Materiały źródłowe

• #1 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). […] This is known as persistent trophoblastic disease. […] Chemotherapy is usually used to treat the condition. Treatment is successful in curing almost all cases of persistent trophoblastic disease. […] Choriocarcinoma is a very rare type of cancer that occurs in around one in 50,000 pregnancies. It can develop if the cells left behind after a pregnancy become cancerous. […] 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.

• #1 Tests and scans 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/tests

  Your GP or specialist might arrange for you to have a number of tests if they think you have an invasive mole or choriocarcinoma. These include: […] hCG is measured in your blood and urine to: help diagnose an invasive mole or choriocarcinoma […] An ultrasound scan can help diagnose many women with an invasive mole or choriocarcinoma. […] You might have a chest x-ray to check for any spread to your lungs. This is the most common place for invasive mole or choriocarcinoma to spread to. […] If you have choriocarcinoma, or your doctors think you have it, you might need to have a CT scan. […] Your guide to diagnosing persistent trophoblastic disease (PDT) and choriocarcinoma and the tests you might have. […] Invasive mole and choriocarcinoma are very rare types of cancer that can occur after pregnancy. They are types of gestational trophoblastic disease (GTD).

• #1 Gestational trophoblastic disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/gestational-trophoblastic-disease?lang=us

  Gestational trophoblastic disease (GTD) results from the abnormal proliferation of trophoblastic tissue and encompasses a wide spectrum of diseases, including gestational choriocarcinoma. […] Gestational choriocarcinoma may look identical to hydatidiform mole. […] Gestational choriocarcinoma arises following known molar pregnancy (50%), miscarriage (30%), normal pregnancy (20%). […] Higher -hCG levels even than a complete mole are observed in gestational choriocarcinoma. […] Patients often can present with multiple metastases without an easily identified primary, as it can often be small in an otherwise normal placenta. […] Metastases can occur in lungs: ~80%, vagina: ~30%, pelvis: 20%, liver and brain: ~10%.

• #1 Gestational Trophoblastic Disease | Chris O’Brien Lifehouse

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

  About 4% of women will have metastatic disease. […] In contrast, only 0.5-5% of patients develop persistent disease after a partial mole. […] The management of persistent GTD is similar to the management of patients diagnosed with PSTT or choriocarcinoma at initial evaluation. […] The FIGO criteria for diagnosis of post-hydatidiform mole trophoblastic neoplasia (GTN) are as follows: 1. When a plateau of human chorionic gonadotropin (hCG) (+/- 10%) lasts for 4 measurements over a period of 3 weeks or longer (i.e. days 1, 7,14, 21). […] 2. When there is a rise of hCG ( 10%) of three consecutive weekly measurements or longer, over at least a period 2 weeks or more (i.e. days 1,7,14). […] 3. When the hCG level remains elevated for 6 months or more. […] 4. If there is a histologic diagnosis of choriocarcinoma.

• #1 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology

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

  Gestational trophoblastic neoplasia (GTN) is a collective term for gestational trophoblastic diseases that invade locally or metastasize. Hydatidiform mole is the most common form of GTN; others are invasive mole (chorioadenoma destruens), choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT. […] Most cases of GTN are diagnosed when the serum hCG levels plateau or rise in patients being observed after the diagnosis of hydatidiform mole. […] Laboratory studies used in the diagnosis of GTN are as follows: Serum quantitative hCG to assess response to therapy and disease status; CBC may help detect anemia secondary to bleeding; liver enzymes may become elevated in patients with metastasis to the liver. […] Imaging studies include pelvic ultrasonography, which may show persistent molar tissue in the uterus, and chest radiograph, which is recommended because the lung is the most frequent site of metastasis.

• #1 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology

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

  CT and MRI are recommended if the patient has hydatidiform mole with metastasis to the lungs, choriocarcinoma, or persistent hydatidiform mole. […] Uterine dilatation and curettage (DC) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma. […] The official International Federation of Gynecology and Obstetrics staging of gestational trophoblastic neoplasia is as follows: Stage I confined to the uterus; Stage II limited to the genital structures; Stage III lung metastases; Stage IV other metastases. […] The currently used prognostic scoring index is a modification of the World Health Organization (WHO) classification. […] Patients with GTN are subdivided into 2 groups: those with a WHO score of less than 7 (low-risk) and those with a score of 7 or higher and who are at high risk of therapy failure.

