Materiały źródłowe

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

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

  Gestational trophoblastic neoplasia is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2% of partial hydatidiform moles. Lung metastases are found in 4-5% of patients with complete hydatidiform moles and rarely in cases of partial hydatidiform moles. […] Choriocarcinoma occurs in 1 out of 40 hydatidiform moles and in 1 out of 20,000-40,000 pregnancies. However, only 1 out of 160,000 term pregnancies is followed by a choriocarcinoma. […] The international rate of choriocarcinoma has been reported to be as high as 1 in 500-600 pregnancies in India to 1 in 50,000 pregnancies in Mexico, Paraguay, and Sweden. These differences are probably due to differences in methodology (eg, identification of cases, accuracy of denominator). […] In the United States, African Americans have the highest incidence of choriocarcinoma and the lowest survival rates. […] The incidence of choriocarcinoma increases with age and is 5-15 times higher in women 40 years and older than in younger women.

• #2 Sal-Like Protein 4-Negative Gestational Trophoblastic Neoplasia | Koi | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/922/565

  Gestational trophoblastic neoplasia (GTN) is a group of pregnancy-related malignancies caused by trophoblast cells, including invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). […] Choriocarcinoma is the most frequent GTN. Because of its rapid growth and strong tendency to metastasize, it is considered the most aggressive form of GTN. The incidence of choriocarcinoma is estimated to be 3 per 100,000 pregnancies in Europe and North America, compared to 23 per 100,000 in Southeast Asia. […] GTN may be cured in 98% of cases if a correct diagnosis is made initially. It is clearly important to distinguish choriocarcinoma from PSTT and ETT because their clinical management and prognosis differ significantly as mentioned above.

• #3 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. GTD is classified into hydatidiform moles (molar pregnancy), which are subclassified into complete and partial moles, and gestational trophoblastic neoplasia (GTN), which is subclassified into choriocarcinoma, invasive moles, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. […] GTN treatment typically starts with chemotherapy. […] Choriocarcinoma: a highly malignant GTN characterized by invasive, highly vascular, and anaplastic trophoblastic tissue without villi. […] The risk of malignant GTN is higher in complete mole than in partial mole. […] Monitor -hCG levels until undetectable, stable, or elevated levels are detected. […] The recurrence risk of hydatidiform mole in a subsequent pregnancy is 1.8%. […] Choriocarcinoma is preceded by: Hydatidiform mole, spontaneous abortion or ectopic pregnancy, term or preterm gestation. […] Treatment of choice: methotrexate or dactinomycin. […] Risk of recurrence.

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

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

  The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). […] In the United States, the reported incidence of choriocarcinoma, the most aggressive form of GTD, is about 2 to 7 per 100,000 pregnancies. […] The U.S. age-standardized (1960 World Population Standard) incidence rate of choriocarcinoma is about 0.18 per 100,000 women between the ages of 15 years and 49 years. […] 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.

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

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

  The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). […] In the United States, the reported incidence of choriocarcinoma, the most aggressive form of GTD, is about 2 to 7 per 100,000 pregnancies. […] The U.S. age-standardized (1960 World Population Standard) incidence rate of choriocarcinoma is about 0.18 per 100,000 women between the ages of 15 years and 49 years. […] Two factors have consistently been associated with an increased risk of GTD: maternal age and history of hydatidiform mole (HM). […] 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.

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

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

  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. […] The probability of cure depends on the following: histological type (invasive mole or choriocarcinoma), extent of spread of the disease/largest tumor size, level of serum beta-hCG, duration of disease from the initial pregnancy event to start of treatment, number and specific sites of metastases, nature of antecedent pregnancy, and extent of prior 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. […] Choriocarcinoma is a malignant tumor of the trophoblastic epithelium.

• #6 Gestational trophoblastic disease – Wikipedia

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

  Overall, GTD is a rare disease. Nevertheless, the incidence of GTD varies greatly between different parts of the world. The reported incidence of hydatidiform mole ranges from 23 to 1299 cases per 100,000 pregnancies. The incidence of the malignant forms of GTD is much lower, only about 10% of the incidence of hydatidiform mole. […] The reported incidence of GTD from Europe and North America is significantly lower than the reported incidence of GTD from Asia and South America. […] One proposed reason for this great geographical variation is differences in healthy diet in the different parts of the world (e.g., carotene deficiency). […] However, the incidence of rare diseases (such as GTD) is difficult to measure, because epidemiologic data on rare diseases is limited. Not all cases will be reported, and some cases will not be recognised. In addition, in GTD, this is especially difficult, because one would need to know all gestational events in the total population. Yet, it seems very likely that the estimated number of births that occur at home or outside of a hospital has been inflated in some reports.

