Gestational Trophoblastic Disease (GTD): Health Information

Gestational Trophoblastic Disease (GTD): A Comprehensive Guide

This information is intended to provide a general overview of Gestational Trophoblastic Disease (GTD). It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.

General Information

Gestational trophoblastic disease (GTD) is a rare group of tumours that develop from the tissue that normally forms the placenta after conception. While the majority of GTD tumours are benign (non-cancerous), some may become malignant (cancerous). It is important to note that the only definitive way to prevent GTD is by not becoming pregnant.

Types of Gestational Trophoblastic Disease

GTD is categorised into two main groups:

Hydatidiform Moles (HM)

Also known as a molar pregnancy, this is the most common type. In a molar pregnancy, abnormal tissue that can look like fluid-filled sacs forms in the uterus.

  • Partial Molar Pregnancy: The fertilised egg has normal DNA from the mother but two sets from the father. A foetus either does not fully develop or does not develop at all, and the placental cells are abnormal.
  • Complete Molar Pregnancy: The fertilised egg does not have DNA from the mother and has two sets from the father. The placental cells are abnormal, and no foetus forms.

Gestational Trophoblastic Neoplasia (GTN)

These are the malignant (cancerous) types of GTD.

  • Choriocarcinoma: A cancerous tumour formed from trophoblast cells that can spread into the muscles of the uterus, blood vessels, and other organs. It can grow and spread more quickly than other GTNs. It may sometimes develop from tissue remaining after a miscarriage or a healthy delivery.
  • Invasive Mole: Although a type of molar pregnancy, it is classified as a GTN due to its potential to grow and spread into the muscle layer of the uterus.
  • Placental-site Trophoblastic Tumour and Epithelioid Trophoblastic Tumour: These are rare tumours developing where the placenta attaches to the uterus. Symptoms can appear years after a full-term pregnancy, miscarriage, or treatment for a molar pregnancy.

Risk Factors

Factors that may increase a woman's risk of developing GTD include:

  • Being pregnant when younger than 20 or older than 35.
  • Having a previous molar pregnancy.
  • Previous miscarriage.
  • A higher risk is also noted for women from Southeast Asia and those with a low dietary intake of carotene.

The great majority of women with risk factors will not develop GTD. However, if risk factors are present, discussing them with a healthcare provider may lead to more frequent monitoring during early pregnancy.

Symptoms

These symptoms may be caused by Gestational Trophoblastic Disease, although they can also be due to other conditions. It is important to discuss any symptoms with a doctor, as they may signal other health issues. GTD symptoms may include:

  • Vaginal bleeding or discharge not related to a woman's menstrual periods.
  • A uterus that is larger than normal during pregnancy.
  • Pain or pressure in the pelvic area.
  • Severe nausea and vomiting during pregnancy.
  • High blood pressure accompanied by headache and swollen hands and feet during early pregnancy.
  • Vaginal bleeding that is longer than normal and/or irregular after delivery or miscarriage.
  • Fatigue, dizziness, and an irregular heartbeat caused by anaemia.
  • A positive pregnancy test long after delivery or miscarriage.

Diagnosis

At SSCHRC, our specialists, including pathologists, diagnostic radiologists, and highly trained technicians, utilise modern, accurate equipment to diagnose gestational trophoblastic disease and determine its stage. This enhances the likelihood of successful treatment.

Diagnostic Tests for Gestational Trophoblastic Tumour

The diagnosis process involves a review of the patient's medical history and a physical examination, and may include one or more of the following tests:

Pelvic Exam

Performed to assess the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.

Transvaginal Ultrasound

An ultrasound test using a small probe placed in the vagina to visualise the uterus and nearby tissue.

Blood Tests

Blood samples are used to measure specific markers, such as beta human chorionic gonadotropin (beta hCG), which may indicate gestational trophoblastic disease.

Additional Tests for Disease Spread

If cancer cells are identified, additional tests may be conducted to confirm if the disease has spread to other areas of the body. These may include:

  • Chest X-ray
  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans

Gestational Trophoblastic Tumour Staging

If a diagnosis of Gestational Trophoblastic Neoplasia (GTN) is confirmed, the doctor will determine the stage of the disease. Staging is a classification system that indicates the extent of the disease in the body and where it has spread. This information is vital for planning the optimal treatment strategy. The stages of GTD are set by FIGO, the International Federation of Gynecology and Obstetrics, ranging from Stage I to Stage IV. Higher stage numbers indicate more advanced cancer that is generally more challenging to treat. There is no staging system for benign hydatidiform moles.

The stages used for Gestational Trophoblastic Neoplasia (GTN) are:

Stage I

The tumour is confined to the uterus only.

Stage II

The tumour has spread beyond the uterus to areas such as the ovary, fallopian tube, vagina, and/or the connective tissues surrounding the uterus.

Stage III

The tumour has spread to the lung(s), which may or may not be accompanied by spread to the ovary, fallopian tube, vagina, and/or the connective tissues around the uterus.

Stage IV

The tumour has spread to distant parts of the body other than the lungs, such as the liver, abdominal cavity, and/or brain.

Treatment

The experts at SSCHRC have access to the most advanced technologies and therapies available today. Our doctors use this expertise to provide personalised treatment for Gestational Trophoblastic Disease. GTD is often curable, particularly when diagnosed early. Even advanced disease is frequently curable with appropriate treatment, underscoring the importance of seeking expert care as soon as possible after diagnosis.

Your customised treatment plan will be determined by your care team and based on several factors, including:

  • Your age when the diagnosis is made.
  • Whether the disease occurred after a molar pregnancy, a miscarriage, or a normal pregnancy.
  • How soon the tumour was diagnosed after the pregnancy began.
  • The level of beta human chorionic gonadotropin (hCG) in the blood.
  • The stage of the disease.
  • Your overall health and medical history.
  • Whether you wish to become pregnant in the future.

The primary treatments for Gestational Trophoblastic Disease are surgery and/or chemotherapy. Treatment for symptoms and side effects may also be included in the care plan. The three standard types of treatment are:

Surgery

  • Hysterectomy: Removal of the uterus (and sometimes the cervix). Nearby lymph nodes and a part of the vagina may also be removed.
  • Dilatation and Curettage (D&C) with Suction Evacuation: The cervix is dilated, and tissue inside the uterus is removed using a small vacuum-like device. A spoon-shaped instrument is then gently used to scrape the uterine walls and remove any remaining material.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells, control their growth, or relieve disease-related symptoms. Treatment may involve a single drug or a combination of two or more drugs, depending on the type and stage of the cancer and its rate of growth.

Radiation Therapy

Radiation therapy employs powerful, focused beams of energy to destroy cancer cells. Various techniques are used to precisely target the tumour while minimising harm to healthy tissue. While rarely used in GTN, radiation therapy may be considered in specific circumstances.

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