Materiały źródłowe

• #1 Invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK

  https://www.nhs.uk/conditions/persistent-trophoblastic-disease-choriocarcinoma/

  Invasive mole and choriocarcinoma are very rare types of cancer that can occur after pregnancy. They are types of gestational trophoblastic disease (GTD). Invasive mole is also called persistent trophoblastic disease (PTD). […] The main treatment for invasive mole or choriocarcinoma is chemotherapy. But some women might be offered surgery. […] You will be closely monitored with blood and urine tests during and after your treatment.

• #2 Persistent trophoblastic disease and choriocarcinoma | nidirect

  https://www.nidirect.gov.uk/conditions/persistent-trophoblastic-disease-and-choriocarcinoma

  Persistent trophoblastic disease and choriocarcinoma are very rare pregnancy-related tumours. They are known as gestational trophoblastic tumours (GTTs). […] Chemotherapy is usually used to treat the condition. Treatment is successful in curing almost all cases of persistent trophoblastic disease. […] Chemotherapy is used to treat choriocarcinoma and usually successfully cures it. […] Overall, the outlook for persistent trophoblastic disease and choriocarcinoma is excellent. 98 to 100 per cent of women who develop a gestational trophoblastic cancer are cured.

• #3 Staging of invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/staging

  An invasive mole is a cancer that can form in the womb after an abnormal type of pregnancy called a molar pregnancy. It is also called persistent trophoblastic disease (PTD). Choriocarcinoma is a very rare cancer that can occur after a normal pregnancy, a molar pregnancy, a miscarriage or a termination of pregnancy (abortion). […] The main treatment for invasive mole or choriocarcinoma is chemotherapy. But some women might be offered surgery. […] Your risk score helps your doctors decide which chemotherapy treatment is best for you.

• #4 Gestational Trophoblastic Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470267/

  Gestational trophoblastic disease (GTD) is a group of tumors defined by abnormal trophoblastic proliferation involving both benign and malignant entities. Histologically, GTD is divided into hydatidiform moles (containing villi) and other trophoblastic neoplasms (lacking villi). The nonmolar or malignant forms of GTD are called gestational trophoblastic neoplasia (GTN) and include the invasive mole, choriocarcinoma, epithelioid trophoblastic tumor (ETT), and placental-site trophoblastic tumor (PSTT). GTN can occur weeks or years following any pregnancy but occurs most commonly after a molar pregnancy. GTN can metastasize and be fatal if not treated. This activity reviews the causes and pathophysiology of GTD and highlights the role of the interprofessional team in its management. […] Clinicians gain insight into patient-centered care and the need for effective communication and collaboration among the interprofessional team to achieve optimal, comprehensive care for patients with GTD.

• #5 Gestational Trophoblastic Disease | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/gestational-trophoblastic-disease

  Gestational trophoblastic disease (GTD) is a group of rare tumors that begin during a pregnancy. These tumors start in the cells that would normally develop into the placenta, which connects the fetus to the uterus. […] GTD can be benign (not cancerous) or malignant (cancerous). Most GTD tumors can be cured, with women able to become pregnant at a later date and experience a normal pregnancy. […] In contrast, all choriocarcinomas, PSTTs, and ETTs are considered cancerous. […] A choriocarcinoma is even rarer than a hydatidiform mole. This type of GTD may have begun as a hydatidiform mole or may arise from tissue that remains in the uterus following a miscarriage or full-term delivery of a baby. […] Unlike a hydatidiform mole, a choriocarcinoma is a malignant and more aggressive form of GTD that spreads into the muscle wall of the uterus. A choriocarcinoma can also spread more widely to other parts of the body such as the lungs, liver, and/or brain.

• #6 Choriocarcinoma: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/24863-choriocarcinoma

  Choriocarcinoma is a rare cancer that starts in your uterus. It develops from cells that were part of the placenta during pregnancy. Its a type of gestational trophoblastic disease. In most cases, choriocarcinoma is curable. […] Most cases of choriocarcinoma are cured by chemotherapy treatment. […] The main treatment for choriocarcinoma is chemotherapy. Chemotherapy is a drug that kills cancer cells. Some people may also need surgery to remove their uterus (hysterectomy), radiation or a combination of treatments. […] Yes, choriocarcinoma is curable. Treatment with chemotherapy is usually successful in curing it. The prognosis is better when choriocarcinoma is caught early, before it spreads to other parts of your body. […] After treatment, your healthcare provider will schedule follow-up exams to make sure the cancer doesn’t return. […] You should contact your healthcare provider if you develop unusual vaginal bleeding or pelvic pain, especially if you’ve had a molar pregnancy.

• #7 Gestational Trophoblastic Disease Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq

  Gestational trophoblastic disease (GTD) is a broad term encompassing both benign and malignant growths arising from products of conception in the uterus. […] The reported incidence of choriocarcinoma, the most aggressive form of GTD, is about 2 to 7 per 100,000 pregnancies. […] The most common antecedent pregnancy in GTD is that of an HM. […] Choriocarcinoma most commonly follows a molar pregnancy but can follow a normal pregnancy, ectopic pregnancy, or abortion, and it should always be considered when a patient has continued vaginal bleeding in the postdelivery period. […] The prognosis for cure of patients with GTDs is good even when the disease has spread to distant organs, especially when only the lungs are involved. […] Selection of treatment depends on these factors plus the patients desire for future pregnancies.

