GTN FRCR CO2A Flashcards
which 2 hospitals provide Rx to GTN in UK?
Charing Cross hospital in London
Weston Park Hospital in Sheffield
What are different types of GTT?
- premalignant : partial and complete molar pregnancy
- Invasive: Choriocarcinoma and Placental Site Trophoblastic Tumor (PSTT)
What’s the Normal Range of B-HCH in premenopausal lady?
0 to 4 IU/L
What’s the Normal Range of B-HCH in postmenopaual lady?
upto 15 IU/L
what’s the peak level of B-HCG in pregnancy and when does it occur?
200,000 IU/L at week 8 to 12
By what time B-HCG falls to normal value post partum?
3 weeks
What’s the significance of elevated B-HCG in the absence of Pregnancy?
Very strong e/0 malignancy
what are the causes of elevated B-HCG in the absence of Pregnancy?
- Gestational or Germ Cell tumors
- other malignancy e.g. lung, stomach and bladder
what is partial mole?
The trophoblast cells are triploid (69 chromosomes)
2 sets of paternal and 1 set of maternal
what causes partial mole?
ovum fertilized by 2 sperm
What’s the risk of change of partial mole to invasive mole?
1:100
what’s the common presentation of partial mole?
Bleeding in the 1st trimester or failed pregnancy
How is partial mole managed?
suction or medical evacuation and despite the low risk of malignant transformation, it is recommended, all patients undergo HCG follow up and monitoring
what is complete mole?
loss of maternal DNA and genetic material is of male origin only
what’s the mc chromosome count ?
46 XX, results from single X duplication
less frequently 46 XY, empty ovum fertilized by two spermH
How does complete mole look on USG?
Complex echogenic intrauterine mass with numerous cystic spacesH
what’s the risk of malignant change of complete mole to malignancy?
14%
How is complete mole managed?
suction evacuation
Who develops recurrent molar pregnancies?
Familial Hydatiform mole, defect in NALP7 gene
What are FIGO recommendations for Rx after evacuation of molar pregnancy?
- an hCG level plateau of four values ±10% recorded over a 3-week duration (days 1, 7, 14 and 21);
- an hCG level increase of more than 10% of three values recorded over a 2-week duration (days 1, 7 and 14);
- persistence of detectable hCG for more than 6 months after molar evacuation.
What are malignant forms of GTT?
- invasive mole
- Choriocarcinoma
- Placental Site Trophoblastic Tumor
What is an invasive mole ?
An invasive mole generally arises from a complete mole and
is characterised by invasion of the myome- trium, which can lead to
perforation of the uterus.
is biopsy recommended for choriocarcinoma?
In suspected cases a tissue biopsy is often hazardous because of the risk of bleeding and is best avoided, as usually a clinical diagnosis can be made safely.
what are characteristic histological features of choriocarcinoma?
sheets of syncytiotrophoblast or cytotrophoblast cells with haemorrhage, necrosis and intravascular growth.
what are Pretreatment investigations in GTT patients?
- an updated serum hCG level
- a Doppler ultrasound of the pelvis and
- a chest X-ray.
what investigations are used for choriocarcinoma and PSTT?
fully staged with CT scans of the thorax, abdomen and pelvis and
MRI scans of the pelvis and the brain.
FIGO staging for GTT
Stage I
Tumour confined to the uterus
Stage II
Tumour extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament)
Stage III
Tumour extends to the lungs with or without genital tract involvement
Stage IV
Tumour involves all other metastatic sites
What’s the Rx for low risk disease?
intramuscular methotrexate given with oral folinic acid rescue,
How is treatment for low risk disease GTT monitored?
A hCG levels checked twice a week and following hCG normalisa- tion, treatment is continued for another three complete cycles (6 weeks) to ensure the eradication of any residual disease present below the level of serological detection.
what to do who have an inadequate response to methotrexate, as shown by an hCG plat- eau or increase ?
move on to second-line therapy.
single-agent actinomycin-D at 1.5 mg/m2 on day 1 of a 14-day cycle or EMA-CO combination chemother- apy dependent on the hCG level at the time of change.
what’s the treatment for High Risk GTT?
EMA-CO chemotherapy