• #7 Gestational Trophoblastic Disease – StatPearls – NCBI Bookshelf

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

  The true incidence of GTN is difficult to definitively quantify, as data concerning the total number of pregnancies and trophoblastic disease vary. Approximately 50% of GTN cases arise after a molar pregnancy, whereas 25% may develop after miscarriage, termination, or ectopic pregnancy; the remaining 25% may result after a preterm or term pregnancy. […] […] Choriocarcinoma is a very rare neoplasm with varied incidence worldwide. Choriocarcinoma composes less than 0.1% of primary ovarian neoplasms in a pure form. In the United States, choriocarcinoma occurs in approximately 1 in 20,000 to 40,000 pregnancies; 50% occur after term pregnancies, 25% after molar pregnancies, and 25% after other gestational events. In Europe, about 1 in 40,000 pregnant patients and 1 in 40 patients with HMs will develop choriocarcinoma. In Southeast Asia and Japan, 9.2 in 40,000 pregnant women and 3.3 in 40 patients with HMs will subsequently develop choriocarcinoma. In China, 1 in 2882 pregnant women will develop choriocarcinoma. This correlates with an increased risk for the development of choriocarcinoma in Asian, Native American, and Black women. […] […] In all populations, the incidence rates of both choriocarcinoma and HMs have declined over the past 30 years.

• #8 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. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] The incidence of hydatidiform mole varies worldwide with rates of 1-2 per 1000 pregnancies in Europe and North America compared with 10 per 1000 pregnancies in India and Indonesia. […] Choriocarcinoma is the most aggressive form of GTN with a reported incidence of one per 40000 pregnancies in Europe and North America compared with 9.2 per 40000 pregnancies in South East Asia. […] The risk of developing choriocarcinoma after a molar pregnancy is higher for CHM (23%) than PHM (1%).

• #9 Pathology Outlines – Choriocarcinoma

  https://www.pathologyoutlines.com/topic/placentachoriocarcinoma.html

  Epidemiology […] – Reproductive age […] – Female […] – History of previous pregnancy, most commonly complete hydatidiform mole […] – 1:40,000 pregnancies in U.S. and Europe, 3.3:40,000 in Japan and 9.2:40,000 in Southeast Asia (Int J Gynaecol Obstet 2018;143:79)

• #10 Gestational trophoblastic neoplasia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Gestational_trophoblastic_neoplasia_epidemiology_and_demographics

  The incidence in Europe ranges from 2 – 3 cases per 100,000 individuals. The incidence in Canada and Greenland is reported to be approximately 3 cases per 100,000 individuals. The reported incidence in Australia is 7 cases per 100,000 individuals. The incidence in Latin America is reported to be 2 cases per 100,000 individuals. The incidence in Saudi Arabia is reported to be 16 cases per 100,000 individuals. The incidence in Asia ranges from 5 – 202 cases per 100,000 individuals. The incidence in Nigeria is 99 cases per 100,000 individuals. […] The prevalence of choriocarcinoma in the United States is 0.075 – 0.01 cases per 100,000 individuals. The prevalence rates from Southeast Asia are 1.5 – 2.5 times higher. […] The 5-year overall mortality rate, after the exclusion of placental site trophoblastic tumors and epithelioid trophoblastic tumors, is 2%. High-risk patients have a 5-year mortality rate of 12%. Patients with an International Federation of Gynecology and Obstetrics (FIGO) score of 13 have a 5-year mortality rate of 38.4%.

• #10 Gestational trophoblastic neoplasia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Gestational_trophoblastic_neoplasia_epidemiology_and_demographics

  The reported incidence of choriocarcinoma in the United States is 2 to 7 per 100,000 pregnancies. The U.S. age-standardized (1960 World Population Standard) incidence rate of choriocarcinoma is approximately 0.18/100,000 women between the ages of 15 – 49 years. The prevalence of choriocarcinoma in the United States is 0.075 – 0.01 per 100, 000. The prevalence rates from Southeast Asia are 1.5 – 2.5 times higher. The 5-year overall mortality rate, after the exclusion of placental site trophoblastic tumors and epithelioid trophoblastic tumors, is 2%. High-risk patients have a 5-year mortality rate of 12%. Patients with an International Federation of Gynecology and Obstetrics (FIGO) score of 13 have a 5-year mortality rate of 38.4%. The incidence of gestational trophoblastic neoplasia is higher in the extremes of reproductive ages.

