GTD (gestational trophoblastic disease) Flashcards
what are the pre-malignant conditions that encompass GTD
molar and partial hydatiform mole (often referred to as molar pregnancy)
If gestational trophoblastic disease persists following treatment what is the name of the disease
Gestational trophoblastic neoplasia
Name the three malignant conditions that are included in GTD
invasive mole
choriocarcinoma
Placental site trophoblastic disease or epitheloid trophoblastic tumour
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
B - 15-20% of those with complete hydadiform mole may need chemotherapy
what is the risk of patients with partial hydatiform moles needing chemotherapy
0.5-1% risk of GTN
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
C - partial moles are triploid and contain maternal and paternal chromosomes (69XXY)
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
B- periods typically restart 2-6 months following chemotherapy
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
D - hormonal contraception can be used if GTN develops
what is the process that usually occurs to lead to partial molar pregnancy?
2 sperm fuse with one maternal ovum (egg) producing a triploid zygote (69XXY or 69XXX)
Which type of molar pregnancy would you expect to find fetal tissue
partial molar pregnancy (mum and dad’s DNA)
what is the process that usually occurs to lead to the development of a complete molar pregnancy
one or two sperm fuse with an empty ovum (anucleate) = diploid ovum + androgenic (46XY or 46 XX)
no fetal tissue
how does molar pregnancy classically present
PVB + positive UPT + USS appearance (snowstorm/ bunch of grapes)
a complete mole contains only genetic material from mum
True or false
false - two copies of DNA from dad only paternal DNA is present hence no fetus/fetal tissue
in both cases of partial or complete molar pregnancy what cells in the developing blastocyst are affected by the extra paternal DNA
trophoblast cells overgrow and this leads to impaired embryonic development
Abnormal paternal DNA leads to defective imprinting in the developing embryo
True or false
true
what layer of the developing trophoblast is responsible for hCG production
A - cytotrophoblast
C- Syncytotrophoblast
C- Syncytotrophoblast
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
C
what is the incidence of GTD
1 in 714
what happens to the incidence of GTD as age increases
risk of GTD increases >50 years old 1 in 8
what ethnicity is associated with higher risk of GTD
asians (1 in 387)
what type of molar GTD is more common
Partial or complete
complete is more common occurring 1 -3 per 1000
partial 1 in 1000
what are the non typical presentations of molar pregnancy
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
what is the risk of developing GTN if diagnosed with partial molar
a - o.5-1%
b- 10%
c- 5%
d- 15-20%
a - 0.5-1%
what is the risk of developing GTN if diagnosed with complete molar
a - o.5-1%
b- 10%
c- 5%
d- 15-20%
d - 15-20%
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
D - histological biopsy is required
what is the classical sign of complete molar pregnancy on USS
snowstorm appearance or ‘bunch of grapes’
what might be seen on USS scan in partial molar pregnancy
empty gestational sac/delayed misc
enlarged placenta/ cystic changes with decidual reaction
how long should a patient diagnosed with partial molar pregnancy avoid pregnancy for?
until follow up complete and 2 consecutive monthly normal hCG levels
how long should a patient avoid pregnancy for following diagnosis and treatment of complete molar pregnancy
6 months (follow up is for 6 months from date of bHCG normalisation or if bHCG normalises by d56 from date of surgey)
if a patient has previously had GTD what is the risk of them developing GTD in a future pregnancy
1-2%
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
immediately, risk of pregnancy from day 5 following treatment
what is the main method of contraception which should be avoided until GTD treatment and follow up completed (hCG levels returned to normal)
Intra-uterine contraception (IUS and IUD)
Ukmec 4 - when hCG levels persistently high
UKMEC 3 - decreasing levels
ukmec 1 - undetectable hCG levels
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
12 months as methotrexate and chemo is teratogenic
how long on average following chemotherapy will periods take to return
2-6 months
what is the cure rate of GTN with chemotherapy
98-100%
what is the risk of future GTD following treatment for GTN
10* risk (1 in 70 pregnancies)
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%
83%
hormonal contraception following treatment for GTD is contra-indicated
True or false
false - no contra-indications to HC following Rx; only CI is IUS and IUD
oral EC is fine
what scoring system is used in the staging of GTN
FIGO
why is surgical treatment preferred in the management of molar pregnancy opposed to medical treatment
worry that medical treatment increased risk of developing GTN due to missed areas (high rate of incomplete removal with medical Rx)