• #8 Gestational Trophoblastic Disease Treatment (PDQ®): Treatment – Health Professional Information [NCI] – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/ncicdr0000062901

  Chemotherapy is ultimately required for persistence or neoplastic transformation in about 15% to 20% of patients after evacuation of a complete HM but for fewer than 5% of patients with partial HM. […] Multiagent chemotherapy is standard for the initial management of high-risk gestational trophoblastic neoplasia (GTN). […] A variety of regimens have been used with no direct comparisons to determine whether one is superior. […] Hysterectomy is the treatment of choice for tumors confined to the uterus. […] In part because of the inherent chemoresistance of PSTTs, resection of tumors is often considered in addition to chemotherapy regimens used for high-risk gestational trophoblastic neoplasias. […] A select group of patients with chemotherapy-resistant and clinically detectable gestational trophoblastic neoplasia may benefit from salvage surgery.

• #9

  https://journals.lww.com/amit/fulltext/2022/09020/histomorphological_analysis_of_gestational.13.aspx

  Hydatidiform mole forms the most common type of GTD with an incidence of complete moles more than partial moles. […] The most common clinical presentation of GTD was vaginal bleeding followed by amenorrhea. […] The Ki-67 proliferation index helped in distinguishing the EPS reaction from neoplastic lesions such as PSTT which requires surgical intervention and chemotherapy. […] Detailed descriptive morphological assessment can help in the histological distinction of benign lesions such as EPS reaction and placental site nodule and avert such cases from being erroneously diagnosed as neoplastic. […] PTD occurs in 15%20% of patients with complete mole and is rare following partial mole. […] The risk factors associated with development of persistent trophoblastic disease are serum hCG levels 100,00 mUI/ml, maternal age 40 years and increased volume of retrieved endocavitary material.

• #10 Gestational Trophoblastic Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7813445/

  Patients are at heightened risk for postmolar gestational trophoblastic neoplasia if they have any of the following: age older than 40 years, pre-evacuation hCG greater than 100,000 milli-international units/mL, excessive uterine enlargement, or theca lutein cysts greater than 6 cm. […] The primary treatment for most forms of gestational trophoblastic neoplasia is chemotherapy, based on the individual patients risk. […] The most frequently used single-agent regimens with methotrexate and actinomycin D are listed in Table 4. […] The overall cure rate for patients with low-risk disease approaches 100% with recurrence rates less than 5%. […] Patients with a FIGO risk score of 7 or higher should initially be treated with aggressive multiagent chemotherapy; surgery or radiation or both are often incorporated into treatment.

• #11 Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 11 (2019)

  https://jnccn.org/view/journals/jnccn/17/11/article-p1374.xml?rskey=5YhKq2&result=6&print

  Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor. […] Postmolar GTN is typically diagnosed using hCG surveillance. The NCCN Guidelines use the FIGO staging criteria for postmolar GTN as meeting one of more of the following criteria after treatment of HM, as indicated by hCG monitoring: hCG levels plateau for 4 consecutive values over 3 weeks; hCG levels rise 10% for 3 values over 2 weeks; hCG persistence 6 months or more after molar evacuation.

• #12 Advances in the diagnosis and early management of gestational trophoblastic disease | BMJ Medicine

  https://bmjmedicine.bmj.com/content/1/1/e000321

  Gestational trophoblastic disease (GTD) describes a heterogeneous group of disorders that arise from abnormal proliferation of placental trophoblastic tissue. […] The diagnosis of GTN is largely based on a combination of obstetric history and elevated concentrations of hCG. […] After molar pregnancy, plateaued or rising hCG concentrations are indicative of GTN. […] Obstetric management of molar pregnancy involves uterine evacuation and histopathological examination of the products of conception. Follow-up serum or urine hCG monitoring is done until hCG values return to within the normal range. […] However, some women develop disease persistence and progress to malignant disease requiring chemotherapy or further surgical intervention. […] Women with invasive mole or choriocarcinoma are stratified into low or high risk GTN categories based on the Federation of Gynaecology and Obstetrics (FIGO) staging and modified WHO prognostic scoring system.

• #13 Gestational Trophoblastic Disease Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq

  Prompt institution of therapy for GTD and continuing follow-up at very close intervals until normal beta-hCG titers are obtained is the cornerstone of management. […] Chemotherapy is necessary when there is a rising beta-hCG titer for 2 weeks (3 titers). […] Chemotherapy is ultimately required for persistence or neoplastic transformation in about 15% to 20% of patients after evacuation of a complete HM but for fewer than 5% of patients with partial HM. […] Multiagent chemotherapy is standard for the initial management of high-risk gestational trophoblastic neoplasia (GTN). […] Because placental-site trophoblastic tumors (PSTTs) are rare, reports of therapeutic results are confined to relatively small case series with accrual extending for very long time periods. […] Hysterectomy is the treatment of choice for tumors confined to the uterus. […] In women with complete HM, risk of persistence or neoplastic transformation is approximately doubled in the setting of certain characteristics. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease.

