Gestational Trophoblastic Neoplasia

Dr Khalid Sait

FRCSC/Gynecologic Oncologist/Ass. Prof

KAUH/Jeddah / Saudi Arabia

khalidsait@yahoo.com

Key Words Group of disease with wide range of

neoplastic potential Create a lot of challenge for us in term of

diagnosis and treatment Diagnosis and management will depends

on the history, HCG level and metastasis work up

Clinical pathology of gestational trophoblastic disease

1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma

2- Intermediate trophoblastic cells derivative

Placental – site tumor

Risk Factors for Moler pregnancy Extremes of reproductive years Prior moler mole Prior spontaneous abortion Vit A deficiency Race ( Indonesia 1:85, USA 1:1500)

Clinical Features Large for date 50 % Hyper emesis 20 % Early PIH 5% Abscent FH ( except in partial mole or

twin pregnancy) Hyperthyroidism symptom and sign 5% Rarely presented with metastasis symptom

and sign

Management of molar pregnancy

Procedure Risk of Persistent GTT

Suction Evacuation

20 %

Hysterectomy 5%

Follow up of patient with molar pregnancy after evacuation

HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months

Contraception for 1 year Pelvic examination every 2 weeks until

normal,then every 3 months Check histopathology

If no proper decrease or BHCG start to increase

Persistent GTD

Indication for initiating treatment during post mole follow up Serum BHCG values rising more than 10 % for 2

wk ( 3 weekly titre) Serum BHCG values on plateau for 3 wk or

decline of less than 10 % Presence of metastasis Significant elevation of serum BHCG values after

reaching normal levels Choriocarcinoma or invasive mole on

histopathology HCG level still elevated 6 months after molar

evacuation HCG > 20000 miu/ml 4 weeks after evacuation

Work up of gestational trophoblastic neoplasia History and physical examination chest XR ( if neg CT ) Pretreatment HCG titre Hematological survey Serum chemistries CT of brain Ultrasound of pelvis Liver scan ( u/s or CT )

CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS

Benign 1) complete mole 2) Partial mole Malignant (invasive mole and

choriocarcinoma) 1) nonmetastatic

2) metastatic a) low risk b) high risk

Risk factors(malignant GTD)

1.Disease present more that 4m(long duration) or

2.pretreatment B-HCG greater than 40,000mlu/ml or

3.presence of met to sites other than lungs or vagina i,e liver or brain etc..

4. prior chemo 5 following Term pregnancy

CHEMOTHERAPY FOR GTN

NON METASTATIC or

GOOD PROGNOSIS METASTATIC

*Single agent chemotherapy

*survival 90-100%

METASTATIC POOR PROGNOSIS

*Combined

chemotherapy

* survival 50 %

REMISSION OF GTN

DISEASE REMISSION

NON METASTATIC 100 %

GOOD PROGNOSIS METASTATIC 100 %

POOR PROGNOSIS METASTATIC 66 %

TOTAL 92 %

SUMMARY

GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES

GTN

Dr Khalid Sait FRCSCAss. Prof of Gynecologic OncologyKAUH,Jeddah Saudi Arabiakhalidsait@yahoo.com

Q&A