GTD Flashcards

1
Q

GTD consists of

A

Hydatidiform mole (partial and complete)
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour
Atypical placental site nodule

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2
Q

Complete molar pregnancies are

A

46XX
Anucleic ovum fusing with one sperm (85%) or with two sperm (15%)

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3
Q

Partial molar pregnancies are

A

Triploid (90%) or tetraploid/mosaic (10%)

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4
Q

Incidence of GTD

A

1 in 714 births

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5
Q

Incidence of GTN after live birth

A

1 in 50000

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6
Q

Cure rate in U.K.

A

98-100%

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7
Q

Chemotherapy rate after partial molar pregnancy

A

0.5-1%

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8
Q

Chemotherapy rate after complete molar pregnancy

A

13-16%

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9
Q

Recurrence risk after 1 molar pregnancy

A

1 in 80

80% same histological type

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10
Q

Recurrence risk after 2 molar pregnancies

A

1 in 6.5

80% same histological type

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11
Q

Choriocarcinoma metsastatic sites

A

Lungs (cannon ball mets)
Kidneys
Spleen
GI tract
Brain
Liver

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12
Q

Signs of GTD

A

Irregular vaginal bleeding
Positive UPT
Sonographic appearance
Enlarged uterus
Hyperemesis
Hyperthyroidism
Early onset PET
Abdominal distension with theca lutein cysts
Haemoptysis
Seizures

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13
Q

Oxytocin is safe?

A

Not recommended

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14
Q

Cervical preparation prior to SEVAC is safe?

A

Yes

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15
Q

Follow up for complete mole

A

6 months if HCG normalises within 56 days
OR
6 months from normalisation of HCG

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16
Q

Follow up for partial mole

A

Concluded on normal HCG x 2 4 weeks apart

17
Q

Avoid pregnancy for how long after chemotherapy?

A

1 year

Early conception associated with stillbirth, LGA and abortion in some studies (not definitive)

18
Q

Treatment for placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT)

A

Hysterectomy
Does not respond to chemotherapy

19
Q

Pregnancy rate after chemotherapy?

A

80%

20
Q

IUD Contraception safety

A

MEC 1 if HCG is undetectable

MEC 3 if decreasing HCG

MEC4 if HCG persistently elevated or malignant disease

21
Q

Progesterone contraception safety

A

MEC 1

22
Q

COCP safety

A

MEC 1

23
Q

Treatment for FIGO score 6 or less

A

Methotrexate for 1 week alternating daily with folinic acid then 6 days rest

24
Q

Treatment for FIGO score 7 or above

A

Multi-agent with:
Methotrexate
Dactinomycin
Etoposide
Cyclophosphamide
Vincristine

Continue until 6 after normalised HCG

25
Q

FIGO 2000 scoring criterion

A

Age
Antecedent pregnancy
Months from index pregnancy to Rx
Pretreatment serum HCG
Largest tumour size (cm)
Size of mets
Number of mets
Previous failed chemotherapy

26
Q

Twin pregnancy with viable fetus and co-existing molar pregnancy management

A

Counsel about risks
Invasive testing for karyotype

27
Q

Twin pregnancy outcomes

A

Early fetal loss 40%
Preterm birth 36%
PET 20%

No affect on outcome after chemo