Gestational Trophoblastic Neoplasia Flashcards

1
Q

Types GTN

A
  1. Invasive Mole
    - Most common GTN
    - Arise post complete or partial molar pregnancy
    - Histology: whole chorionic villi with trophoblstic overgrowth and invasion
  2. Choriocarcinoma
    - Can follow molar pregnancy or normal gestation
    - Can arise without gestation
    -Sheets of anaplastic cyto and syncitio-trophoblasts withoutchorionic villi
    - Very malignant
    Locally invasive
    Early metastases
    * Lung 80%
    * Vaginal 30%
    * Hepatic and cerebral 10%
  3. Placental site trophoblastic Tumour
    o Most cases follow a normal term pregnancy
    o Rare, locally invasive tumour
    o Associated with low bhCG, low proliferation
    o Chemotherapy resistant, hysterectomy is first line
  4. Invasive Mole:
    - treated with single agent Chemo
  5. Epithelioid trophoblastic tumour
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2
Q

Diagnosis

A
  • persistent, plateau or rise in BhCG levels
  • Exclude new intrauterine pregnancy
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3
Q

Examination

A
  • General and vitals
  • Chest auscultation
  • Uterine size plapation
  • vaginal examination for mets
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4
Q

Investigations

A
  • Full set of bloods
    -CXR
  • CT abdo/pelvis
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5
Q

Staging and Prognosis

A
  • I: Confined to uterus – 97% 5 year survival
  • II: Outside uterus but within genital tract
  • III: Lung metastases
  • IV: Other distant metastases – 60% 5 year survival

WHO Prognostic scoring to guide management
* Based on:
- Patient age
- Type of antecedent pregnancy
- Interval from index pregnancy
- Pre-treatment bhCG
- Largest tumour size
- Site and number of metastases
- Previously failed chemotherapy
* Low risk: 0-6, high risk: >=7

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6
Q

Management

A
  • Gynae-oncology referral
  • Multidisciplinary meeting and pathology review
  • Low risk
    o Single-agent chemotherapy with methotrexate
    o Hysterectomy if fertility not desired or to control bleeding or vaginal metastases
  • High-risk
    o Multi-agent chemotherapy
    o Etoposide, methotrexate, dactinomycin alternating with cyclophosphamide and vincristine
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7
Q

Follow up

A
  • bhCG tracking
    o Stage I-III
  • Usually followed with monthly bhCG for 12 months after treatment completed
    o Stage IV
  • Usually followed with monthly bhCG for 24 months after treatment completed
  • Contraception essential
    o Should avoid pregnancy until given all-clear from oncology team
    o All options reasonable after liaison with oncology
    o Consider DVT risks of OCP during chemotherapy
    o IUD not advised if uterine disease
  • In future pregnancies placenta should be sent for histopathology and bhCG tracked to 0 post-partum
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