Current management of gestational trophoblastic diseases. Therefore, treatment with chemotherapy is frequently initi ated without a. Gestational trophoblastic disease includes hydatidiform mole complete and partial and gestational trophoblastic neoplasia invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. It replaces the management of gestational trophoblastic neoplasia, which was published in 2004. Gestational trophoblastic disease ii american journal of obstetrics. Gestational trophoblastic disease gtd forms a group of disorders spanning the conditions of complete and partial molar pregnancies through to the malignant conditions of invasive mole. At one end of the condition, hcg level monitoring is all that is required, whereas other patients require combination chemotherapy regimens and surgery to cure the disease. Current management of gestational trophoblastic neoplasia donald peter goldstein, mda, ross s. Mar 28, 2017 gestational trophoblastic disease gtd is the general term used to describe growth disturbances of the placental trophoblast. This is the ideal management of gestational trophoblastic disease, to evacuate the mole inside the womans uterus and avoid any further complications if it stays longer inside the reproductive system.
Abstract gestational trophoblastic disease gtd arises from abnormal placenta and is composed of a spectrum of premalignant to malignant. Gestational trophoblastic disease is a spectrum of neoplastic abnormalities arising from fetal trophoblastic tissue. Lurain, md g estational trophoblastic disease gtd is a spectrum of cellular proliferations arising from the placental villous trophoblast encompassing 4. Definitions gestational trophoblastic disease gtd forms a group of. Gestational trophoblastic disease gtd comprises a group of. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy. Pdf update on the diagnosis and management of gestational. Trophoblasts are the population of cells responsible for the formation of the placenta, a temporary but essential organ responsible for both the delivery of nutrients to and removal of waste from the growing fetus.
Berkowitz, mdb gestational trophoblastic neoplasms gtn are malignant lesions that arise from placental villous and extravillous trophoblast. Treatment of gestational trophoblastic disease by type and stage. Pdf management of gestational trophoblastic diseasesan update. Theirearlydiagnosis and treatment arefundamental to achieve cure. Modified triple therapy in the management of highrisk metastatic gestational trophoblastic tumors. Gestational trophoblastic disease is a condition of uncertain etiology, comprised of hydatiform mole complete and partial, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. The united kingdom has a highly centralised system for registering, monitoring, and treating women with this disease that requires close collaboration with nonspecialist. Early diagnosis of gestational trophoblastic disease and its potential complications is important for timely and successful management.
Gestational trophoblastic disease gtd is a spectrum of both benign and malignant gestational tumors, including hydatidiform mole complete and partial, invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Histologically, it includes the premalignant partial phm and complete hydatidiform mole chm, as well as the malignant invasive mole, choriocarcinoma, placental site trophoblastic tumor pstt, and epithelioid trophoblastic tumor ett. Gestational trophoblastic disease greentop guideline no. Current management of gestational trophoblastic neoplasia. Management of gestational trophoblastic disease 2021 bjog. The role of surgery in the management of women with gestational. The added value of hysterectomy in the management of gestational trophoblastic neoplasia. Diagnosis and management of gestational trophoblastic disease. Pdf gestational trophoblastic disease gtd arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders find.
Thorough evaluation and staging allow selection of appropriate therapy that maximizes chances for cure while minimizing toxicity. Gestational trophoblastic diseases gtd are rare pregnancyrelated diseases having an overall favorable survival rate 12 3 4. Management of gestational trophoblastic disease cgyn 31 3 1. Diagnosis and treatment of gestational trophoblastic disease.
Feb 16, 2018 gestational trophoblastic neoplasia gtn is a collective term for gestational trophoblastic diseases that invade locally or metastasize. Management of gestational trophoblastic disease 2021. Gestational trophoblastic neoplasia gtn is highly chemosensitive and has a high cure rate. Gestational trophoblastic disease benign to malignant. Nov 28, 2017 treatment of gestational trophoblastic disease by type and stage. It arises from abnormal proliferation of trophoblastic tissue. Mar, 2017 gestational trophoblastic disease gtd is a spectrum of both benign and malignant gestational tumors, including hydatidiform mole complete and partial, invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.
Gestational trophoblastic disease gtd is a group of disorders derived from a pregnancy. Gestational trophoblastic disease gestational trophoblastic. Malignant change occurs in approximately 15% of complete moles and in 0. The early detection of gestational trophoblastic disease is successful in patients who have had a hydatidiform mole as the pregnancy event that begins the process but unsuccessful in the early detection of the development of choriocarcinoma after a normal term delivery, abortion spontaneous or elective, or ectopic pregnancy. Women of reproductive age with gestational trophoblastic diseases. In addition to histology, molecular genetic studies can help in the diagnostic pathway.
Acog clinical is designed for easy and convenient access to the latest clinical guidance for patient care. The range of the diseases in this group varies from relatively. The third edition was published in 2010 under the same title. All forms of gtd can be treated, and in the great majority of.
Upon identification of the trophoblastic disease, the physician would schedule a surgical intervention to remove it from the uterus of the woman. Update on the diagnosis and management of gestational trophoblastic disease. Gestational trophoblastic disease gtd arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Management of chemoresistant and quiescent gestational. Gtn is included in the group of pregnancyrelated disorders that constitute gestational trophoblastic disease gtd. Recently,measurement of hyperglycosylated hcg has been proposed for the management of patients with quiescent gtd. Update on the diagnosis and management of gestational.
