Malignant Gestational Trophoblastic Disease (GTD) Flashcards
(33 cards)
What are the malignant forms of gestational trophoblastic disease?
Choriocarcinoma, persistent hydatidiform mole, invasive mole, placental site trophoblastic tumour (PSTT)
What are key risk factors for GTD requiring chemotherapy?
Age ≥40, preceding molar pregnancy, long interval since last pregnancy, tumour size >5cm, hCG >10⁵ mIU/L, previous chemotherapy, large/multiple metastases
What is the WHO/FIGO scoring system used for in GTD?
To stratify risk and guide treatment planning (single vs multi-agent chemo)
What score indicates low-risk vs high-risk GTN?
0–7: Low-risk (single agent); >7: High-risk (multi-agent)
What is choriocarcinoma?
A highly invasive, rapidly growing, and metastasising trophoblastic tumour related to pregnancy
Which pregnancies are most likely to be followed by choriocarcinoma?
H. mole (50%), term pregnancy (25%), abortion (20%), ectopic pregnancy (5%)
What are the histological features of choriocarcinoma?
Cytotrophoblast + syncytiotrophoblast with no villi, necrosis, haemorrhage, vascular invasion
What is FIGO stage I of choriocarcinoma?
Disease limited to uterine corpus
What is FIGO stage IV of choriocarcinoma?
Distant metastases (brain, liver, GIT)
What are common clinical signs of choriocarcinoma?
Irregular post-pregnancy bleeding
What metastatic symptoms may occur in choriocarcinoma?
Haemoptysis, breathlessness, neurological symptoms, jaundice, vaginal nodules
How is choriocarcinoma diagnosed?
High β-hCG levels and clinical suspicion post-pregnancy with irregular bleeding
What is the expected timing for hCG to return to normal after various pregnancy outcomes?
H. mole: 84–100 days; abortion: 19–30 days; delivery: 12 days; ectopic: 8–9 days
What investigations are necessary before chemotherapy?
FBC, RFT, LFT, HIV, CXR, pelvic USS, brain imaging, serial quantitative β-hCG
What drugs are commonly used for chemotherapy in GTN?
Methotrexate, Actinomycin D, 5-FU, Vincristine, Cyclophosphamide, Etoposide, Chlorambucil
What is the treatment principle for low-risk GTN?
Single-agent chemotherapy (e.g., Methotrexate or Act-D)
What is the standard chemotherapy regimen for high-risk GTN?
EMA-CO regimen (Etoposide, MTX, Act-D, Cyclophosphamide, Vincristine)
What are common toxic effects of chemotherapy in GTN?
Bone marrow suppression, GI ulceration, liver/renal dysfunction
How is follow-up done after treatment of GTN?
Repeat β-hCG every 1–2 weeks; continue treatment until undetectable + 2 cycles; monitor monthly for 1 year
Why should women avoid pregnancy for one year after chemotherapy?
To avoid confusion with rising hCG levels that could indicate relapse
What are the surgical options in the treatment of GTN?
Hysterectomy, internal iliac artery ligation, embolization, metastasis resection (thoracotomy, craniotomy)
What is an invasive mole?
A molar pregnancy that invades the myometrium or vasculature
What are key pathological features of invasive mole?
Penetrative behaviour, extensive local invasion, trophoblastic proliferation, preserved villi
How does invasive mole differ from choriocarcinoma?
Presence of villi in invasive mole (absent in choriocarcinoma)
