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Early Pregnancy > GTD > Flashcards

GTD Flashcards

1
Q

Gestational Trophoblastic Disease is…

A

A group of placental related disorders derived from a pregnancy

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2
Q

What is the incidence of GTD?

A

1:200-1000 1:390 for Asian women, 1:750 for non-Asian women Higher at both ends of the reproductive system, < 15 or >45

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3
Q

Gestational trophoblastic neoplasia is…

A

GTD requiring chemotherapy or excisional treatment because of persistence of HCG or presence of metastasis

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4
Q

What age groups are at higher risk for GTD?

A

Extremes of maternal age <15 or > 45

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5
Q

Histology diploid. Type of molar?

A

Complete Paternal duplication / disperm fertilisation

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6
Q

Histology triploid. Type of molar?

A

Partial 2 paternal sets and 1 maternal haploid set DNA 1 ovum fertilised by 2 sperm

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7
Q

What histological findings suggest a complete molar pregnancy?

A

Absence of fetal tissue Extensive hydropic change to the villi Excess trophoblast proliferation Absent p57 staining

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8
Q

What histological findings suggest an partial molar pregnancy?

A

Presence of fetal tissue Focal hydropic change to villi Some excess trophoblast proliferation Positive staining for p57

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9
Q

What percentage of complete molar pregnancies persist / change into malignant disease?

A

15-25%

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10
Q

What percentage of partial molar pregnancies persist / change into malignant disease?

A

0.5-4%

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11
Q

If affected by a molar pregnancy, what is the risk of another molar pregnancy?

A

1% 1:70

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12
Q

What is the most common type of GTN?

A

Gestational choriocarcinoma

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13
Q

What histological findings are suggestive of a choriocarcinoma?

A

Absence of chorionic villi Presence of abnormal intermediate trophoblast and cytotrophoblast, rimmed with syncytiotrophoblasts with areas of necrosis and haemorrhage

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14
Q

What guides treatment of gestational choriocarcinoma? What are the two treatment options?

A

FIGO Score If =6: single-agent therapy with MTX (and folic acid) If 7+: combination therapy with EMA/CO - E: Etoposide - M: Methotrexate - A: Actinomycin / Dactinomycin - C: Cyclophosphamide - O: Ovencin / Vincristine

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15
Q

What are the treatment options for Placental Site Trophoblastic Tumours and Epitheloid Trophoblast Tumour?

A

Hysterectomy Usually resistant to chemotherapy

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16
Q

What is the fetal consideration in a pregnancy affected by choriocarcinoma?

A

Tumour crosses the placenta so the newborn of a mother newly diagnosed with choriocarcinoma must be investigated to exclude lung disease

17
Q

Epithelioid trophoblast tumour is _______ aggressive than choriocarcinoma

A

Less

18
Q

What is the risk of cancer with atypical placental site nodules?

A

10-15%

19
Q

What are the FIGO criteria for dx of postmolar GTN?

A
  • plateau of HCG lasts for 4 measurements over 3 weeks or longer - rise in HCG for three consecutive weekly measurements over at least 2 weeks - histological diagnosis
20
Q

What is the recommended management for a twin pregnancy with one viable fetus and one molar pregnancy?

A

Refer to MFM and GTD centre Counsel regarding risks 40% early fetal loss 36% PTB 20% PET

21
Q

What is the follow up HCG process for molar pregnancy?

A

Weekly until normal on three occasions If partial: can then stop If complete: monthly and stop 6 months after normalisation (RANZCOG guideline)

22
Q

What are the three most common types of GTN?

A

Gestational Choriocarcinoma Placental Site Trophoblastic Tumours Epitheloid Trophoblast Tumour Other: Atypical Placental Site Nodules

23
Q

What is the risk of having another molar pregnancy when:

  • Had 1 previous molar?
  • Had 2 previous molar?
A
  • 1 previous: 1%
  • 2 previous: 11-25%
24
Q

What % of GTN develops from molar pregnancies?

What % of GTN develops from live births?

A

From molar pregnancy: 60%

From live births: very rare

25
Q

How would you tell the difference between a hydropic abortus and a partial molar pregnancy on histology?

A

Partial mole:

  • Two types of villi
  • Modest trophoblast proliferation

Hydropic abortus:

  • Large range of villi
  • Minimal trophoblast proliferation
26
Q

If monitoring of tumour hCG levels is satisfactory and complete following a complete or partial molar pregnancy, what is the risk of GTN following this?

A

For partial mole: 0%

For complete mole: 0.3%

27
Q

What is the indication of a second uterine evacuation following a molar pregnancy?

What is the benefit of performing a second evacuation in these circumstances?

A

Indications: decided by GTN MDM.

  • Hydatidiform mole on histology
  • Persistently elevated hCG but <5000
  • No evidence of metastases
  • FIGO 2000 score between 0-4.

Benefit: 40% of patients will avoid chemotherapy.

28
Q

What advice would you give regarding the prognosis of future pregnancies following treatment for a molar pregnancy?

A
  • Risk of recurrent molar pregnancy 1:80. Higher with increasing numbers of molar pregnancies.
    • 1% if one previous
    • 11-25% if two previous
    • If a molar pregnancy does occur, 68-80% will be of the same histological type
  • No affect on future fertility.

Subsequent pregnancy outcomes:

  • 70% term live births
  • 15% spontaneous miscarriage
  • 2-8% preterm birth
  • Risk of congenital malformations similar to normal population (0.4-2.5%)
29
Q

Chemotherapy for GTN:

What are the risks associated with combination chemotherapy EMA-CO?

A
  • Risk of secondary cancers (if survival >25 years after treatment) RR 1.5
  • Premature ovarian insufficiency
  • Earlier menopause:
    • 1 year if single agent chemotherapy
    • 3 years if multi-agent chemotherapy
30
Q

Chemotherapy for GTN:

What is the risk of relapse following chemotherapy for GTN?

What is the median time to relapse?

A

Relapse risk 3.5%.

Median time to relapse 4 months.

31
Q

Chemotherapy for GTN:

What is the cure rate for low risk GTN?

What is the cure rate for high risk GTN?

A

Low risk GTN cure rate: close to 100%

High risk GTN cure rateL 85%

32
Q
A

Early Pregnancy (3 decks)

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