• #1 Gestational Trophoblastic Disease | Doctor

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

  The estimation of hCG levels may be of value in diagnosing molar pregnancies. […] The definitive diagnosis of a molar pregnancy is made by histological examination. […] The histological assessment of material obtained from the medical or surgical management of all miscarriages is recommended to exclude trophoblastic neoplasia if no fetal parts are identified at any stage of the pregnancy. […] Indications for chemotherapy in GTD include plateaued or rising hCG levels after evacuation and histological evidence of choriocarcinoma. […] 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. […] Women suspected of choriocarcinoma require more extensive investigation in the specialist centre, including computerised tomography of the chest and abdomen, or magnetic resonance imaging of the head and pelvis, all with contrast in addition to the serum hCG and a Doppler ultrasound of the pelvis.

• #1 Diagnosis of gestational trophoblastic disease | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/diagnosis

  Tumour marker tests can be used to diagnose GTD, but they are generally used to check how treatment is working or your response to cancer treatment. […] Human chorionic gonadotropin (hCG or b-hCG) is the most common tumour marker test used to diagnose GTD, monitor how well it responds to treatment and check if it has come back (recurred). […] GTD is often diagnosed by a DC. […] Sometimes GTD can cause your thyroid to make too much thyroid hormone (called hyperthyroidism). So your healthcare team may do blood tests to check your thyroid levels. […] In some cases, a PET scan may be used to look for cancerous GTD that has spread outside the uterus or has come back after treatment. […] A lumbar puncture may be done if symptoms suggest that cancerous GTD has spread to the brain.

• #1 Gestational trophoblastic disease – Wikipedia

  https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease

  Cases of GTD can be diagnosed through routine tests given during pregnancy, such as blood tests and ultrasound, or through tests done after miscarriage or abortion. Vaginal bleeding, enlarged uterus, pelvic pain or discomfort, and vomiting too much (hyperemesis) are the most common symptoms of GTD. But GTD also leads to elevated serum hCG (human chorionic gonadotropin hormone). […] The initial clinical diagnosis of GTD should be confirmed histologically, which can be done after the evacuation of pregnancy in women with hydatidiform mole. However, malignant GTD is highly vascular. If malignant GTD is suspected clinically, biopsy is contraindicated, because biopsy may cause life-threatening haemorrhage. […] Women with persistent abnormal vaginal bleeding after any pregnancy, and women developing acute respiratory or neurological symptoms after any pregnancy, should also undergo hCG testing, because these may be signs of a hitherto undiagnosed GTD. […] Persistent elevation of serum hCG levels after a non molar pregnancy always indicate persistent GTD (very frequently due to choriocarcinoma or placental site trophoblastic tumour), but this is not common, because treatment mostly is successful.

• #1 Gestational Trophoblastic Neoplasia Workup: Laboratory Studies, Imaging Studies, Procedures

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

  Serum quantitative hCG is used to assess response to therapy and disease status. […] A uterine dilatation and curettage (DC) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma. […] A DC may be part of the evaluation of a patient with an elevated serum hCG levels of unknown origin: The tissue is sent for histopathologic examination; examination may reveal a hydatidiform mole (complete or partial) or a choriocarcinoma. […] Although the choriocarcinoma has no chorionic villi, it has sheets of trophoblasts, hemorrhage, and necrosis. […] The official International Federation of Gynecology and Obstetrics staging of gestational trophoblastic neoplasia is as follows: Stage III Lung metastases. […] The currently used prognostic scoring index is a modification of the World Health Organization (WHO) classification.

• #1

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

  The Ki-67 proliferation index helped in distinguishing the EPS reaction from neoplastic lesions such as PSTT which requires surgical intervention and chemotherapy. […] Histomorphological examination and analysis are essential for confirmatory diagnosis. […] The most common clinical manifestation of GTD was vaginal bleeding followed by amenorrhea.

