GTD Flashcards
GTD consists of
Hydatidiform mole (partial and complete)
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour
Atypical placental site nodule
Complete molar pregnancies are
46XX
Anucleic ovum fusing with one sperm (85%) or with two sperm (15%)
Partial molar pregnancies are
Triploid (90%) or tetraploid/mosaic (10%)
Incidence of GTD
1 in 714 births
Incidence of GTN after live birth
1 in 50000
Cure rate in U.K.
98-100%
Chemotherapy rate after partial molar pregnancy
0.5-1%
Chemotherapy rate after complete molar pregnancy
13-16%
Recurrence risk after 1 molar pregnancy
1 in 80
80% same histological type
Recurrence risk after 2 molar pregnancies
1 in 6.5
80% same histological type
Choriocarcinoma metsastatic sites
Lungs (cannon ball mets)
Kidneys
Spleen
GI tract
Brain
Liver
Signs of GTD
Irregular vaginal bleeding
Positive UPT
Sonographic appearance
Enlarged uterus
Hyperemesis
Hyperthyroidism
Early onset PET
Abdominal distension with theca lutein cysts
Haemoptysis
Seizures
Oxytocin is safe?
Not recommended
Cervical preparation prior to SEVAC is safe?
Yes
Follow up for complete mole
6 months if HCG normalises within 56 days
OR
6 months from normalisation of HCG
Follow up for partial mole
Concluded on normal HCG x 2 4 weeks apart
Avoid pregnancy for how long after chemotherapy?
1 year
Early conception associated with stillbirth, LGA and abortion in some studies (not definitive)
Treatment for placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT)
Hysterectomy
Does not respond to chemotherapy
Pregnancy rate after chemotherapy?
80%
IUD Contraception safety
MEC 1 if HCG is undetectable
MEC 3 if decreasing HCG
MEC4 if HCG persistently elevated or malignant disease
Progesterone contraception safety
MEC 1
COCP safety
MEC 1
Treatment for FIGO score 6 or less
Methotrexate for 1 week alternating daily with folinic acid then 6 days rest
Treatment for FIGO score 7 or above
Multi-agent with:
Methotrexate
Dactinomycin
Etoposide
Cyclophosphamide
Vincristine
Continue until 6 after normalised HCG
FIGO 2000 scoring criterion
Age
Antecedent pregnancy
Months from index pregnancy to Rx
Pretreatment serum HCG
Largest tumour size (cm)
Size of mets
Number of mets
Previous failed chemotherapy
Twin pregnancy with viable fetus and co-existing molar pregnancy management
Counsel about risks
Invasive testing for karyotype
Twin pregnancy outcomes
Early fetal loss 40%
Preterm birth 36%
PET 20%
No affect on outcome after chemo
