MALIGNANT GESTATIONAL TROPHOBLASTIC DISEASE Flashcards
What is the classification of malignant gestational trophoblastic neoplasia (GTN)?
Choriocarcinoma, persistent hydatidiform mole, invasive mole, and placental-site trophoblastic tumor (PSTT).
List the risk factors for malignant GTD requiring chemotherapy.
Older age (≥40 years), preceding molar pregnancy, large tumor size (>5cm), high hCG levels (>10^5 miu/L), previous chemotherapy, and metastases.
What is the role of the WHO prognostic scoring system in GTD?
It classifies GTD into low-risk (score 0-7) and high-risk (score >7) groups.
Define choriocarcinoma.
A rapidly growing, invasive pregnancy-related tumor originating from trophoblast cells.
What are the histopathological findings in choriocarcinoma?
Dimorphic cytotrophoblast and syncytiotrophoblast populations, myometrial invasion, prominent necrosis, and hemorrhage.
Describe the FIGO anatomic staging for choriocarcinoma.
Stage 1: Uterine involvement; Stage 2: Vaginal metastases; Stage 3: Lung metastases; Stage 4: Distant metastases.
What are the common clinical presentations of choriocarcinoma?
Irregular vaginal bleeding, metastatic symptoms (e.g., breathlessness, CNS disturbances, epigastric pain).
How is choriocarcinoma diagnosed?
High β-hCG levels and persistent bleeding after pregnancy.
What is the normal timeline for hCG to return to baseline after different pregnancy outcomes?
H. Mole: 84-100 days; Artificial abortion: 30 days; Spontaneous abortion: 19 days; Normal delivery: 12 days; Ectopic pregnancy: 8-9 days.
List the investigations necessary for GTN diagnosis and management.
FBC, RFT, LFT, HIV, CXR, USS, CT/MRI, brain imaging, and serial β-hCG levels.
What is the mainstay of treatment for GTN?
Chemotherapy is the primary treatment.
Name commonly used chemotherapy drugs for GTN.
Methotrexate, Actinomycin D, 5-Fluorouracil, Vincristine, Cyclophosphamide, Etoposide.
What distinguishes low-risk from high-risk GTN?
Low-risk: Single-agent therapy; High-risk: Multi-agent therapy (EMA-CO regimen).
What are the principles of chemotherapy for GTN?
Low-risk patients receive single-agent; high-risk patients receive multi-agent therapy.
What is the role of follow-up monitoring in GTN treatment?
Regular β-hCG monitoring and additional chemotherapy courses after normalization.
Why is hCG follow-up critical after hysterectomy for GTN?
To detect and manage potential metastases.
What are the surgical options for GTN management?
Hysterectomy, arterial ligation, embolization, and metastatic lesion removal.
Define an invasive mole.
A hydatidiform mole with villi penetrating deeply into the myometrium or blood vessels.
What are the clinical features of an invasive mole?
Vaginal bleeding, intraperitoneal bleeding, uterine subinvolution, pelvic pain.
How is an invasive mole diagnosed?
Persistent high β-hCG levels and imaging findings.
What distinguishes an invasive mole from a choriocarcinoma?
Presence of villi distinguishes invasive mole from choriocarcinoma.
What is the treatment for invasive moles?
Chemotherapy ± hysterectomy.
Define placental-site trophoblastic tumor (PSTT).
A rare trophoblastic tumor predominantly composed of intermediate trophoblasts.
How is PSTT diagnosed?
Persistent vaginal bleeding, low serum β-hCG (<10,000), histology.
What is the treatment for PSTT?
Hysterectomy.
What are the risk factors for developing an invasive mole?
History of complete hydatidiform mole, older age, high β-hCG levels.
What is the significance of syncytiotrophoblast cells in GTD histology?
Their absence in PSTT histology.
What are the metastatic symptoms associated with choriocarcinoma?
Hemoptysis, neurological symptoms, epigastric pain, jaundice.
What is the survival rate for low-risk GTN treated with single-agent therapy?
Nearly 100%.
Describe the EMA-CO regimen for high-risk GTN.
A multi-agent regimen combining etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine.
How is hCG monitored during GTN treatment?
Monitored every 1-2 weeks until normalization and monthly for 1 year post-treatment.
What is the role of hysterectomy in older patients with GTN?
To manage localized disease or excessive bleeding.
What are the complications of untreated invasive moles?
Persistent hemorrhage, uterine perforation, distant metastases.
What is the pathology of invasive moles?
Excessive trophoblastic proliferation with preserved villous pattern.
How is PSTT different from other forms of GTD?
PSTT is locally invasive, indolent, and resistant to chemotherapy.
What are the signs of metastasis in GTN?
Bluish vaginal nodules, CNS disturbances, lung symptoms.
What is the importance of staging in GTN management?
Guides treatment and prognosis.
How does age affect the prognosis of GTN?
Older age is associated with worse outcomes.
Why is chemotherapy less effective in PSTT?
Due to its indolent nature and lower hCG production.
What are the indications for selective arterial embolization in GTN?
To control localized bleeding.
What are the adverse effects of GTN chemotherapy?
Bone marrow suppression, GI ulceration, liver/renal dysfunction.
How is bleeding managed in patients with GTN?
Uterine artery embolization or hysterectomy.
Why should conception be avoided for one year post-GTN treatment?
To allow for complete recovery and minimize recurrence risk.
What are the features of chorioadenoma destruens?
Abnormal penetrativeness and extensive invasion by trophoblastic cells.
How is persistent low-level hCG in PSTT managed?
Monitoring and hysterectomy if needed.
What imaging techniques are used in GTN diagnosis?
Ultrasound, CT, MRI, and brain imaging.
What is the role of β-hCG in GTN diagnosis and monitoring?
Essential for diagnosis, staging, treatment response, and follow-up.
What percentage of complete hydatidiform moles become invasive?
Approximately 16%.
Describe the presentation of metastatic nodules in GTN.
Bluish nodules filled with dark red blood.
How is uterine subinvolution related to invasive moles?
It indicates incomplete uterine recovery, often linked to invasive mole.