• #14 Gestational Trophoblastic Disease | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/gestational-trophoblastic-disease

  A woman with a choriocarcinoma may register a positive home urine pregnancy. However, when the HCG levels are measured through a blood test at a doctors office, they will be much higher than in women experiencing a normal pregnancy. […] A woman with an hydatidiform mole (partial or complete) or choriocarcinoma may experience one or more of these symptoms: irregular, non-menstrual vaginal bleeding, possibly with blood clots or a watery brown discharge; pelvic pain or discomfort; nausea and vomiting that are more frequent and severe than what a woman typically experiences during a normal pregnancy; fatigue and shortness of breath due to anemia resulting from blood loss through vaginal bleeding; faster growth than expected for weeks of pregnancy, due to extension of the uterus; rapid heartbeat, warm skin, and mild tremor or shaking; caused by an overactive thyroid gland, this complication may occur rarely in women with high HCG levels; preeclampsia (also known as toxemia)a pregnancy-related condition which can cause a sharp rise in blood pressure.

• #15 Gestational Trophoblastic Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470267/

  Choriocarcinoma is a rare and aggressive neoplasm. The 2 significant choriocarcinoma subtypes, namely gestational and nongestational, have very different biological activity and prognoses. […] Choriocarcinoma develops from an abnormal trophoblastic population undergoing hyperplasia and anaplasia, most frequently following a molar pregnancy. […] Choriocarcinoma is a very rare neoplasm with varied incidence worldwide. […] Choriocarcinoma can also occur in males, usually between the ages of 20 and 30. […] Choriocarcinoma tends to metastasize, and clinicians should note symptoms that arise from other organ systems, for example, hemoptysis or gastrointestinal (GI) bleeding. […] Following treatment and hCG normalization, quantitative hCG levels should be checked monthly for 1 year with a physical exam twice in the same time frame. […] Management of GTN requires the collaboration of laboratory personnel, ultrasonographers, nurses, advanced practice practitioners, radiologists, pathologists, gynecologists, medical oncologists, and gynecologic oncologists.

• #16 Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 11 (2019)

  https://jnccn.org/view/journals/jnccn/17/11/article-p1374.xml?rskey=5YhKq2&result=6&print

  Repeat dilation and curettage or hysterectomy can be considered for persistent postmolar GTN. […] Several groups have discussed the optimal characteristics of candidates for repeat uterine evacuation. […] The NCCN Panel recommends hCG assay monitoring every 1 to 2 weeks until levels have normalized, defined in the guidelines as 3 consecutive normal assays. After initial normalization, hCG should be measured twice in 3-month intervals to ensure levels remain normal. If hCG levels remain elevated, treat per the postmolar GTN algorithm. […] The presentation of GTN can vary depending on the antecedent pregnancy event and disease type and extent. […] Workup for GTN includes history and physical examination and metastatic imaging workup, to include chest/abdominal/pelvic CT scan with contrast (or MRI if contrast is contraindicated) and brain MRI (preferred) or brain CT if pulmonary metastasis.

• #17

  https://journals.lww.com/jfmpc/fulltext/2020/09030/a_review_on_management_of_gestational.3.aspx

  One of the main steps in the management of GTN is its diagnosis because these kinds of tumors could be treated nearly at all times and afterwards fertility could be maintained in the majority of cases. […] The precise diagnosis of hydatidiform mole masses is an important factor in instituting lifesaving chemotherapy for proper management of these malignant type of masses. […] Recently, some advances in genetics and biological issues at a molecular level have provided some novel comprehension of GTN pathogenesis which could be applied for proper diagnosis, management, and treatment of such disorders. […] The diagnosis procedure of GTN mainly carried out based on the persistent increment of the levels of hCG exactly after a molar pregnancy. […] Patients who suffer from post-molar GTN need a history, clinical examination, urine or/and serum hCG testing, ultrasonography of chest, and also pelvic Doppler ultrasonography.

• #18 SGO, FWC, and GOG-F* Communique: Considerations When Treating Gestational Trophoblastic Neoplasia in the Setting of a Methotrexate Shortage | Society of Gynecologic Oncology

  https://www.sgo.org/news/drugshortage3/

  Gestational trophoblastic neoplasia (GTN) comprises the following subtypes: invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). […] GTN is staged according to International Federation of Gynecology and Obstetrics (FIGO). Additionally, GTN is stratified as low-risk or high-risk disease by the World Health Organization (WHO) scoring system based on the risk of disease progression and resistance to single-agent chemotherapy. […] Patients with low-risk disease who desire to preserve fertility may be cured with single-agent chemotherapy, using either methotrexate or dactinomycin. […] When methotrexate is in short supply, it should be preserved for curative intent treatment in patients with high-risk GTN (e.g. WHO score 7 or WHO score of 5-6 with additional high-risk features) or for the treatment of patients with low-risk GTN who did not respond to, relapsed from, or had an allergic reaction to single-agent treatment with dactinomycin.

• #19 Gestational Trophoblastic Disease Treatment – NCI

  https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq

  Gestational trophoblastic neoplasia (GTN) is a type of gestational trophoblastic disease (GTD) that is almost always malignant. […] A choriocarcinoma is a malignant tumor that forms from trophoblast cells and spreads to the muscle layer of the uterus and nearby blood vessels. […] The treatment of gestational trophoblastic neoplasia is based on the type of disease, stage, or risk group. […] Treatment options also depend on whether the woman wishes to become pregnant in the future. […] There are different types of treatment for patients with gestational trophoblastic disease. […] Three types of standard treatment are used: Surgery, Chemotherapy, Radiation therapy. […] Treatment for gestational trophoblastic disease may cause side effects. […] Patients may want to think about taking part in a clinical trial.