• #1 Center for the Precision Medicine of Trophoblastic Disease < Pathology

  https://medicine.yale.edu/pathology/clinical/precision-medicine-trophoblastic-disease/

  The first step in the diagnostic work-up of GTD is morphologic evaluation on HE-stained sections. Based on the microscopic features, the cases are triaged for further ancillary studies using published algorithm. Correlative morphological review is crucial for correct interpretation of ancillary studies, particularly molecular genotyping in the diagnosis of molar gestations. […] DNA genotyping has become the gold standard in the diagnosis and subclassification of hydatidiform moles with superb diagnostic sensitivity and specificity. Genotyping does not require fresh tissue and can be performed on formalin fixed paraffin-embedded tissue samples. Genotyping may also play a crucial role in the diagnosis of gestational trophoblastic tumors and their risk scoring for clinical patient management.

• #1 GTD Overview

  https://gynonc.nm.org/gtd-overview.html

  Gestational trophoblastic neoplasia (GTN) includes persistent postmolar gestational trophoblastic neoplasia, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. The overall cure rate in treating these tumors at our center currently exceeds 90 percent. […] Choriocarcinoma is a malignant disease that can invade into the uterine walls and blood vessels resulting in spread to distant sites, such as the lungs, brain, liver, kidneys, intestines, spleen, and vagina. Choriocarcinoma affects about 1 in 40,000 pregnancies. Although choriocarcinoma can arise in association with any pregnancy, 50 percent arise from molar pregnancy. There are no characteristic signs or symptoms. […] When GTN is diagnosed, evaluation and staging (including blood work, laboratory tests, X-rays, MRI and/or CT scans) is the next step to determine risk factors and treatment. Treatment is then based on classification into risk groups defined by a combination of stage (where the disease is located) and score (prognostic factors). Use of this staging system is essential for determining the most appropriate initial therapy to assure the best possible outcomes with the least toxicity.

• #1 Diagnosis and Management of Gestational Trophoblastic Disease | SpringerLink

  https://link.springer.com/10.1007/978-3-319-17002-2_11-2

  Gestational trophoblastic disease (GTD) refers to all tumors that arise from the maternal placenta. Gestational trophoblastic neoplasm (GTN) is a subset of GTD and refers to choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Persistent GTD may develop after treatment of a molar pregnancy and is also referred to as GTN. The treatment of GTN is stratified based on whether the patient is low risk or high risk as determined by the World Health Organization (WHO) score and International Federation of Gynecology and Obstetrics (FIGO) staging system. Low-risk GTN is treated with single-agent chemotherapy, whereas high-risk GTN should be treated with combination regimens. GTN that does not respond to first-line treatment is said to be resistant or refractory. Resistance to a particular chemotherapeutic regimen is evidenced by a plateau or rise in beta-hCG levels. The overall prognosis for GTN is excellent, even in the setting of refractory disease. […] This chapter also discusses the management of GTN with special considerations such as brain and vaginal metastasis, role of secondary curettage, and post-molar prophylactic chemotherapy.

• #1 Gestational choriocarcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Gestational_choriocarcinoma

  A confirmed diagnosis usually happens after the disease has progressed to a late clinical stage. […] Similar to other non-gestational tumors, gestational choriocarcinoma can be reflected via an elevated level in serum hCG concentration. […] Based on the International Federation of Gynecology and Obstetrics (FIGO)’s updated guidelines on gestational trophoblastic disease management, the diagnostic criteria of a post-gestational trophoblastic neoplasia (GTN) is as follows: Over a period of 3 weeks or longer (day 1, 7, 14, 21), there are 4 or more plateaued hCG levels. […] To differentiate gestational choriocarcinoma from other tumors such as lung or brain cancers, a genetic test is usually completed on top of a pathological diagnosis.

