Gestational Trophoblastic disease Flashcards
(43 cards)
What is Gestational Trophoblastic Disease (GTD)?
Gestational Trophoblastic Disease (GTD) refers to a group of rare diseases that involve abnormal proliferation of placental trophoblastic cells. It includes conditions like hydatidiform mole (complete or partial), gestational trophoblastic neoplasia (GTN), choriocarcinoma, and placental site trophoblastic tumors.
What are the types of diseases included under GTD?
The diseases under GTD include:
Hydatidiform mole (complete or partial)
Gestational Trophoblastic Neoplasia (GTN)
Choriocarcinoma
Placental site trophoblastic tumors
What is a Hydatidiform Mole?
A Hydatidiform Mole is a type of GTD characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta. It can be complete, where all the placental tissue is abnormal, or partial, where some normal placental tissue is present.
What is Gestational Trophoblastic Neoplasia (GTN)?
Gestational Trophoblastic Neoplasia (GTN) is a malignant form of GTD that can develop after any type of pregnancy but is most common following a molar pregnancy. It is characterized by persistent high levels of hCG and can metastasize to other organs.
What is the significance of a complete molar pregnancy in GTD?
A complete molar pregnancy is a major risk factor for developing GTN. About 20% of women with a complete molar pregnancy develop malignant disease.
What is the most common early sign of Gestational Trophoblastic Neoplasia (GTN)?
The most common early sign of GTN is irregular or heavy vaginal bleeding following a molar pregnancy, miscarriage, or delivery
What are common symptoms of GTN related to elevated hCG levels?
Symptoms related to elevated hCG levels in GTN include persistent nausea and vomiting (hyperemesis), excessive tiredness, and signs of hyperthyroidism.
What are the potential metastatic symptoms of GTN?
Hemoptysis (coughing up blood) if lung metastases are present
Neurological symptoms like headaches, dizziness, or seizures if brain metastases are involved
Abdominal pain due to liver metastases
How can GTN present in terms of uterine size?
GTN can present with an abnormally large uterus for the gestational age, often due to the rapid growth of the abnormal trophoblastic tissue
What are some systemic signs of GTN that indicate the disease has progressed?
Systemic signs of advanced GTN include respiratory distress (due to lung involvement), jaundice (from liver involvement), and signs of central nervous system involvement, such as confusion or seizures.
What is the first step in managing a patient suspected of having Gestational Trophoblastic Neoplasia (GTN)?
The first step is to perform initial investigations, which include a vaginal ultrasound, chest X-ray, and vaginal examination. If metastatic lesions are found, additional imaging of the liver and brain should be performed.
What is the standard treatment approach for low-risk GTN?
Low-risk GTN (FIGO score ≤ 6) is treated with single-agent chemotherapy, typically methotrexate.
How is high-risk GTN managed?
High-risk GTN (FIGO score > 6) requires initial multiple-drug chemotherapy. Etoposide
Methotrexate (MTX)
Actinomycin D
Leucovorin calcium
Cyclophosphamide
Vincristine
When might a hysterectomy be considered in the management of GTN?
A hysterectomy may be considered for women who have completed childbearing and have disease confined to the uterus, or in cases of Placental Site Trophoblastic Tumor, which is less responsive to chemotherapy.
What additional treatment might be necessary for patients with brain metastasis from GTN?
Patients with brain metastasis from GTN may require radiation therapy in addition to chemotherapy.
What is the significance of follow-up in the management of GTN?
Follow-up is crucial to ensure the disease does not persist or recur. It includes serial hCG monitoring, clinical examinations, and avoiding pregnancy until hCG levels are undetectable
What is Persistent Gestational Trophoblastic Neoplasm (GTN)?
Persistent GTN refers to the condition where the trophoblastic disease continues after initial treatment, usually following a molar pregnancy, and is characterized by continued elevated levels of hCG or the presence of metastatic disease.
What are the main signs indicating Persistent GTN?
The main signs of Persistent GTN include persistently elevated or rising hCG levels after the evacuation of a molar pregnancy, abnormal uterine bleeding, and evidence of metastasis.
How is Persistent GTN diagnosed?
Persistent GTN is diagnosed through serial hCG measurements that remain elevated or rise after treatment, along with imaging studies such as ultrasound, chest X-ray, and, if necessary, liver and brain imaging
What is the treatment approach for Persistent GTN?
Persistent GTN is treated with chemotherapy, and the regimen is based on the FIGO Prognostic Score Index. Low-risk patients receive single-agent chemotherapy (methotrexate), while high-risk patients require multiple-drug chemotherapy
What is the role of surgery in managing Persistent GTN?
Surgery, such as a hysterectomy, may be considered for patients with Persistent GTN confined to the uterus, especially if they have completed childbearing. Surgery is required in cases of Placental Site Trophoblastic Tumor, which is less responsive to chemotherapy
Why is follow-up important in cases of Persistent GTN?
Follow-up is crucial to monitor the response to treatment and detect any recurrence early. It involves regular hCG measurements, clinical assessments, and avoiding pregnancy until hCG is undetectable
What role does a vaginal examination play in the investigation of GTN?
A vaginal examination is performed to assess for metastatic lesions in the vagina and suburethral area, although biopsy of these lesions should be avoided due to the risk of hemorrhage.
Why is serial hCG measurement important in GTN?
Serial hCG measurement is crucial for diagnosing and monitoring GTN, as persistently elevated or rising levels after treatment indicate the presence of persistent or metastatic disease.