• #20 Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 11 (2019)

  https://jnccn.org/view/journals/jnccn/17/11/article-p1374.xml?rskey=5YhKq2&result=6&print

  Based on these findings, the GTN should be staged and scored according to the current FIGO staging and prognostic scoring system. […] Low-risk GTN encompasses cases with a FIGO prognostic score 6. Standard front-line treatment of low-risk GTN is single-agent chemotherapy using methotrexate or dactinomycin. […] High-risk GTN should be treated with multiagent chemotherapy. […] Adjuvant surgery or radiation therapy may be included. […] The most commonly used regimen in this setting is EMA/CO (etoposide, methotrexate, and dactinomycin alternating with cyclophosphamide and vincristine). […] For persistent or recurrent disease after EMA/CO combination therapy, treat per the high-risk GTN algorithm with etoposide/platinum-based regimens and surgical resection as feasible. […] ITTs are relatively chemoresistant and thus follow a somewhat different treatment paradigm than invasive mole and choriocarcinoma, with surgical intervention playing a more critical role.

• #21 Cancer drug treatment for invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/treatment/cancer-drug-treatment

  Chemotherapy is the most common treatment for an invasive mole or choriocarcinoma. […] Your healthcare team will regularly check the level of a hormone in your blood. This is called human chorionic gonadotrophin (hCG). This tells your team how well the chemotherapy is working. You have chemotherapy until your hCG levels go back to normal and for 6 more weeks after that. […] You usually have treatment with methotrexate if you have low risk disease. You have it as an injection into a muscle (intramuscularly) every other day for a week. […] If your hCG levels don’t go back down to normal or they begin to go up again, it is known as methotrexate resistance. You will change chemotherapy. The drugs you have depend on your hCG levels. Your healthcare team will explain your treatment and what this involves.

• #22 Gestational Trophoblastic Neoplasia Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/279116-treatment

  Patients with gestational trophoblastic disease (GTD) do not require medical therapy. […] Because 20% of patients with hydatidiform mole develop malignant disease, such as persistent hydatidiform mole with or without metastasis, some have suggested the use of a prophylactic dose of methotrexate in noncompliant patients. […] However, observing patients with weekly serum hCG levels is preferable, and only patients with rising or plateauing titers, as occurs in patients with gestational trophoblastic neoplasia (GTN), should be treated with chemotherapy. […] Patients with low-risk GTN are treated with single-agent chemotherapy. […] Many in the United States prefer methotrexate. […] However, actinomycin D can be used in patients with poor liver function. […] During treatment, the serum hCG levels are monitored every week.

• #23 Gestational Trophoblastic Disease molar pregnancy

  https://www.mylifehouse.org.au/departments/gynae-oncology-2-2/gestational-trophoblastic-disease/

  Additional treatment involves chemotherapy. You will be given a drug or combination of drugs to destroy the remaining molar cells. Treatment is very effective and will not affect your ability to have more children. […] The type of chemotherapy needed will depend upon the hCG hormone level at the time of treatment and the results of other tests. […] The majority of patients who need treatment after a documented molar pregnancy fall into the low risk treatment group and will receive treatment with a combination of drugs called methotrexate and folinic acid. […] For patients that need treatment after the evacuation of a molar pregnancy the chemotherapy treatment usually continues for about 3 to 5 months. […] Once a patient is in remission, meaning the hCG level has returned to normal, it is most likely that you have been cured; however, there is a 1-3% chance that it may flare up again. […] For those patients who have chemotherapy, fertility may be affected by the use of the drugs.

• #24

  http://waocp.com/journal/index.php/apjcc/article/view/1407

  Objective: To report clinical characteristics, treatment outcomes and chemotherapy-related toxicities in patients with low-risk GTN at tertiary care centre in India. […] Low-risk GTN typically responds well to single-agent chemotherapy, such as methotrexate (MTX) or actinomycin D (Act D), achieving nearly 100% survival rates. […] For patients with a prognostic score of 5-6 or a pathological diagnosis of choriocarcinoma, the risk of failure of first-line single-agent chemotherapy is significantly increased and combined chemotherapy is selected according to the regimen of patients with high prognostic score. […] Overall survival (OS) and cure rates for all patients with low-risk GTN were 100%. […] The MTX regimen was remarkably effective in treating women with low-risk GTN, achieving a complete response (CR) rate of 91.4% without encountering severe adverse effects.

• #25 Gestational Trophoblastic Neoplasia Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/279116-treatment

  Six weeks of maintenance chemotherapy is administered after a normal serum hCG level. […] After 3-4 normal serum hCG levels, the levels are observed once per month for 1 year. […] A switch from methotrexate to actinomycin D is made if the patient receiving methotrexate for nonmetastatic or metastatic low-risk GTN develops rising or plateauing serum hCG levels. […] Patients with high-risk GTN have good prognosis if treated aggressively as follows: These patients are treated with a combination of etoposide, methotrexate, and actinomycin D administered in the first week of a 2-week cycle and cyclophosphamide and vincristine (Oncovin) administered in the second week. […] At least 6 weeks of maintenance of EMA-CO or EMA-EP are administered after a normal serum hCG level. […] Patients with metastasis to the brain receive whole brain irradiation (3000 cGy) in combination with chemotherapy.