• #1 Gestational Trophoblastic Diseases | GLOWM

  https://www.glowm.com/section-view/heading/Gestational%20Trophoblastic%20Diseases/item/262

  Complete and partial hydatidiform mole, invasive mole, and choriocarcinoma all exhibit proliferation of both cytotrophoblast and syncytiotrophoblast cells that maintain secretion of hCG. In contrast, the placental site tumor may be either a benign or a malignant neoplasm derived from the intermediate cytotrophoblast that usually produces low levels of hCG. A functional understanding of the differences in the pathology of the disease processes that comprise GTD is important, even though clinical management is most often based on the individual patient’s clinical presentation and pattern of hCG level changes even in the absence of a firm histopathologic diagnosis. […] Gestational choriocarcinoma is characterized by a dimorphic population of cytotrophoblast and syncytiotrophoblast elements. Varying amounts of pleomorphism and anaplasia are present; in the absence of clinical history, the histopathology may be misinterpreted in biopsy specimens of metastatic sites as undifferentiated carcinoma or sarcoma. Chorionic villi are not present, even in primary uterine sites of disease. If villous structures are identified in metastatic deposits, the histologic diagnosis is invasive mole.

• #1 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). […] Participants gain insights into evidence-based diagnostic approaches, including histopathological evaluation and imaging modalities, to facilitate accurate and timely diagnosis. […] Choriocarcinoma is a rare and aggressive neoplasm. The 2 significant choriocarcinoma subtypes, namely gestational and nongestational, have very different biological activity and prognoses.

• #1 Gestational Trophoblastic Disease

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

  The primary treatment for most forms of gestational trophoblastic neoplasia is chemotherapy, based on the individual patients risk. […] The best treatment for liver or other high-risk sites of metastases has not been established; these patients are most often managed with highly individualized multimodality therapy, incorporating chemotherapy, with potential surgical resection of isolated metastases, embolization of liver metastases, or localized radiation therapy. […] 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.

• #1 Gestational Trophoblastic Neoplasia – UChicago Medicine

  https://www.uchicagomedicine.org/cancer/types-treatments/gestational-trophoblastic-neoplasia

  The blood levels of the pregnancy hormone -HCG are used to follow the tumors response to treatment. Once the -HCG level is undetectable, these levels are monitored for at least six to 12 months to ensure there is no evidence of recurrent disease. […] If the initial tumor returns or does not go away with treatment, a full work-up to restage the tumor is performed. This usually includes more bloodwork and a physical exam. Patients also undergo a CT scan or MRI to investigate whether the disease has spread. If the tumor recurs, patients can receive single-drug chemotherapy treatment, but many recurrent tumors require a multi-drug chemotherapy regimen. Even still, many patients can be cured of their disease with the use of the appropriate chemotherapy drugs.

• #1 Stages of gestational trophoblastic disease (GTD) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/staging

  Recurrent GTN means that cancerous GTD has come back after it has been treated. If it comes back in the same place that the cancer first started, its called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, its called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence. […] Usually any abnormal trophoblast cells left behind after a hydatidiform mole is removed will die off. In some cases, these trophoblast cells will keep growing and can become an invasive mole. An invasive mole that develops after a hydatidiform mole is removed may also be called a persistent mole or persistent trophoblastic disease.

• #1 Gestational Trophoblastic Disease | Chris O’Brien Lifehouse

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

  The cumulative overall survival for these patients has been reported to be as high as 80%. […] After attaining a normal hCG level, the risk of tumour relapse in women with persistent GTN is 3-9% with a mean time to recurrence is approximately 6 months regardless of initial stage of disease. […] Following either low or high risk chemotherapy treatment, fertility is usually maintained and regular menstruation restarts 2-6 months after the end of chemotherapy. […] The recently revised FIGO risk score recognizes the poor prognosis associated with liver metastases.

• #1 Gestational Trophoblastic Diseases | GLOWM

  https://www.glowm.com/section-view/heading/Gestational%20Trophoblastic%20Diseases/item/262

  We recommend that patients with hydatidiform mole have therapy instituted according to the following criteria: (1) hCG level rise, (2) hCG level plateau (≥10%) for three or more consecutive weekly measurements, (3) appearance of metastases, or (4) histologic evidence of choriocarcinoma, placental site trophoblastic tumor, or invasive mole. Using these criteria, we have continued to treat approximately 20% of our patients after molar evacuation.

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

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

  Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] Given the extremely good therapeutic outcomes of most of these tumors, an important goal is to distinguish patients who need less-intensive therapies from those who require more-intensive regimens to achieve a cure. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease. […] Treatment of hydatidiform mole (HM) is within the purview of the obstetrician/gynecologist and is not discussed separately here. […] 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.

