Gestational Trophoblastic Neoplasia Flashcards
1
Q
Types GTN
A
- Invasive Mole
- Most common GTN
- Arise post complete or partial molar pregnancy
- Histology: whole chorionic villi with trophoblstic overgrowth and invasion - 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% - 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 - Invasive Mole:
- treated with single agent Chemo - Epithelioid trophoblastic tumour
2
Q
Diagnosis
A
- persistent, plateau or rise in BhCG levels
- Exclude new intrauterine pregnancy
3
Q
Examination
A
- General and vitals
- Chest auscultation
- Uterine size plapation
- vaginal examination for mets
4
Q
Investigations
A
- Full set of bloods
-CXR - CT abdo/pelvis
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
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
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