• #26 Gestational Trophoblastic Disease (GTD) Treatment | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/gestational-trophoblastic-disease/treatment

  Choriocarcinoma, for example, is an uncommon yet almost always curable cancer. […] About 85 to 90 percent of women with low-risk GTN are cured by the initial chemotherapy, and the remaining are cured by stronger combinations of drugs, or by surgery. […] Similarly, 85-90 percent of women who develop high-risk GTN are cured by chemotherapy used together with selective surgery and radiation. […] Approximately 10-15 percent of women with high-risk GTN will develop drug resistance after prolonged chemotherapy. […] Chemotherapy is the main treatment for GTN and is generally highly effective. […] Patients can preserve fertility and still be cured with chemotherapy even in the presence of widespread disease. […] Most women who require treatment for GTN can become pregnant again and have normal pregnancies.

• #27 Cancer drug treatment for invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/treatment/cancer-drug-treatment

  If you have a high risk invasive mole or choriocarcinoma, you usually have a combination of chemotherapy drugs. Your healthcare team will explain your treatment and what this involves. […] If your risk score is over 13, you might have a lower dose of chemotherapy to start with. This is to lower the risk of serious side effects. This is called induction chemotherapy. […] Some women might have disease that spreads to their brain. This is rare. In this situation, you might have treatment with methotrexate into your spinal fluid (intrathecally). […] Immunotherapy drugs help your immune system to attack cancer. Although rare, some women might develop resistance to chemotherapy drugs. These women might have treatment with an immunotherapy drug called pembrolizumab (Keytruda). […] You need to have blood tests to make sure its safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment. […] Chemotherapy for invasive mole or choriocarcinoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

• #28 Gestational Trophoblastic Neoplasia Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/279116-treatment

  Corticosteroids (dexamethasone) with systemic effect are administered to reduce brain edema. […] A gynecologic oncologist experienced in managing GTN should be consulted. […] Patients with resistant disease may benefit from consultation at a regional trophoblastic disease center. […] Patients with GTN should have follow-up serum hCG levels measured once per week until 4 normal values are obtained. […] Then, hCG levels should be obtained once per month for 1 year. […] During the period of follow-up care, patients with GTN should use a reliable method of contraception, such as oral contraceptives or depot progesterone. […] A hysterectomy may be necessary in case of uncontrolled vaginal bleeding. […] Hysterectomy may reduce the total number of chemotherapy cycles needed to achieve remission.

• #29 Gestational Trophoblastic Neoplasia Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/279116-treatment

  Uterine or hypogastric artery ligation or embolization of feeding vessels may be needed to control hemorrhage. […] A repeat DC in the presence of persistent tissue on pelvic ultrasonography may reduce the number of chemotherapy cycles needed to achieve remission. […] Craniotomy may be needed to control bleeding and provide decompression. […] Resection of solitary metastasis (eg, thoracotomy) or disease within the myometrium may help achieve a remission. […] The early diagnosis of GTN by the close follow-up of serum hCG levels after the evacuation of a hydatidiform mole results in therapeutic intervention prior to the development of high-risk disease. […] In patients with a history of gestational trophoblastic disease (GTD), measuring serum hCG levels 6 weeks after any subsequent pregnancy should be strongly considered to exclude occult GTN.

• #30 Update on gestational trophoblastic disease – O&G Magazine

  https://www.ogmagazine.org.au/24/3-24/update-on-gestational-trophoblastic-disease/

  Following confirmation of a CHM or PHM, it is essential that the patient is informed and advised of the importance of follow up, risk of persistent disease and the need to avoid further pregnancy until advised otherwise. […] Gestational trophoblastic disease management must therefore be timely and according to evidence-based guidelines. While recurrence rates for GTN are low at 0.62%, the risk of recurrence significantly increases without long-term follow up, supporting the need for ongoing care. […] Response to chemotherapy is excellent for the vast majority of patients and the decision to use low- or high-risk regimens is based on FIGO stage and WHO risk score. […] Given GTN is exquisitely sensitive to chemotherapy, consideration should be given to a diagnosis of non-gestational choriocarcinoma (where a non-pregnancy related malignancy has de-differentiated into choriocarcinoma) if the response to chemotherapy is not as expected. […] Currently there is emerging data that immunotherapy (i.e. anti PD-1/PDL-1 immune check point inhibitors) could be effective in recurrent high-risk disease such as choriocarcinoma or ETT/PSTT.

• #31 Gestational Trophoblastic Disease, GTD Pregnancy & Neoplasia | Dr. Nazish Khalid

  https://www.drnazishkhalid.com/gestational-trophoblastic-disease/

  Persistent trophoblastic disease (PTD) is a tumour that can form in the uterus after an abnormal type of pregnancy called molar pregnancy. […] Choriocarcinoma is a very rare tumour that can occur after a normal pregnancy, molar pregnancy, a miscarriage or a termination of pregnancy. […] Surgery is not often used for PTD and Choriocarcinoma. Usually you only have chemotherapy. Your doctor might suggest surgery if your PTD or Choriocarcinoma is not responding to chemotherapy. […] Persistent trophoblast treatment often involves chemotherapy to eliminate any remaining cancerous cells. […] For patients diagnosed with gestational trophoblastic neoplasia GTN, Dr. Nazish Khalid provides comprehensive care and advanced treatment options to ensure the best possible outcomes. […] Dr. Nazish Khalid provides expert care and comprehensive management for GTD pregnancies, ensuring thorough evaluation and effective treatment to safeguard maternal health and well-being.