• #11 Gestational Trophoblastic Diseases | GLOWM

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

  The epidemiology of gestational choriocarcinoma has been less extensively studied, owing to problems in histologic control and fewer cases than those of hydatidiform mole. The single highest risk factor is prior hydatidiform mole; the incidence of choriocarcinoma is increased 1000-2000-fold compared with term pregnancy. […] The risk was increased approximately two-fold in nonwhites compared with whites. Increased risks were seen at the extremes of reproductive age groups, including an 8.6-fold increase among patients older than the age of 40. […] As is evident from these studies, the epidemiology of choriocarcinoma is very poorly understood and further efforts are needed to elucidate epidemiologic causal relationships.

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

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

  Chemotherapy is necessary when there is a rising beta-hCG titer for 2 weeks (3 titers), 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. […] 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). […] The results of a large, consecutive case series of 272 patients with up to 16 years of follow-up showed a complete remission rate of 78% using this regimen, and these results are consistent with other case series in the literature that employed EMA/CO.

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

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

  The relative risk of molar pregnancy is highest in those pregnancies at the extremes of the reproductive age group. […] Malignant GTD is often referred to as gestational trophoblastic neoplasia (GTN) to distinguish it from the benign forms of GTD, and can develop from a molar pregnancy or can arise after any gestational event, including a spontaneous or induced abortion, ectopic pregnancy or term pregnancy. […] Persistent GTN is usually diagnosed in asymptomatic women undergoing routine hCG monitor following evacuation of a molar pregnancy, accounting for greater than 90 percent of malignant GTN. […] Rates of persistent disease range from 15-25% after a complete mole and the majority of this is localized disease. […] About 4% of women will have metastatic disease. […] In contrast, only 0.5-5% of patients develop persistent disease after a partial mole.

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

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

  While GTN is rare after a partial mole, both localized or metastatic disease has been reported, emphasizing the importance of appropriate follow-up. […] Following evacuation of uterine contents, patients should be closely monitored and their care supervised by doctors with expertise in this condition, although this does not mean they must, out of necessity, be managed by a certified gynaecologic oncologist. […] We recommend quantitative hCG titres to be drawn weekly until three normal levels have been obtained. […] A plateau or rise in hCG is generally indicative of the development of persistent trophoblastic disease and usually requires chemotherapeutic treatment. […] 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).

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

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

  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. […] Gestational trophoblastic neoplasia (GTN) is diagnosed when there is clinical, radiologic, pathologic, and/or hormonal evidence of persistent or relapsed gestational trophoblastic disease. […] The management of persistent GTD is similar to the management of patients diagnosed with PSTT or choriocarcinoma at initial evaluation. […] 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.

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

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

  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. […] Despite the absence of randomized trials to prove its superiority, the combination of etoposide, methotrexate, and dactinomycin followed by cyclophosphamide and vincristine (EMA/CO) has become the preferred regimen for initial treatment of high-risk GTD in most countries. […] Current data shows a cure rate for high risk patients of 80-90%. […] 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. […] Patients with stage IV disease who enter complete remission are followed for 24 months given their increased risk of late relapse.

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

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

  In simplest terms, gestational trophoblastic disease (GTD) represents a spectrum of diseases which arise from abnormal trophoblastic tissue. […] Although these diseases are relatively rare, GTD is a highly curable disease process; nonetheless, accurate diagnosis and careful follow-up is essential in order to maximize the outcome for these patients. […] The classification system of GTD can be confusing and has undergone many different iterations. Recently, the International Federation of Gynecology and Obstetrics (FIGO) reissued new guidelines for the staging and diagnosis of GTD in hopes of trying to standardize the diagnosis and allow for more accurate comparison across different centres. […] The incidence of molar pregnancies ranges from 1:200-1:1000 pregnancies. […] There may be a higher incidence of molar pregnancies in Africa and Asia; however the varying standards in the frequency and accuracy of pathology and demographics make accurate comparisons difficult.

