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FRCR CO2A Clinical Oncology > GTN FRCR CO2A > Flashcards

GTN FRCR CO2A Flashcards

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1
Q

which 2 hospitals provide Rx to GTN in UK?

A

Charing Cross hospital in London

Weston Park Hospital in Sheffield

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2
Q

What are different types of GTT?

A
  1. premalignant : partial and complete molar pregnancy
  2. Invasive: Choriocarcinoma and Placental Site Trophoblastic Tumor (PSTT)
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3
Q

What’s the Normal Range of B-HCG in premenopausal lady?

A

0 to 4 IU/L

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4
Q

What’s the Normal Range of B-HCG in postmenopaual lady?

A

upto 15 IU/L

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5
Q

what’s the peak level of B-HCG in pregnancy and when does it occur?

A

200,000 IU/L at week 8 to 12

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6
Q

By what time B-HCG falls to normal value post partum?

A

3 weeks

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7
Q

What’s the significance of elevated B-HCG in the absence of Pregnancy?

A

Very strong e/0 malignancy

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8
Q

what are the causes of elevated B-HCG in the absence of Pregnancy?

A
  1. Gestational or Germ Cell tumors
  2. other malignancy e.g. lung, stomach and bladder
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9
Q

what is partial mole?

A

The trophoblast cells are triploid (69 chromosomes)

2 sets of paternal and 1 set of maternal

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10
Q

what causes partial mole?

A

ovum fertilized by 2 sperm

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11
Q

What’s the risk of change of partial mole to invasive mole?

A

1:100

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12
Q

what’s the common presentation of partial mole?

A

Bleeding in the 1st trimester or failed pregnancy

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13
Q

How is partial mole managed?

A

suction or medical evacuation and despite the low risk of malignant transformation, it is recommended, all patients undergo HCG follow up and monitoring

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14
Q

what is complete mole?

A

loss of maternal DNA and genetic material is of male origin only

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15
Q

what’s the mc chromosome count in complete mole ?

A

46 XX, results from single X duplication

less frequently 46 XY, empty ovum fertilized by two spermH

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16
Q

How does complete mole look on USG?

A

Complex echogenic intrauterine mass with numerous cystic spacesH

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17
Q

what’s the risk of malignant change of complete mole to malignancy?

A

14%

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18
Q

How is complete mole managed?

A

suction evacuation

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19
Q

Who develops recurrent molar pregnancies?

A

Familial Hydatiform mole, defect in NALP7 gene

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20
Q

What are FIGO recommendations for Rx after evacuation of molar pregnancy?

A
  1. an hCG level plateau of four values ±10% recorded over a 3-week duration (days 1, 7, 14 and 21);
  2. an hCG level increase of more than 10% of three values recorded over a 2-week duration (days 1, 7 and 14);
  3. persistence of detectable hCG for more than 6 months after molar evacuation.
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21
Q

What are malignant forms of GTT?

A
  1. invasive mole
  2. Choriocarcinoma
  3. Placental Site Trophoblastic Tumor
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22
Q

What is an invasive mole ?

A

An invasive mole generally arises from a complete mole and

is characterised by invasion of the myome- trium, which can lead to

perforation of the uterus.

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23
Q

is biopsy recommended for choriocarcinoma?

A

In suspected cases a tissue biopsy is often hazardous because of the risk of bleeding and is best avoided, as usually a clinical diagnosis can be made safely.

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24
Q

what are characteristic histological features of choriocarcinoma?

A

sheets of syncytiotrophoblast or cytotrophoblast cells with haemorrhage, necrosis and intravascular growth.