• #32 Gestational Trophoblastic Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7813445/

  The majority of women with gestational trophoblastic disease can be successfully managed with preservation of their reproductive capacity. […] It is important to manage molar pregnancies properly to minimize acute complications and to identify gestational trophoblastic neoplasia promptly. […] Patients with gestational trophoblastic neoplasia should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients. […] Currently, most women can be cured, and their reproductive function can be preserved, but it is important that the initial management and follow-up of patients be timely and appropriate. […] Hysterectomy should be considered in women older than age 40 y. […] Medical complications usually regress promptly after evacuation of the mole and may not require specific therapy.

• #33 SGO, FWC, and GOG-F* Communique: Considerations When Treating Gestational Trophoblastic Neoplasia in the Setting of a Methotrexate Shortage | Society of Gynecologic Oncology

  https://www.sgo.org/news/drugshortage3/

  When cisplatin is in short supply, it should be reserved for curative intent treatment in patients with GTN who have not responded to, or relapsed, after multi-agent chemotherapy regimens. […] Despite drug shortages patients should not be undertreated. All patients require three additional courses of chemotherapy after hCG normalization. […] Consider referral of patients with high-risk GTN to centers with trophoblastic disease expertise for care and potential enrollment in clinical trials. […] Patients with high-risk GTN are likely to develop drug resistance if single-agent therapy is administered. Therefore, patients are treated with multi-agent regimens. […] Nearly 50% of patients with high-risk, metastatic GTN will require adjuvant surgery to achieve cure, even in the presence of multi-organ involvement. This should be considered in the setting of chemoresistant residual disease or significant uterine bleeding. […] The preferred treatment modality for most patients diagnosed with these GTN subtypes is hysterectomy. Select patients with high-risk tumors diagnosed 48 months after the antecedent pregnancy may benefit from the addition of chemotherapy after hysterectomy.

• #34 Gestational Trophoblastic Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7813445/

  It is recommended that all patients with high-risk gestational trophoblastic neoplasia be referred to specialists with experience in the management of this disease. […] After hCG remission has been achieved, patients with gestational trophoblastic neoplasia should be managed with serial determinations of hCG levels at 2-week intervals during the first 3 months of remission and then at monthly intervals for at least 12 months.

• #35 Nursing practice in gestational trophoblastic disease | Nursing Times

  https://www.nursingtimes.net/archive/nursing-practice-in-gestational-trophoblastic-disease-05-10-2000/

  Most patients with choriocarcinoma will require chemotherapy. […] Patients are advised not to get pregnant until 12 months after completing their chemotherapy. This minimises the potential capacity to produce foetal malformation from the treatment and avoids confusion between a new pregnancy or relapsed disease as the cause of a rising HCG. […] It is vital that nurses who care for these patients have knowledge of the disease. It is important to emphasise that despite the short-term difficulties, the long-term outlook is excellent. […] At the end of treatment, these women will need encouragement to re-establish their normal lifestyle and relationships with their families.

• #36 Advances in the diagnosis and early management of gestational trophoblastic disease | BMJ Medicine

  https://bmjmedicine.bmj.com/content/1/1/e000321

  Women treated with chemotherapy after a molar pregnancy are advised to avoid pregnancy for at least a year when the risk of relapse is greatest. […] Importantly, all guidelines recommend that GTN should be considered in the differential diagnosis of all women who present with irregular vaginal bleeding after pregnancy and that serum hCG measurement should be included in the diagnostic investigations. […] The prognosis for women after a molar pregnancy is excellent but some uncertainty remains around the cause of GTD, the risk factors that contribute to malignant transformation, and the optimum surveillance period. […] The treatment options for GTN over the past decade have improved considerably with most women now cured and salvage treatment pathways available for those who develop chemoresistance.

• #37 Gestational Trophoblastic Disease Nursing Care & Management

  https://nurseslabs.com/gestational-trophoblastic-disease/

  Gestational Trophoblastic Disease (GTD) is a rare but potentially serious condition that arises from abnormal trophoblastic cell growth during pregnancy. This group of disorders encompasses molar pregnancies and gestational trophoblastic neoplasia, each demanding specialized nursing care to optimize patient outcomes. As compassionate and dedicated caregivers, nurses play a pivotal role in recognizing the early signs, providing emotional support, and coordinating multidisciplinary care for women affected by GTD. […] By equipping nursing professionals with in-depth knowledge, practical insights, and the ability to address the unique physical and emotional needs of GTD patients, we aim to enhance the quality of care and support provided throughout their challenging journey. […] Nurses must also take action during the critical stages of the pregnancy. We must be able to function on our own while waiting for any orders from the physician.

• #38 Gestational Trophoblastic Disease Nursing Care & Management

  https://nurseslabs.com/gestational-trophoblastic-disease/

  Assess the abdominal girth of the pregnant woman to check if it is within the usual landmark of pregnancy. […] Provide your patient with an open environment and a trusting relationship so she would be encouraged to express her feelings. […] Provide an assurance that it is not her own fault that this happened to her to lessen her sense of guilt and self-blame. […] The pain a mother experiences at the loss of a pregnancy is never comparable to any pain in the world. Expecting for an addition in the family and losing it before it is even born is a difficult situation, but somehow we, as nurses, have the ability to give them comfort and reduce the pain they are feeling through the knowledge that we have.

