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MFSRH part 1 > GTD (gestational trophoblastic disease) > Flashcards

GTD (gestational trophoblastic disease) Flashcards

1
Q

what are the pre-malignant conditions that encompass GTD

A

molar and partial hydatiform mole (often referred to as molar pregnancy)

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2
Q

If gestational trophoblastic disease persists following treatment what is the name of the disease

A

Gestational trophoblastic neoplasia

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3
Q

Name the three malignant conditions that are included in GTD

A

invasive mole
choriocarcinoma
Placental site trophoblastic disease or epitheloid trophoblastic tumour

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4
Q

Which of the following statements regarding gestational trophoblastic disease is true?
A - 5% of those with partial hydatidiform moles may need chemotherapy
B- 15-20% of those with complete hydatidiform moles may need chemotherapy
C- GTN has a 95% cure rate
Risk of GTD is highest in young people (e.g.. aged <18)
D- Overall incidence of GTD (with no previous history) is 1 in 70

A

B - 15-20% of those with complete hydadiform mole may need chemotherapy

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5
Q

what is the risk of patients with partial hydatiform moles needing chemotherapy

A

0.5-1% risk of GTN

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6
Q

Which of the following statements is true?
A- Complete moles are triploid and androgenic
B- Typically, partial moles are triploid and contain just paternal chromosomes
C- Typically, partial moles are triploid and contain both maternal and paternal chromosomes
D- GTD is dysfunction of the zona pellucida
E- GTD is dysfunction of the bilaminar layer

A

C - partial moles are triploid and contain maternal and paternal chromosomes (69XXY)

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7
Q

Which of the following statements is false? After undergoing chemotherapy for GTD…
A- There is a 10x risk of recurrence of GTD in subsequent pregnancies if diagnosed with GTN
B- Periods restart 1 year after chemotherapy
C- Avoid pregnancy for 1 year after completion of chemotherapy
D- Undergoing chemotherapy for leads to increased risk of premature menopause
E- Over 80% of those who want to conceive again will have at least one live birth

A

B- periods typically restart 2-6 months following chemotherapy

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8
Q

Which of the following statements regarding contraception after GTD is true?
A- Patients do not need contraception until after hCG levels have normalised
B- All hormonal contraception and LARCs can be started on the day of evacuation
C- Oral EC is contraindicated for 1 month after GTD
D- Combined hormonal contraception can be used if GTN develops
E- Cu-IUCD and IUS is UKMEC 2 in patients with GTD with decreasing hCG levels

A

D - hormonal contraception can be used if GTN develops

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9
Q

what is the process that usually occurs to lead to partial molar pregnancy?

A

2 sperm fuse with one maternal ovum (egg) producing a triploid zygote (69XXY or 69XXX)

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10
Q

Which type of molar pregnancy would you expect to find fetal tissue

A

partial molar pregnancy (mum and dad’s DNA)

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11
Q

what is the process that usually occurs to lead to the development of a complete molar pregnancy

A

one or two sperm fuse with an empty ovum (anucleate) = diploid ovum + androgenic (46XY or 46 XX)

no fetal tissue

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12
Q

how does molar pregnancy classically present

A

PVB + positive UPT + USS appearance (snowstorm/ bunch of grapes)

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13
Q

a complete mole contains only genetic material from mum

True or false

A

false - two copies of DNA from dad only paternal DNA is present hence no fetus/fetal tissue

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14
Q

in both cases of partial or complete molar pregnancy what cells in the developing blastocyst are affected by the extra paternal DNA

A

trophoblast cells overgrow and this leads to impaired embryonic development

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15
Q

Abnormal paternal DNA leads to defective imprinting in the developing embryo

True or false

A

true

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16
Q

what layer of the developing trophoblast is responsible for hCG production

A - cytotrophoblast
C- Syncytotrophoblast

A

C- Syncytotrophoblast

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17
Q

what are the characteristic features seen on histology associated with GTD

A- proliferation of the hyoblast
B- proliferation of the cytotrophoblast
C- proliferation of the villous trophoblast associated with hydropic swelling of the chorionic villi
D- proliferation of the zona pellucida

