GYN Oncology- GTD Flashcards
What is Gestational trophoblastic disease?
A spectrum of diseases that involves cellular proliferation of the placental villous trophoblast
What are the different forms of gestational trophoblastic disease?
- Hydatiform mole
- Invasive mole
- choriocarcinoma
- Placental site trophoblastic tumor
What are the different types of hydatiform moles?
Complete mole
Incomplete mole
What are features of complete mole?
46XX or 46 XY ( all paternal)
Fetus is absent
Large uterine size
Theca lutein cyst common
GTN risk is 20%
What are features of incomplete mole?
69XXX or 69XXY
Fetus is present
Small uterine size
GTN risk is 5%
What are theca lutein cyst associated with in molar pregnancies?
Associated with high hcg levels
What is the treatment for molar pregnancy?
Suction curettage
Can consider hysterectomy if no future desire for pregnancy
What is the chance of a repeat molar pregnancy after having 1?
1-2%
What is the post op follow up after treatment of molar pregnancy?
- Reliable contraception
- hcg surveillance weekly until normal x 3 weeks, then monthly x 3 months for complete mole or 1 month for partial mole
What things during surveillance of molar pregnancy should make you concerned for post molar GTN?
- Increasing hcg>10% across 3 values over a 2 week period
- Plateauing hcg: 4 measurements that remain within +/- 10% over at least a 3 week period
What is GTN?
Gestational trophoblastic neoplasia consisting of
1. Invasive mole
2. Choriocarcinoma
3. Placental site trophoblastic tumor
4. Epithelial trophoblastic tumor
What is the management of GTN?
Chemotherapy
What are bad prognostic factors for GTN?
- > 4 months since pregnancy
- hcg level >40,000
- metastasis to liver & brain
- Previous term pregnancy
- Previous therapy failed
How do you determine treatment for GTN?
Based on FIGO staging system and WHO scoring system for single agent treatment resistance
0-6 low risk
>7 high risk
What is the chemotherapy treatment for GTN?
WHO score 0-6= Low risk get single agent therapy with methotrexate or actinomycin D
WHO score >7= High risk gets multi agent therapy with EMA-CO
What is the most common cause of cancer death in US women?
Lung cancer
What is the most common cause of cancer death in the world?
Lung cancer
What is the most common cause of GYN cancer death in the world?
Breast cancer
Most common GYN cancer in the world?
Cervical cancer
Most common GYN cancer in USA?
Uterus
Most common GYN cancer death in USA?
Ovary
What tumor would you find Schiller Duval bodies?
Endodermal sinus tumor
What tumor would you find Call Exner bodies?
Granulosa cell tumor
What tumor would you find Coffee bean nuclei?
Granulosa cell tumor
Brenner tumor