• #39 Gestational Trophoblastic Disease (Hydatidiform mole) – RNpedia

  https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/gestational-trophoblastic-disease-hydatidiform-mole/

  1. Ensure physical well being of the client through accurate assessment and interventions. […] 2. Prepare for suction curettage evacuation of the uterus (induction of labor with oxytocic agents or prostaglandins is not recommended because of the increased risk of hemorrhage). […] 3. Ensure appropriate follow-up and self-care by explaining that frequent possibility of recurrence of the problem or progression to choriocarcinoma. Also explain that hCG levels should be monitored for 1 year. […] 4. Discuss the need to prevent pregnancy for at least 1 year after diagnosis and treatment. […] 5. Inform the client that oral birth control agents are not recommended because they suppress pituitary luteinizing hormone, which may interfere with serum hCG measurement. […] 6. Describe and emphasize signs and symptoms that must be reported (i.e., irregular vaginal bleeding, persistent secretion from the breast, hemoptysis, and severe persistent headaches). These symptoms may indicate spread of the disease to other organs.

• #40 Gestational Trophoblastic Disease (Hydatidiform mole) – RNpedia

  https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/gestational-trophoblastic-disease-hydatidiform-mole/

  7. The primary treatment for a molar pregnancy is the surgical removal of the abnormal trophoblastic tissue from the uterus, typically through a procedure called dilation and curettage (DC). […] 8. It is essential to ensure complete removal of the molar tissue to reduce the risk of complications, such as persistent gestational trophoblastic disease (GTD) or, in rare cases, choriocarcinoma, a malignant form of GTD. […] 9. Educate the patient about the DC procedure, including what to expect before, during, and after the procedure. […] 10. Emphasize the importance of follow-up care, including monitoring hCG levels to ensure that all molar tissue has been removed and to detect any potential complications. […] 11. Provide emotional support, as the loss of a pregnancy can be distressing.

• #41 Gestational Trophoblastic Disease (Hydatidiform mole) – RNpedia

  https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/gestational-trophoblastic-disease-hydatidiform-mole/

  12. Nurse Laura should educate the patient on the nature of a hydatidiform mole, including the need for treatment and follow-up care to monitor hCG levels and prevent potential complications. […] 13. Nurses should educate the patient about the nature of the condition and provide emotional support due to the loss of a potential pregnancy. […] 14. Nurse Jessica should immediately refer Mrs. Carter for further diagnostic testing, including an ultrasound and hCG level measurement, to confirm the presence of a hydatidiform mole. […] 15. Early diagnosis is important to prevent potential complications and to begin appropriate treatment. […] 16. Monitor hCG levels closely in patients with a history of molar pregnancy, as these levels can help in early detection of recurrent trophoblastic disease.

• #42 Nursing Care Plan For Gestational Trophoblastic Disease – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gestational-trophoblastic-disease/

  The nursing care plan for gestational trophoblastic disease (GTD) is a vital component in providing comprehensive and individualized care for women facing this uncommon but potentially serious condition. GTD encompasses a spectrum of disorders that arise from abnormal trophoblastic proliferation during pregnancy. […] The nursing care plan places equal emphasis on physical and emotional aspects. Collaboration between the healthcare team, including obstetricians, oncologists, nurses, and other allied professionals, is paramount in delivering comprehensive care and ensuring a multidisciplinary approach. […] The diagnosis of gestational trophoblastic disease can evoke anxiety and emotional distress in patients due to its rare and potentially serious nature. Nursing interventions should involve providing emotional support, addressing concerns, and facilitating open communication with the healthcare team.

• #43 Gestational Trophoblastic Disease | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/gestational-trophoblastic-disease.html

  Gestational trophoblastic disease (GTD) is a group of rare tumors that develop from placental tissue. […] While most GTD tumors are benign (noncancerous), some may become malignant (cancerous). […] Choriocarcinoma: This cancerous tumor forms from trophoblast cells and can spread into the muscles of the uterus, nearby blood vessels, and other organs. It can grow and spread more quickly than other GTNs. […] At MD Andersons Gynecologic Oncology Center, some of the nation’s top experts work together to carefully plan your gestational trophoblastic disease treatment. […] They customize your plan of action to deliver the most advanced GTD treatment with the least impact on your body. […] Your personal group of experts, which includes highly specialized pathologists, radiologists, radiation oncologists and gynecological oncologists, is supported by a thoroughly trained staff. […] They communicate and collaborate at every step to increase your chances for successful GTD treatment. […] From support groups to counseling to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.

• #44 Types – Gestational Trophoblastic Disease | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/cancer/gestational-trophoblastic-disease/types.html

  At Stanford Womens Cancer Center, we understand that a diagnosis of gestational trophoblastic disease can be emotionally overwhelming. Our skilled experts and supportive staff work together to provide compassionate care and successfully treat you not just your disease. […] The Stanford Gynecologic Cancer Program in the internationally recognized Stanford Womens Cancer Center provides care and treatment for gestational trophoblastic disease. […] Our gestational trophoblastic disease care team is experienced in helping women who are newly diagnosed and those who are facing a repeat occurrence of the disease. […] We offer the most advanced minimally invasive treatments and technologies, and our experts help care for both the physical and emotional aspects of the disease. […] Caring for all aspects of your life is part of your treatment. Our support system includes nurses, nurse practitioners, nutritionists, social workers, psychiatric support, and support groups for you and your family.

• #45

  https://journals.lww.com/jfmpc/fulltext/2020/09030/a_review_on_management_of_gestational.3.aspx

  The main impressive factor for achieving the most effective management of GTD is the measurement of the amount of beta-human chorionic gonadotropin in the blood among GTN patients. […] The procedure of fertility control mainly during treatment and 1 or 2 years follow-up after conducting chemotherapy should be carried out mainly through administering combined oral contraceptive pills. […] The GTN expansion among women would cause considerable mood affective, sexual, and marital disorders as well as creating extra concerns around the possibility of future fertility issue. […] The survival rate among patients who suffer from low and high risk GTN disease is over than 95% and 80%, respectively.