• #14 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. […] The use of chemotherapy in the first-line management of low-risk GTN has been assessed in a Cochrane Collaboration systematic review. […] The initial regimen is generally given until a normal beta human chorionic gonadotropin (beta-hCG) is achieved and sustained for 3 consecutive weeks. […] 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. […] 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.

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

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

  Most choriocarcinomas have an aneuploid karyotype, and about three-quarters of them contain a Y chromosome. […] Nearly all GTDs that are preceded by nonmolar pregnancies are choriocarcinomas; the rare exceptions generally are PSTTs. […] The FIGO staging system is as follows: Stage I Gestational trophoblastic tumors strictly confined to the uterine corpus. […] Stage II Gestational trophoblastic tumors extending to the adnexa or to the vagina, but limited to the genital structures. […] Stage III Gestational trophoblastic tumors extending to the lungs, with or without genital tract involvement. […] Stage IV All other metastatic sites. […] 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.

• #15 Gestational Trophoblastic Tumors

  https://www.cancernetwork.com/view/gestational-trophoblastic-tumors

  Overall, approximately 80% of cases of GTTs, are hydatidiform moles, 15% are chorioadenoma destruens, and 5% are choriocarcinomas. […] Choriocarcinoma is associated with an antecedent mole in 50% of cases, a history of abortion in 25%, term delivery in 20%, and ectopic pregnancy in 5%. […] True estimates of the incidence of molar pregnancies are difficult to obtain because of considerable worldwide variation in the presentation and management of both normal and abnormal pregnancies. […] Ethnic and racial differences also may contribute to the variable incidence of GTTs. […] Although the etiology of GTT is not well understood, the occurrence of this tumor has been associated with several factors: extremes of reproductive age (younger than 20 and older than 40 years), prior molar pregnancy, lower socioeconomic class, and particular ABO blood groups.

• #16 Gestational choriocarcinoma – Wikipedia

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

  Gestational choriocarcinoma is a form of gestational trophoblastic neoplasia, which is a type of gestational trophoblastic disease (GTD), that can occur during pregnancy. […] The amount and degree of choriocarcinoma spread to other parts of the body can vary greatly from person to person. […] Gestational choriocarcinoma can happen during and after any type of pregnancy event, though risk of the disease is higher in and after complete or partial molar pregnancies. […] Risk of disease may also be higher in those experiencing pregnancy at younger or older ages that average, such as below 15 years old or above 45 years old. […] Approximately 50% of those with gestational choriocarcinoma have experienced molar pregnancy, approximately 25% developed the disease after a regular, term pregnancy, and other situations have included history of ectopic pregnancy, where the pregnancy does not occur in the uterus.

• #16 Gestational choriocarcinoma – Wikipedia

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

  Guidelines from the Federation of Gynecologists and Obstetricians (FIGO), Royal College of Obstetricians and Gynaecologists (RCOG), European Society for Medical Oncology (ESMO), and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) exist to evaluate risk and treatment of the disease. […] There are generally three levels of risk: low risk, high risk, and ultrahigh risk. […] The primary form of treatment is chemotherapy with one or more agents. […] Depending on the risk of gestational trophoblastic disease (GTD) development, such as in certain people with mole pregnancies, chemotherapy has been used in a preventative manner in the past. […] However, this type of use is now advised against due to risk of toxicity and resistance to agents that may be needed in future treatment of the disease, on top of medical costs.

• #17 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). […] GTD (hydatidiform mole, invasive mole, choriocarcinoma, PSTT) is an uncommon occurrence in the UK, with a calculated incidence of 1 in 714 live births: […] There is evidence of ethnic variation in the incidence of GTD in the UK, with women from Asia having a higher incidence compared with non-Asian women (1 in 387 versus 1 in 752 live births, respectively). […] The incidence of GTD is associated with age at conception, being higher in the extremes of age (women aged less than 15 years, 1 in 500 pregnancies; women aged more than 50 years, 1 in 8 pregnancies).

• #17 Gestational Trophoblastic Disease | Doctor

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

  However, these figures may under-represent the true incidence of the disease because of problems with reporting, particularly in regard to partial moles. […] GTN may develop after a molar pregnancy, a non-molar pregnancy or a live birth. The incidence after a live birth is estimated at 1 in 50 000. […] Outcomes for women with GTN and GTD are better with ongoing management from GTD centres. The registration of affected women with a GTD centre represents a minimum standard of care. […] In the UK, the registration and treatment programme has a cure rate of 98-100%, and a chemotherapy rate of 0.5-1.0% for GTN after partial molar pregnancy and 13-16% after complete molar pregnancy. […] The outlook for women treated for GTN is generally excellent with an overall cure rate close to 100%. The cure rate for women with a FIGO score of 6 or less is almost 100%, while the rate for women with a score of 7 or greater is 94%.