• #1 Gestational Trophoblastic Disease Treatment – NCI

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

  The type of GTD, whether the tumor has spread to the uterus, lymph nodes, or distant parts of the body, and the level of beta-hCG in the blood are factors that affect prognosis and treatment options. […] Treatment for gestational trophoblastic disease may cause side effects. […] Recurrent gestational trophoblastic neoplasia (GTN) is cancer that has recurred (come back) after it has been treated. […] Gestational trophoblastic neoplasia that does not respond to treatment is called resistant GTN.

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

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

  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 increased use of molecular genotyping has improved the diagnostic accuracy of GTD classification, which is critical for prognostic stratification. […] Identification of women with GTD is of paramount importance because this disorder is highly curable.

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

  https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-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). […] An invasive mole and choriocarcinoma are cancers that grow from the tissue that forms in the womb during pregnancy. […] If you develop an invasive mole or choriocarcinoma it usually shows up on tests before you notice any symptoms. Your specialist team will then ask you to go in to see them. […] You might have a number of tests or scans to help diagnose or monitor an invasive mole or choriocarcinoma. […] The main known risk factor for invasive mole and choriocarcinoma is a previous molar pregnancy.

• #2 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. […] Because the vast majority of GTD types are associated with elevated human chorionic gonadotropin (hCG) levels, an hCG blood level and pelvic ultrasound are the initial steps in the diagnostic evaluation. […] 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.

• #2 Gestational Trophoblastic Disease – StatPearls – NCBI Bookshelf

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

  Following the evacuation of a complete or partial molar pregnancy, if hCG levels rise or remain elevated over several weeks, the patient is classified as having GTN. […] High clinical suspicion should be maintained for choriocarcinoma in women with hemoptysis and molar pregnancy, current or recent pregnancy, or irregular vaginal bleeding.

• #2 Gestational choriocarcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Gestational_choriocarcinoma

  A confirmed diagnosis usually happens after the disease has progressed to a late clinical stage. […] Similar to other non-gestational tumors, gestational choriocarcinoma can be reflected via an elevated level in serum hCG concentration. […] Based on the International Federation of Gynecology and Obstetrics (FIGO)’s updated guidelines on gestational trophoblastic disease management, the diagnostic criteria of a post-gestational trophoblastic neoplasia (GTN) is as follows: Over a period of 3 weeks or longer (day 1, 7, 14, 21), there are 4 or more plateaued hCG levels. […] To differentiate gestational choriocarcinoma from other tumors such as lung or brain cancers, a genetic test is usually completed on top of a pathological diagnosis.

• #2 Gestational Trophoblastic Disease – StatPearls – NCBI Bookshelf

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

  Choriocarcinoma develops from an abnormal trophoblastic population undergoing hyperplasia and anaplasia, most frequently following a molar pregnancy. […] The healthcare professional should conduct a thorough history and physical examination for any patient with suspected choriocarcinoma. […] Ultrasound is the primary diagnostic tool for GTD. […] Despite ultrasound’s diagnostic utility, in patients presumed to have had a spontaneous abortion, a molar pregnancy is detected only after pathologic evaluation. […] Following the diagnosis of choriocarcinoma, the healthcare professional should evaluate patients for metastasis; the lungs are the most common site for metastasis. […] If molar pregnancy is suspected from ultrasound findings and hCG levels, evaluation should be undertaken for possible medical complications, such as electrolyte imbalances from hyperemesis, anemia, hyperthyroidism, and preeclampsia.

• #2 Diagnosis of gestational trophoblastic disease | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing gestational trophoblastic disease (GTD) usually begins when tests normally done to confirm a pregnancy or during pregnancy suggest there is a problem. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for GTD or other health problems. […] The following tests are usually used to rule out or diagnose GTD. Many of the same tests used to diagnose GTD are also used to find out if it has spread beyond the uterus. Your doctor may also order other tests to check your general health and to help plan your treatment. […] An ultrasound is usually the first test done if the doctor suspects GTD. It is used to: diagnose the presence of GTD, look for trophoblastic tissue that remains in the uterus after childbirth, miscarriage or an abortion, confirm that there is no new pregnancy, check if GTD has spread to other areas of the pelvis or abdomen.