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25
what are Pretreatment investigations in GTT patients?
1. an updated serum hCG level 2. a Doppler ultrasound of the pelvis and 3. a chest X-ray.
26
what investigations are used for choriocarcinoma and PSTT?
fully staged with CT scans of the thorax, abdomen and pelvis and MRI scans of the pelvis and the brain.
27
FIGO staging for GTT
Stage I Tumour confined to the uterus Stage II Tumour extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament) Stage III Tumour extends to the lungs with or without genital tract involvement Stage IV Tumour involves all other metastatic sites
28
What's the Rx for low risk disease?
intramuscular methotrexate given with oral folinic acid rescue,
29
How is treatment for low risk disease GTT monitored?
A hCG levels checked twice a week and following hCG normalisa- tion, treatment is continued for another three complete cycles (6 weeks) to ensure the eradication of any residual disease present below the level of serological detection.
30
what to do who have an inadequate response to methotrexate, as shown by an hCG plat- eau or increase ?
move on to second-line therapy. single-agent actinomycin-D at 1.5 mg/m2 on day 1 of a 14-day cycle or EMA-CO combination chemother- apy dependent on the hCG level at the time of change.
31
what's the treatment for High Risk GTT?
EMA-CO chemotherapy
32
33
What is gestational trophoblastic disease (GTD)?
A rare complication of pregnancy involving tumours like invasive mole, choriocarcinoma, and placental site trophoblastic tumour (PSTT)
34
What percentage of complete moles develop into an invasive mole?
15%
35
What percentage of complete moles may develop into choriocarcinomas?
3%
36
What are the risk factors for gestational trophoblastic disease?
* Age (<16 and >40 years) * Previous molar pregnancy * Asian origin
37
What characterizes choriocarcinoma?
Absence of chorionic villi with sheets of anaplastic cyto- and syncytiotrophoblasts
38
What are common clinical features of persistent trophoblastic disease?
* Irregular vaginal bleeding * Persistently elevated serum beta-hCG
39
What is the commonest site of metastasis for GTD?
Lung
40
What is the follow-up procedure for women after evacuation of a molar pregnancy?
Serum beta-hCG estimation
41
What percentage of women may need chemotherapy for persistent GTD?
5–10%
42
What defines low-risk disease in FIGO-WHO prognostic scoring? GTD
Total score of ≤6
43
What defines high-risk disease in FIGO-WHO prognostic scoring? GTD
Total score of ≥7
44
What is the treatment of choice for low-risk GTD?
Single agent chemotherapy, commonly methotrexate or dactinomycin
45
What are the indications for chemotherapy in persistent trophoblastic disease?
* Serum hCG >20,000 iu/l after evacuations * Static or rising hCG levels after evacuations * Persistent hCG elevation six months post-evacuation * Persistent vaginal bleeding with raised hCG levels * Pulmonary metastasis with static or rising hCG levels * Metastasis in liver, brain, or GI tract * Histological diagnosis of choriocarcinoma
46
What are the stages of FIGO staging for GTD?
* Stage I – Disease confined to uterus * Stage II – Disease beyond uterus but confined to genital structures * Stage III – Lung metastasis with or without genital tract involvement * Stage IV – Distant metastasis other than lung
47
What is the common chemotherapy regime for high-risk GTD?
Combination chemotherapy with or without surgery
48
What percentage of patients may be resistant to treatment or relapse after initial treatment? GTN
20–30%
49
What is the treatment of choice for placental site trophoblastic tumour (PSTT) limited to the uterus?
Hysterectomy
50
How is response to treatment assessed in patients receiving chemotherapy for low-risk GTD?
Weekly hCG monitoring after one course of chemotherapy
51
What is advised regarding conception after treatment for GTD?
Women are advised not to conceive for at least 12 months after treatment
52
What is the risk associated with chemotherapy in terms of future pregnancies?
Chemotherapy generally results in early menopause
53
What is the risk of second tumours after GTD treatment?
Risk of acute myeloid leukemia (AML)
54
55
What serum hCG level indicates the need for chemotherapy in persistent trophoblastic disease?
>20,000 iu/l after one or two uterine evacuations ## Footnote Indicates a significant elevation that may require treatment.
56
What is a sign of persistent trophoblastic disease after uterine evacuations?
Static or rising hCG levels after one or two uterine evacuations ## Footnote Suggests that the disease is not resolving as expected.
57
What defines persistent hCG elevation in relation to uterine evacuation?
Persistent hCG elevation six months post-uterine evacuation ## Footnote Indicates ongoing disease activity.
58
What symptom combined with raised hCG levels may indicate the need for chemotherapy?
Persistent vaginal bleeding with raised hCG levels ## Footnote Sign of potential malignancy or ongoing disease.
59
What does pulmonary metastasis with static or rising hCG levels indicate?
Need for chemotherapy ## Footnote Indicates advanced disease requiring treatment.
60
What types of metastasis require chemotherapy in persistent trophoblastic disease?
* Metastasis in liver * Metastasis in brain * Metastasis in GI tract ## Footnote Indicates widespread disease that is more challenging to treat.
61
What histological diagnosis necessitates chemotherapy in trophoblastic disease?
Choriocarcinoma ## Footnote A malignant form of gestational trophoblastic disease.
62
What characterizes FIGO Stage I of GTD?
Disease confined to uterus ## Footnote Indicates localized disease without spread.
63
What characterizes FIGO Stage II of GTD?
Disease beyond uterus but confined to genital structures ## Footnote Suggests more advanced disease but still within a limited area.
64
What characterizes FIGO Stage III of GTD?
Lung metastasis with or without genital tract involvement ## Footnote Indicates significant disease spread requiring more aggressive treatment.
65
What characterizes FIGO Stage IV of GTD?
Distant metastasis other than lung ## Footnote Represents the most advanced stage of the disease.
66
What are the first-line chemotherapy treatments for low-risk GTD?
* Methotrexate with folinic acid * D-actinomycin ## Footnote Standard treatments for low-risk cases to minimize adverse effects.
67
What is the salvage chemotherapy regimen for low-risk GTD?
MEA (methotrexate, etoposide, and dactinomycin) ## Footnote Used when first-line treatments are ineffective.
68
What is the first-line chemotherapy for high-risk GTD?
EMA/CO (methotrexate, etoposide, dactinomycin/cyclophosphamide and vincristine) ## Footnote More aggressive treatment for higher risk patients.
69
What is the salvage chemotherapy for high-risk GTD?
EMA/EP (methotrexate, etoposide, dactinomycin/etoposide, cisplatin) ## Footnote Used when first-line therapies fail in high-risk cases.

FRCR CO2A Clinical Oncology (35 decks)

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