• #46 Gestational Trophoblastic Disease (GTD) Treatment | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/gestational-trophoblastic-disease/treatment

  After the diagnosis of complete or partial hydatidiform mole is made or suspected, the uterine contents are removed by suctioning (called dilation and evacuation, DE). […] Following this procedure, testing for human chorionic gonadotropin (hCG,) should be performed every week in order to determine if the molar pregnancy is malignant. […] A rise in the hormone level indicates that the molar pregnancy has become malignant and will be called gestational trophoblastic neoplasia (GTN). […] Even if GTN has spread to other parts of the body, it is still highly curable. […] The chemotherapy used for the treatment of GTN is generally well tolerated without long-term side effects, with two exceptions the use of multi-agent chemotherapy is associated with an earlier menopause and a low risk of secondary tumors.

• #47

  https://www.feinberg.northwestern.edu/sites/obgyn/divisions/gynecologic-oncology/trophoblastic.html

  The successful treatment of gestational trophoblastic diseases with chemotherapy has resulted in an increasing number of women who have retained reproductive potential. […] No evidence exists of reactivation of disease due to a subsequent pregnancy; however, patients have approximately a one percent risk of another trophoblastic disease episode in a subsequent pregnancy.

• #48 Gestational Trophoblastic Disease | Doctor

  https://patient.info/doctor/gestational-trophoblastic-disease

  Gestational trophoblastic disease (GTD) comprises a group of disorders spanning the premalignant conditions of complete and partial molar pregnancies (also known as hydatidiform moles) through to the malignant conditions of invasive mole, choriocarcinoma and the very rare placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). […] Choriocarcinoma most often follows a molar pregnancy but can follow a normal pregnancy, ectopic pregnancy or abortion, and should always be considered when a patient has continued vaginal bleeding after the end of a pregnancy. […] Outcomes for women with GTN and GTD are better with ongoing care from GTD centres. The registration of affected women with a GTD centre represents a minimum standard of care. […] Women with evidence of persistent GTD should undergo assessment of their disease followed by chemotherapy. Treatment used is based on the International Federation of Gynecology and Obstetrics (FIGO) 2000 scoring system for GTN following assessment at the treatment centre.

• #49 Molar pregnancy and gestational trophoblastic disease | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/molar-pregnancy-and-gestational-trophoblastic-disease/

  GTD is an uncommon group of conditions that includes complete and partial molar pregnancies. […] Treatment of a molar pregnancy is usually a small operation to remove abnormal pregnancy tissue from your uterus (womb). […] Uncommonly molar pregnancy tissue can persist after surgery and you might need further treatment with chemotherapy. […] You will be followed up in a specialist centre with expertise in the management of molar pregnancy and GTD. […] If you are diagnosed with GTN, you will usually need to have further treatment. This will be organised by the specialist centre that you have been registered with. […] Further treatment usually involves drugs (chemotherapy), although sometimes you may be offered a second operation to empty your uterus. […] Continuing with this specialist follow-up is important as it is very successful in treating GTD (98-100% cure rate) and there are very low rates of progression to more serious forms of GTD.

• #50 King Edward Memorial Hospital – Western Australian Trophoblastic Centre

  https://www.kemh.health.wa.gov.au/For-Health-Professionals/Cancer/WA-Trophoblastic-Centre

  The Western Australian Trophoblastic Centre (WATC) is a specialist multidisciplinary service that provides holistic care in partnership with the patients General Practitioner, for those affected by Gestational Trophoblastic Disease. […] The WATC provides centralised and specialised care to our patients with trophoblastic diseases. This includes all patients with partial mole, complete mole, choriocarcinoma, atypical placental site nodule, placental site trophoblastic disease and epithelioid trophoblastic disease, regardless of the planned follow-up / treatment. […] A multidisciplinary clinic involving medical, gynaecology, nursing, oncology and psychology staff. […] Any new diagnosis of trophoblastic disease (partial mole, complete mole, choriocarcinoma, atypical placental site nodule, placental site trophoblastic disease, epithelioid trophoblastic disease). […] For clinical advice regarding Gestational Trophoblastic Disease, GPs are always welcome and encouraged to phone KEMH and ask to speak to the Gynaecologic Oncology Fellow or the on-call Gynaecologic Oncology Consultant via phone number (08) 6458 2222.

• #51

  https://journals.lww.com/jfmpc/fulltext/2020/09030/a_review_on_management_of_gestational.3.aspx

  The rare presence of malignant cancerous cells afar any type of pregnancy is known as gestational trophoblastic neoplasia (GTN). […] These kinds of diseases would be occurring mainly due to the following clinicopathologic conditions: (I) existence of epithelioid trophoblastic tumor (ETT), (II) rare type of choriocarcinoma cancer, (III) gestational trophoblastic tumor of mole, and (IV) the rare malignant tumor of placental site trophoblastic tumor. […] In spite of the fact that GTN patients are treated with conventional surgical therapies or/and chemotherapy, in some patients with resistant disease, these therapies may not be effective and patients may die. […] The newest issues are related to GTN diagnosis, process of progression of hydatidiform mole (HM) to GTN, and the issue of GTN drug resistance.

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