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

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

  Women older than 40 years and younger than 20 years may be at higher risk. […] Gestational choriocarcinoma may look identical to hydatidiform mole. […] Gestational choriocarcinoma arises following known molar pregnancy (50%), miscarriage (30%), normal pregnancy (20%). […] 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%.

• #19 Multicenter Study of Persistent Gestational Trophoblastic Disease | Slone Epidemiology Center

  https://www.bu.edu/slone/research/studies/gestational-trophoblastic-disease/

  To assess the relationship of long-term oral contraceptive use and exposure to sexually transmitted diseases to the risk of persistent gestational trophoblastic disease. […] The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI = 0.8-6.4) and 1.8 (95% CI = 1.0-3.0), respectively. […] Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results.

• #20 Epidemiology of gestational trophoblastic diseases

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W2047202741

  The epidemiology of gestational trophoblastic diseases is unclear. Problems with collection and interpretation of differing data abound. Hydatidiform mole (HM) is associated with abnormal gametogenesis and/or fertilization. This is further influenced by age, ethnicity and a prior history of an HM suggesting a genetic basis for its aetiology. Whilst a prior HM is significant in the development of trophoblastic neoplasia there is no clear explanation for the development of gestational trophoblastic neoplasia in association with a normal gestation. The development and improvements in suction curettage, termination of pregnancy, contraceptive techniques, diagnostic imaging and biochemical testing have been associated not only with a fall in the birth rate, but also with a reduction in the incidence of trophoblastic diseases. Future study should examine the mechanism of malignant change in normal and abnormal trophoblast.

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

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

  The probability of cure depends on the following: Histological type (invasive mole or choriocarcinoma), extent of spread of the disease/largest tumor size, level of serum beta-hCG, duration of disease from the initial pregnancy event to start of treatment, number and specific sites of metastases, nature of antecedent pregnancy, extent of prior treatment. […] Beta-hCG is a sensitive marker to indicate the presence or absence of disease before, during, and after treatment. […] Treatment of hydatidiform mole (HM) is within the purview of the obstetrician/gynecologist and is not discussed separately here. […] However, since they carry a risk of persistence or progression to malignant gestational trophoblastic disease (GTD), they must be followed carefully with weekly serum human chorionic gonadotropin (hCG) levels to normalization.

• #22 Practice Guidelines: Gestational Trophoblastic Disease

  https://www.cancernetwork.com/view/practice-guidelines-gestational-trophoblastic-disease

  Gestational trophoblastic disease is a term applied to a rare group of tumors that have several common characteristics: the tumor cells arise in the fetal chorion during pregnancy; the vast majority of the tumors make human chorionic gonadotropin (hCG); the amount of hCG produced is proportional to the amount of viable tumor; and they are sensitive to a variety of cytotoxic chemotherapeutic agents. […] Gestational choriocarcinoma is the highly malignant form of gestational trophoblastic disease that, unfortunately, can arise in any form of pregnancy. […] Because of the rarity of it developing after a term delivery (1/12,000 to 1/40,000), it is not practical to follow patients after term deliveries or even miscarriages with hCG assays to detect malignant disease. […] The most useful measure of tumor activity is the pattern of beta-hCG levels.

• #22 Practice Guidelines: Gestational Trophoblastic Disease

  https://www.cancernetwork.com/view/practice-guidelines-gestational-trophoblastic-disease

  A reliable assay of hCG is critical for diagnosis, monitoring of response to therapy, defining complete response, and surveillance for recurrence. […] The two most commonly used staging classifications, the National Institutes of Health (NIH) clinical classification and the Bagshawe/WHO system are actually designed to allow the proper selection of chemotherapy rather than to plan surgery or radiation therapy. […] Patients in the childbearing age range who have evidence of progressive metastatic disease, an elevated level of hCG, and a history of a relatively recent pregnancy event should be evaluated to determine their risk category in either the NIH or the WHO classification system. […] The likelihood of gestational trophoblastic disease recurring after completion of chemotherapy is related to initial risk status.

