Gestational Trophoblastic Disease 4

Question 1

What patients are at the highest risk for postmolar gestational trophoblastic neoplasia?

Answer 1

• Uterine size > dates or >20 week size
• Theca-lutein cysts
• Age > 40
• Very high hCG levels
• Medical complications: toxemia, hyperthyroidism, trophoblastic embolization
• Repeat hydatidiform mole

Question 2

What are the important factors in regards to the clinical evaluation of patients with gestational trophoblastic neoplasia?

Answer 2

• History
• Physical examination
• CXR (chest CT if negative)
• Abdominal-pelvic CT scan
• Brain CT scan or MRI
• CBC and platelets
• Serum chemistries
• hCG level

Question 3

What are the features of low risk metastatic gestational trophoblastic neoplasias?

Answer 3

• hCG < 40,000 mIU/mL serum
• Sx present for < 4 months
• No brain or liver metastases
• No prior chemotherapy
• Pregnancy event not term delivery
• Nonmetastatic disease
• Metastatic disease (Stage II-III)
  
  • WHO/FIGO score < 7
  • Not FIGO stage IV

Question 4

What are the features of a high risk gestational trophoblastic neoplasia?

Answer 4

• hCG >100,000 IU/24-hr urine or > 40,000 mIU/mL serum
• Sx present for > 4 months
• Brain or liver metastases
• Prior chemotherapy failure
• Antecedent term pregnancy
• FIGO stages II & III, risk score >7
• FIGO stage IV

Question 5

Describe the FIGO clinical staging of gestational trophoblastic neoplasia?

Answer 5

• Stage I - Tumor strictly contained to the uterine corpus
• Stage II - Tumor extends outside the uterus, but is limited
• to the genital structures
• Stage III - Tumor extends to the lungs with or without
• genital tract involvement
• Stage IV - Tumor metastatic to any other site