• #2 Gestational trophoblastic disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/gestational-trophoblastic-disease/

  Gestational trophoblastic disease (GTD) is a class of neoplastic conditions characterized by abnormal trophoblast-cell growth in the uterus. Diagnosis of GTD is established on the basis of significantly elevated serum -HCG and ultrasound findings. If GTN is suspected, workup must include x-ray of the chest to screen for lung metastases. […] A type of malignant GTD characterized by a high risk of local invasion and metastasis. […] Choriocarcinoma: a highly malignant GTN characterized by invasive, highly vascular, and anaplastic trophoblastic tissue without villi. […] Diagnostics -hCG: Increased in all types (GTN complete mole partial mole). […] Chest x-ray: cannonball metastases (in hematogenous spread). […] Treatment of choice: methotrexate or dactinomycin. […] Monitor -HCG levels for at least 12 months. […] Risk of recurrence.

• #2 Gestational Trophoblastic Neoplasia – UChicago Medicine

  https://www.uchicagomedicine.org/cancer/types-treatments/gestational-trophoblastic-neoplasia

  The blood levels of the pregnancy hormone -HCG are used to follow the tumors response to treatment. Once the -HCG level is undetectable, these levels are monitored for at least six to 12 months to ensure there is no evidence of recurrent disease. […] If the initial tumor returns or does not go away with treatment, a full work-up to restage the tumor is performed. This usually includes more bloodwork and a physical exam. Patients also undergo a CT scan or MRI to investigate whether the disease has spread. If the tumor recurs, patients can receive single-drug chemotherapy treatment, but many recurrent tumors require a multi-drug chemotherapy regimen. Even still, many patients can be cured of their disease with the use of the appropriate chemotherapy drugs.

• #2 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology

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

  CT and MRI are recommended if the patient has hydatidiform mole with metastasis to the lungs, choriocarcinoma, or persistent hydatidiform mole. […] Uterine dilatation and curettage (DC) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma. […] The official International Federation of Gynecology and Obstetrics staging of gestational trophoblastic neoplasia is as follows: Stage I confined to the uterus; Stage II limited to the genital structures; Stage III lung metastases; Stage IV other metastases. […] The currently used prognostic scoring index is a modification of the World Health Organization (WHO) classification. […] Patients with GTN are subdivided into 2 groups: those with a WHO score of less than 7 (low-risk) and those with a score of 7 or higher and who are at high risk of therapy failure.

• #2 Gestational Trophoblastic Disease and Choriocarcinoma | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688234/1.1/Gestational_Trophoblastic_Disease_and_Choriocarcinoma

  Gestational trophoblastic disease (GTD) is a group of rare conditions associated with pregnancy that consists of abnormal overgrowth of the placental trophoblast tissue. The most common condition is the hydatidiform mole which is often benign but may progress to an invasive mole or a malignant process such as choriocarcinoma (1). […] Choriocarcinoma: malignant tumor with absent chorionic villi, abnormal syncytiotrophoblast, cytotrophoblast, necrosis and hemorrhage (2) […] Most common type of gestational trophoblastic neoplasia (GTN). […] Prior CM (1620%) or PM (0.51%) (3). […] No specific recommendations on prevention. Counsel those women with above risk factors.

• #2 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. […] Tests that examine the uterus are used to detect (find) and diagnose gestational trophoblastic disease. […] 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. […] There is no staging system for hydatidiform moles. […] The following stages are used for gestational trophoblastic neoplasia: Stage I, Stage II, Stage III, Stage IV. […] After gestational trophoblastic neoplasia has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.

• #2 Gestational Trophoblastic Neoplasia Workup: Laboratory Studies, Imaging Studies, Procedures

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

  Serum quantitative hCG is used to assess response to therapy and disease status. […] A uterine dilatation and curettage (DC) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma. […] A DC may be part of the evaluation of a patient with an elevated serum hCG levels of unknown origin: The tissue is sent for histopathologic examination; examination may reveal a hydatidiform mole (complete or partial) or a choriocarcinoma. […] Although the choriocarcinoma has no chorionic villi, it has sheets of trophoblasts, hemorrhage, and necrosis. […] The official International Federation of Gynecology and Obstetrics staging of gestational trophoblastic neoplasia is as follows: Stage III Lung metastases. […] The currently used prognostic scoring index is a modification of the World Health Organization (WHO) classification.