• #23 Gestational Trophoblastic Disease | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4757-3943-5_4

  Gestational trophoblastic disease (GTD) includes disorders of placental development (hydatidiform mole) and neoplasms of the trophoblast [choriocarcinoma and placental site trophoblastic tumor (PSTT)]. A common feature of all of these trophoblastic lesions is that they produce human chorionic gonadotropin (hCG), which serves as a marker for the presence of persistent or progressive trophoblastic tissue. […] Identification and separation of the different pathologic forms of the disease are important, since they have different clinical presentations and behavior. […] Epidemiology of hydatidiform mole and choriocarcinoma. […] Epidemiology of gestational trophoblastic disease.

• #24 Gestational Trophoblastic Disease (GTD) Part I: Molar Pregnancy

  https://www.contemporaryobgyn.net/view/gestational-trophoblastic-disease-gtd-part-i-molar-pregnancy

  Post-evacuation SurveillanceWhy? To determine when pregnancy can be allowed To detect persistent trophoblastic disease (i.e. GTN) […] The Post-evacuation Surveillance. How? A baseline serum -hCG level is obtained within 48 hours after evacuation. Levels are monitored every 1 to 2 weeks while still elevated to detect persistent trophoblastic disease (GTN). […] Practically once hCG has normalized after molar evacuation, the possibility of GTN developing is very low.

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

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

  The diagnosis of GTN is largely based on a combination of obstetric history and elevated concentrations of hCG. […] 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. […] Obstetric management of molar pregnancy involves uterine evacuation and histopathological examination of the products of conception. […] 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.

• #26 FAQs – Charing Cross Gestational Trophoblast Disease Service

  https://www.hmole-chorio.org.uk/frequently-asked-questions/

  Molar pregnancies carry a risk of developing into persistent trophoblastic disease which needs further treatment most commonly with chemotherapy. Overall the risk of needing this treatment is about 1 in 10 after a complete molar pregnancy and 1 in 100 after a partial molar pregnancy. […] In the UK all cases of molar pregnancy should be registered for hCG (pregnancy test hormone) based follow-up. […] The abbreviation hCG is short for human Chorionic Gonadotrophin, the pregnancy test hormone that is detected in home pregnancy tests. […] Once the hCG level reaches normal and then for a further 6 weeks after that to kill off any residual cells. […] Women who have had one molar pregnancy do have an increased risk of developing another molar pregnancy when they are next pregnant. However this risk is still quite low, we would estimate it at around 1 in 100.

• #27 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. […] Choriocarcinoma is a very rare type of cancer that occurs in around one in 50,000 pregnancies. […] Although choriocarcinoma starts in the womb, it can spread to other parts of the body, most commonly, the lungs. […] 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.

• #28 Choriocarcinoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/choriocarcinoma-1?lang=us

  Choriocarcinoma is an aggressive, highly vascular tumor. When it is associated with gestation, it is often considered part of the spectrum of gestational trophoblastic disease; it is then termed gestational choriocarcinoma. When it occurs in the absence of preceding gestation, it is termed non-gestational choriocarcinoma (these occur most often in the ovary or testis). […] Gestational choriocarcinoma has an incidence rate of 1 in 20,000 – 30,000 pregnancies, with 50% arising from molar pregnancies. 25% arise from previous abortions, and ~22% occur following normal pregnancies. […] Trophoblastic cells have an affinity for blood vessels and therefore the tumors have a tendency to metastasize through the hematogenous route. […] Choriocarcinoma is one of the causes of cannonball metastases to the lungs. […] The tumor is aggressive in its behavior and metastases are frequent, with the lungs being a common site of metastasis. Despite its aggressiveness, it is generally highly chemosensitive and carries a much better cure rate than other comparable malignancies.

• #29 Gynaecological Cancers | ESMO

  https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-gynaecological-cancers/gestational-trophoblastic-disease-esmo-clinical-practice-guidelines

  First ever ESMO Clinical Practice Guideline in Gestational Trophoblastic Disease features incidence and epidemiology of a spectrum of disorders from pre-malignant conditions to malignant forms of the disease.

• #30

  https://link.springer.com/article/10.1007/BF00144796

  An epidemiological study with the aim of establishing the incidence of hydatidiform mole, persistent trophoblastic disease and choriocarcinoma in Stockholm County was performed. […] Non-molar choriocarcinoma occurred in 1/33,717 deliveries. […] Difficulties in assessing the incidence of gestational trophoblastic disease are discussed.

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