A

C

18
Q

what is the incidence of GTD

A

1 in 714

19
Q

what happens to the incidence of GTD as age increases

A

risk of GTD increases >50 years old 1 in 8

20
Q

what ethnicity is associated with higher risk of GTD

A

asians (1 in 387)

21
Q

what type of molar GTD is more common

Partial or complete

A

complete is more common occurring 1 -3 per 1000

partial 1 in 1000

22
Q

what are the non typical presentations of molar pregnancy

A

hyperemesis
abdominal bloating - due to development of theca lutein cysts
hyperthyroidism (triggered due to rising hCG)
pre-eclampsia
rarely respiratory or neurological signs due to secondary mets

23
Q

what is the risk of developing GTN if diagnosed with partial molar

a - o.5-1%
b- 10%
c- 5%
d- 15-20%

A

a - 0.5-1%

24
Q

what is the risk of developing GTN if diagnosed with complete molar

a - o.5-1%
b- 10%
c- 5%
d- 15-20%

A

d - 15-20%

25
Q

inorder to confirm the diagnosis of molar pregnancy which of the following investigations is the gold standard

A- hCG serum
B- TV USS
c- CTAP
d- Histological biopsy

A

D - histological biopsy is required

26
Q

what is the classical sign of complete molar pregnancy on USS

A

snowstorm appearance or ‘bunch of grapes’

27
Q

what might be seen on USS scan in partial molar pregnancy

A

empty gestational sac/delayed misc
enlarged placenta/ cystic changes with decidual reaction

28
Q

how long should a patient diagnosed with partial molar pregnancy avoid pregnancy for?

A

until follow up complete and 2 consecutive monthly normal hCG levels

29
Q

how long should a patient avoid pregnancy for following diagnosis and treatment of complete molar pregnancy

A

6 months (follow up is for 6 months from date of bHCG normalisation or if bHCG normalises by d56 from date of surgey)

30
Q

if a patient has previously had GTD what is the risk of them developing GTD in a future pregnancy

A

1-2%

31
Q

when should patients be advised to start contraception following treatment of GTD

A - immediately
B - once follow up complete
c- once hCG levels return to normal
d- one month after GTD treatment

A

immediately, risk of pregnancy from day 5 following treatment

32
Q

what is the main method of contraception which should be avoided until GTD treatment and follow up completed (hCG levels returned to normal)

A

Intra-uterine contraception (IUS and IUD)

Ukmec 4 - when hCG levels persistently high
UKMEC 3 - decreasing levels
ukmec 1 - undetectable hCG levels

33
Q

a patient is diagnosed with GTN (gestational trophoblastic neoplasia) and treated with methotrexate and chemotherapy. How long should you advice her to wait before trying for a baby?

A - 1 month
b- 6 months
c- 9 months
D - 12 months

A

12 months as methotrexate and chemo is teratogenic

34
Q

how long on average following chemotherapy will periods take to return

A

2-6 months

35
Q

what is the cure rate of GTN with chemotherapy

A

98-100%

36
Q

what is the risk of future GTD following treatment for GTN

A

10* risk (1 in 70 pregnancies)

37
Q

following treatment of GTN what is the chance that a patient will have a normal live birth

a - 50%
b- 62%
c- 75%
d- 83%

A

83%

38
Q

hormonal contraception following treatment for GTD is contra-indicated

True or false

A

false - no contra-indications to HC following Rx; only CI is IUS and IUD
oral EC is fine

39
Q

what scoring system is used in the staging of GTN

A

FIGO

40
Q

why is surgical treatment preferred in the management of molar pregnancy opposed to medical treatment

A

worry that medical treatment increased risk of developing GTN due to missed areas (high rate of incomplete removal with medical Rx)

MFSRH part 1 (20 decks)

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