Women diagnosed with a gestational trophoblastic disease should be referred to a. The management of gestational trophoblastic disease. Global epidemiological data pertaining to gestational trophoblastic neoplasia gtn is limited. Requirements for diagnosis, treatment, and monitoring diagnostics. Gtd encompasses the complete mole, partial mole, invasive mole, choriocarcinoma, placental site trophoblastic tumor pstt, and epithelioid trophoblastic tumor ett. This term covers hydatidiform mole including complete and partial moles, invasive mole, gestational choriocarcinoma, and placental site trophoblastic tumour pstt. The following are the standard treatment options according to the type of gestational trophoblastic disease gtd and the stage and prognostic group of the disease. These women need aggressive expeditious management women with gtd are best managed by a gynecologic oncologist with experience in gtd gestational trophoblastic disease. Diagnosis, classification and treatment of gestational. Nccn clinical ractice guidelines in oncology nccn guidelines. Gestational trophoblastic disease gtd is a group of uncommon conditions associated with pregnancy.
The overall cure rate in treating these tumors is currently 90%. An overview gestational trophoblastic disease gtd is a rare group of interrelated tumors that develop following conception that lead to abnormal development of the placenta. Gestational trophoblastic neoplasia gtn includes invasive mole, choriocarcinoma, pla. Diagnosis and management of gestational trophoblastic. Gestational trophoblastic disease consists of a pregnancy. Gestational trophoblastic disease is a rare tumor highly sensitive to systemic drug therapy. The second edition was published in 2004 titled the management of gestational trophoblastic neoplasia, which replaced the management of gestational trophoblastic disease, published in april 1999. The same seminar found that placentalsite trophoblastic tumor accounted for about 0. Gestational trophoblastic neoplasia gtn is the term to describe a set of malignant placental. Suction evacuation of the uterus is the preferred initial management. The epidemiology, pathology, clinical presentation, and diagnosis of each of these trophoblastic disease variants are discussed. Women with lowrisk gestational trophoblastic neoplasia should undergo. The commonest types of gtd are usually diagnosed in early pregnancy and are commonly referred to as molar pregnancies.
The standard regimens of chemotherapy of i and ii lines for patients in the highrisk group for. Cyclophosphamide iv 3 mgkgday d15 actd im 12 gkgday d15 methotrexate iv 1 mgkgday d1,3,5,7 brain metastases received 3000 cgy of whole brain irradiation 2 patients. Pdf management of gestational trophoblastic diseasesan. Management of gestational trophoblastic disease termination of. Gestational trophoblastic disease gtd is a group of disorders derived. Definitions gestational trophoblastic disease gtd forms a group of disorders spanning the conditions of complete and. These treatments are discussed in more detail in surgery, chemotherapy, and radiation therapy. Suction evacuation of the uterus is the preferred initial management regardless of. Treatment of gestational trophoblastic disease by type and. The management of gestational trophoblastic disease this is the third edition of this guideline. The latter four entities are referred to as gestational trophoblastic neoplasia gtn. There is almost always a role for urgent surgical management for the woman.
Although representing a small proportion of gtd cases, the manage. Gestational trophoblastic disease gtd forms a group of disorders spanning the conditions of complete and partial molar pregnancies through to the malignant. Gestational trophoblastic disease gtd is a term used for a group of pregnancyrelated tumours. Jul 24, 2018 gestational trophoblastic disease gtd means different things to the pathologist and the clinician. Kenwright, journalthe new zealand medical journal, year2016, volume129 1431, pages 3845. The onset of malignant change is termed persistent trophoblastic disease ptd or gestational trophoblastic neoplasia gtn and is represented by plateauing or rising hcg. Patient summary gestational trophoblastic disease gtd is the name given to some uncommon tumours of placental tissue. View management of gestational trophoblastic disease. This term covers hydatidiform mole including complete and partial moles, invasive mole, gestational choriocarcinoma, and. Much has been learnt in the past 50 years, however, and most women can now be cured. These tumours are rare, and they appear when cells in the womb start to proliferate uncontrollably. Molar pregnancy and other gestational trophoblastic. Apr 29, 2020 this study was conducted to prospectively evaluate the incidence of gestational trophoblastic disease gtd and characterize the host factors, risk factors, histology, management and followup in a tertiary care hospital in mysore, india. Nov 01, 2017 gestational trophoblastic disease incorporates a spectrum of disorders ranging from benign to malignant subtypes.
Hydatidiform mole is the most common form of gtn see the image below. Current management of gestational trophoblastic disease. Pdf management of gestational trophoblastic disease. Sep 29, 2020 this is the fourth edition of this guideline. Changes in epidemiology of gtd have been noted in various countries. Gestational trophoblastic neoplasia gtn refers more specifically to malignant disease. Firstline hysterectomy for women with lowrisk nonmetastatic gestational trophoblastic neoplasia no longer wishing to conceive. The management of gestational trophoblastic disease rcog. The pathologist utilizes a classification based on histopathology, while the clinician uses a clinically based classification, and does not always need to submit tissue for histopathology to appropriately manage the patient, particularly with post. The need for treatment for persistent gtd increased in women with a partial hydatidiform mole.
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