GYN Oncology- GTD

Question 1

What is Gestational trophoblastic disease?

Answer 1

A spectrum of diseases that involves cellular proliferation of the placental villous trophoblast

Question 2

What are the different forms of gestational trophoblastic disease?

Answer 2

1. Hydatiform mole
2. Invasive mole
3. choriocarcinoma
4. Placental site trophoblastic tumor

Question 3

What are the different types of hydatiform moles?

Answer 3

Complete mole
Incomplete mole

Question 4

What are features of complete mole?

Answer 4

46XX or 46 XY ( all paternal)
Fetus is absent
Large uterine size
Theca lutein cyst common
GTN risk is 20%

Question 5

What are features of incomplete mole?

Answer 5

69XXX or 69XXY
Fetus is present
Small uterine size
GTN risk is 5%

Question 6

What are theca lutein cyst associated with in molar pregnancies?

Answer 6

Associated with high hcg levels

Question 7

What is the treatment for molar pregnancy?

Answer 7

Suction curettage
Can consider hysterectomy if no future desire for pregnancy

Question 8

What is the chance of a repeat molar pregnancy after having 1?

Answer 8

1-2%

Question 9

What is the post op follow up after treatment of molar pregnancy?

Answer 9

1. Reliable contraception
2. hcg surveillance weekly until normal x 3 weeks, then monthly x 3 months for complete mole or 1 month for partial mole

Question 10

What things during surveillance of molar pregnancy should make you concerned for post molar GTN?

Answer 10

1. Increasing hcg>10% across 3 values over a 2 week period
2. Plateauing hcg: 4 measurements that remain within +/- 10% over at least a 3 week period

Question 11

What is GTN?

Answer 11

Gestational trophoblastic neoplasia consisting of
1. Invasive mole
2. Choriocarcinoma
3. Placental site trophoblastic tumor
4. Epithelial trophoblastic tumor

Question 12

What is the management of GTN?

Answer 12

Chemotherapy

Question 13

What are bad prognostic factors for GTN?

Answer 13

1. > 4 months since pregnancy
2. hcg level >40,000
3. metastasis to liver & brain
4. Previous term pregnancy
5. Previous therapy failed

Question 14

How do you determine treatment for GTN?

Answer 14

Based on FIGO staging system and WHO scoring system for single agent treatment resistance
0-6 low risk
>7 high risk

Question 15

What is the chemotherapy treatment for GTN?

Answer 15

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

Question 16

What is the most common cause of cancer death in US women?

Answer 16

Lung cancer

Question 17

What is the most common cause of cancer death in the world?

Answer 17

Lung cancer

Question 18

What is the most common cause of GYN cancer death in the world?

Answer 18

Breast cancer

Question 19

Most common GYN cancer in the world?

Answer 19

Cervical cancer

Question 20

Most common GYN cancer in USA?

Answer 20

Uterus

Question 21

Most common GYN cancer death in USA?

Answer 21

Ovary

Question 22

What tumor would you find Schiller Duval bodies?

Answer 22

Endodermal sinus tumor

Question 23

What tumor would you find Call Exner bodies?

Answer 23

Granulosa cell tumor

Question 24

What tumor would you find Coffee bean nuclei?

Answer 24

Granulosa cell tumor
Brenner tumor

Question 25

What is the management in the subsequent pregnancy after a molar pregnancy?

Answer 25

1. 1st trimester ultrasound
2. Send placenta for evaluation after delivery
3. Monitor hcg levels for 6 weeks after pregnancy

Question 26

What are risk factors for GTN?

Answer 26

1. High hcg level
2. Theca lutein cyst, uterine enlargement
3. Age>40

Question 27

What risk factors go into the WHO scoring system for GTN treatment?

Answer 27

1. Age
2. Antecedent pregnancy
3. Interval from last pregnancy
4. Pretreatment hcg level
5. Largest tumor
6. Site of metastasis
7. # of metastasis
8. Prior chemotherapy