the UK?
1/714 live births
Asian 1/387
Incidence AFTER live birth is 1/50,000
What are the cure rates and chemotherapy rates in the UK?
Cure 98-100%
Chemo 5-8%
How do molar pregnancies present?
Irregular PV bleeding
Hyperemesis
Excessive uterine enlargement
Rarer: Hyperthyroidism Early PET Abdo distension due to theca lutein cysts Acute resp failure, seizures (mets)
What are the ultrasound features of molar pregnancy?
Cystic spaces in the placenta
Ratio of transverse to anteriorposterior dimension of gestation sac >1.5
What is the optimal treatment of molar pregnancy?
Suction curettage unless fetal parts too large then use medical
If failed pregnancy managed medically and POC not sent for histology for UPT in 3/52
How should persisting gynaecological symptoms after an evacuation for molar pregnancy be managed?
Consultation with screening centre prior to 2nd evacuation
How should coexistant twin pregnancy and mole be managed?
- Advice from FMU and screening centre
- If one twin viable - counsel re: increased risk perinatal morbidity (25% chance live birth) and outcome for GTN
- If unclear or abnormal placenta - invasive karyotyping
Which women should be registered at the GTD screening centre?
- Complete/partial mole (including coexistant twin)
- Limited histological change suggesting mole
- Choriocarcinoma, placental site trophoblastic tumour
- Atypical placental site nodules
If hCG has reverted to normal within 56 days of evacuation of molar pregnancy what is the follow up?
6/12 from evac date
If hCG has not reverted to normal within 56 days of evacuation of molar pregnancy what is the follow up?
6/12 from normalisation of hCG level
What is the follow up for future pregnancies with a previous hx of mole?
Notify screening centre at the end of any pregnancy, whatever outcome
hCG in 6-8 weeks
What % of women require chemotherapy following diagnosis of partial and complete mole?
Partial - 0.5%
Complete - 15%
What is the cut off for chemo and what are the regimes for GTN?
FIGO staging
=<6 - single agent methotrexate
>6 - multiagent; methotrexate, dactinomycin,
etoposide, cyclophosphamide and vincristine.
Treatment until hCG normal then for 6/52 after
What is the treatment for placental site trophoblastic tumour?
Surgery; less responsive to chemo
What is gestational trophoblastic neoplasia?
Persistent GTD, most commonly defined as a persistent elevation of βhCG
When can women conceive following treatment of GTD?
Not until follow up complete
If underwent chemo then 1 year after treatment
What is the risk of recurrence of molar pregnancy?
1/80
68-80% will be same histological type
What is the rate of stillbirth in women who conceive within 1 year of multi-agent chemo for GTN?
18.6/1000 births
No increase in congenital abnormality
How much earlier will women who underwent chemo go throught the menopause?
1 year if single agent
3 years if multi agent
Which GTN chemotherapy component may increase risk of secondary cancers?
Etoposide
- AML x16 RR
- Colon x4.6
- Melanoma x3.4
- Breast x5.79 if survive >20yrs
No increase if limited to <6/12 Rx
Which contraception is advised following GTD?
COCP once hCG normalised - if started before GTD diagnosis can stay on it
No intrauterine until hCG normalised