• #2 Gestational Trophoblastic Disease Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.gestational-trophoblastic-disease-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062901

  Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] The modified World Health Organization (WHO) Prognostic Scoring System should be used, and combination chemotherapy should be initiated when warranted by the patient’s score. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease. […] Chemotherapy is necessary when there is a rising beta-hCG titer for 2 weeks, a tissue diagnosis of choriocarcinoma, or persistence of detectable beta-hCG 6 months after mole evacuation. […] Multiagent chemotherapy is standard for the initial management of high-risk gestational trophoblastic neoplasia (GTN). […] There are distinctions in underlying biology between PSTTs and the other gestational trophoblastic tumors, particularly resistance to chemotherapy, that justify specific treatment strategies.

• #2 Gestational Trophoblastic Disease | Chris O’Brien Lifehouse

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

  Patients who have or who are suspected of having persistent GTN, choriocarcinoma, or PSTT should be referred to a centre with expertise in the management of malignant trophoblastic disease. […] They must undergo a thorough evaluation prior to institution of therapy. […] The choice of single agent versus combination chemotherapy depends on disease stage, risk category and response to previous drug treatment. […] The introduction of combination chemotherapy treatments has transformed the poor prognosis of high risk trophoblastic disease. […] Combination chemotherapy is used for disease that is either refractory to single-agent therapy or for newly diagnosed high-risk malignant GTD (i.e. Stage II/III disease with a high prognostic risk score, Stage IV disease and/or PSTT or choriocarcinoma.

• #2 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. […] Choriocarcinoma is most common in people who have a molar pregnancy (when the sperm and egg join incorrectly and make a hydatidiform mole). It can also happen after an ectopic pregnancy, a pregnancy that ends in miscarriage or even after a full-term pregnancy resulting in a birth. […] Most cases of choriocarcinoma are cured by chemotherapy treatment. […] A healthcare provider diagnoses choriocarcinoma with the following tests: Blood test to look for hCG (human gonadotrophin), which is high in people with choriocarcinoma. […] The main treatment for choriocarcinoma is chemotherapy. Chemotherapy is a drug that kills cancer cells.

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

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

  If gestational trophoblastic disease is suspected on ultrasound, serum hCG levels should be taken as well as patient blood type and a baseline full blood count. […] 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. […] If the hCG is 5000 IU/L, and residual, non-myoinvasive, uterine confined disease is identified on ultrasound, a second curettage by an experienced practitioner can be considered. […] 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.

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

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

  Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Hydatidiform mole typically presents in the first trimester with irregular vaginal bleeding and can be suspected on ultrasound but confirmation requires histopathological evaluation of the products of conception. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] 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. […] Identification of the origin of choriocarcinoma can be challenging and genetic profiling can help to differentiate gestational from non-gestational choriocarcinoma, with non-gestational choriocarcinoma having a worse prognosis.

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

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

  Chemotherapy for GTN continues until hCG normalizes. […] After completion of chemotherapy, testing for human chorionic gonadotropin (hCG) in the patients blood continues monthly for 12 months (24 months for patients with Stage IV disease). […] Choriocarcinoma, for example, is an uncommon yet almost always curable cancer. […] Although choriocarcinoma is a highly malignant tumor and life-threatening disease, it is very sensitive to chemotherapy. […] 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. […] Surgery may also be used to remove cancer involving the lungs and other organs that has not gone away with drug therapy. […] Placental-site and epithelioid trophoblastic tumors are less sensitive than choriocarcinoma to chemotherapy. […] Most women who require treatment for GTN can become pregnant again and have normal pregnancies.

