Gestational trophoblastic neoplasm

Question 1

Outline your assessment of woman suspected of having GTN

Answer 1

History and exam specifically looking for:

• Uterine/vagina metastases
• Pulmonary mets
• Brain/CNS mets

Imaging: pelvic USS, CXR, CT abdo/pelvis, MRI brain

Bloods: FBC, U&Es, LFTs, tumour hCG

Other investigations: lumbar puncture

Question 2

Briefly explain treatment of GTN

Answer 2

• Chemotherapy:
  
  • MTX or
  • EMA-CO (combination chemotherapy). Risk of secondary malignancies and earlier menopause.
  • Aim to make thCG negative.
• Follow-up of thCG:
  
  • Low risk/MTX: 12 months
  • High risk/EMA-CO: 2 years
• Relapse risk 3.5%
• Contraception recommended: avoid conceiving for 12 months after last dose of chemotx

Question 3

Briefly outline possible treatments of resistant or recurrent GTN

Answer 3

• Alternative chemotx: actinomycin Dor EMA-CO (etopsimide, MTX, actinomycin D, cyclophosphomide, vincristine)
• Hysterectomy (with ovarian conservation).
• Resection of metastases from bowel, spleen, kidney, liver, lungs and brain.