• #2 Diagnosis and Treatment of Choriocarcinoma – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/patients_info/diagnosis-and-treatment-of-choriocarcinoma/

  In this section we refer to choriocarcinoma as a malignancy developing within the placenta during an otherwise normal pregnancy. […] The illness can sometimes take a while to diagnose. However the elevated hCG level in a woman who is not pregnant is highly supportive of the diagnosis. […] The treatment for choriocarcinoma takes place initially as an in-patient at Charing Cross and generally with EMA-CO chemotherapy. […] Fortunately choriocarcinoma is a highly sensitive to chemotherapy, with a very high expectation of cure once diagnosed. […] Treatment for choriocarcinoma usually takes 4-5 months to complete and the cure rate is over 95%. […] The treatment in choriocarcinoma is continued for 6-8 weeks after the hCG level has reached normal and then the follow-up is as described in the timetable of hCG follow up.

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

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

  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 increased use of molecular genotyping has improved the diagnostic accuracy of GTD classification, which is critical for prognostic stratification. […] Identification of women with GTD is of paramount importance because this disorder is highly curable.

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

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

  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. […] The outlook for choriocarcinoma in its early stages is good. The survival rate for people with low-risk gestational choriocarcinoma is almost 100%. The survival rate for people with high-risk gestational choriocarcinoma is 94%.

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

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

  Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Hydatidiform mole typically presents in the first trimester with irregular vaginal bleeding and can be suspected on ultrasound but confirmation requires histopathological evaluation of the products of conception. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] 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. […] Identification of the origin of choriocarcinoma can be challenging and genetic profiling can help to differentiate gestational from non-gestational choriocarcinoma, with non-gestational choriocarcinoma having a worse prognosis.

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  #3 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology

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

• #3 Gestational Trophoblastic Neoplasia Workup: Laboratory Studies, Imaging Studies, Procedures

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

  Serum quantitative hCG is used to assess response to therapy and disease status. […] A uterine dilatation and curettage (DC) performed in a woman with abnormal vaginal bleeding and a positive pregnancy test result may reveal a choriocarcinoma. […] A DC may be part of the evaluation of a patient with an elevated serum hCG levels of unknown origin: The tissue is sent for histopathologic examination; examination may reveal a hydatidiform mole (complete or partial) or a choriocarcinoma. […] Although the choriocarcinoma has no chorionic villi, it has sheets of trophoblasts, hemorrhage, and necrosis. […] The official International Federation of Gynecology and Obstetrics staging of gestational trophoblastic neoplasia is as follows: Stage III Lung metastases. […] The currently used prognostic scoring index is a modification of the World Health Organization (WHO) classification.

• #3 Gestational Trophoblastic Disease Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.gestational-trophoblastic-disease-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062901

  Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] The modified World Health Organization (WHO) Prognostic Scoring System should be used, and combination chemotherapy should be initiated when warranted by the patient’s score. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease. […] Chemotherapy is necessary when there is a rising beta-hCG titer for 2 weeks, a tissue diagnosis of choriocarcinoma, or persistence of detectable beta-hCG 6 months after mole evacuation. […] Multiagent chemotherapy is standard for the initial management of high-risk gestational trophoblastic neoplasia (GTN). […] There are distinctions in underlying biology between PSTTs and the other gestational trophoblastic tumors, particularly resistance to chemotherapy, that justify specific treatment strategies.

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

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

  Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] Given the extremely good therapeutic outcomes of most of these tumors, an important goal is to distinguish patients who need less-intensive therapies from those who require more-intensive regimens to achieve a cure. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease. […] Treatment of hydatidiform mole (HM) is within the purview of the obstetrician/gynecologist and is not discussed separately here. […] 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.

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

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

  Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] Accurate monitoring of hCG is critical to successfully diagnose and monitor the treatment course of gestational trophoblastic disease. […] Chemotherapy is necessary when there is a rising beta-hCG titer for 2 weeks, a tissue diagnosis of choriocarcinoma, a plateau of the beta-hCG for 3 weeks, persistence of detectable beta-hCG 6 months after mole evacuation, metastatic disease, an elevation in beta-hCG after a normal value, or postevacuation hemorrhage not caused by retained tissues. […] Treatment of hydatidiform mole (HM) is within the purview of the obstetrician/gynecologist and is not discussed separately here. […] Multiagent chemotherapy is standard for the initial management of high-risk gestational trophoblastic neoplasia (GTN).