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Path Prezi

Gestational Trophoblastic Disease Management and Treatment

Steven McGuire

on 12 May 2010

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Transcript of Path Prezi

Diagnosis, Management, and Treatment of 3 types of GTD Gestational trophoblastic disease (GTD) is a proliferative disorder of trophoblastic cells Hydatidiform mole (complete or partial)
Persistent/invasive gestational trophoblastic neoplasia (GTN)
Placental site trophoblastic tumors noninvasive, localized tumors that develop as a result of an aberrant fertilization event that leads to a proliferative process. They comprise 90 percent of GTD cases.
Virtually all metastatic GTD is Choriocarcinoma

1 in 16,000 normal gestations,
1 in 15,000 abortions,
1 in 40 complete molar pregnancies. Choriocarcinoma — 50% arise from complete mole
25% arise after normal pregnancies
25% after spontaneous abortion or ectopic pregnancy Complete and partial hydatidiform moles Quick Background/Review 1 2 Evaluation
and Diagnosis Consider GTD in any premenopausal woman with abnormal vaginal bleeding. If hCG is High Do ultrasound R/O pregnancy (normal, ectopic, spontaneous abortion) * Usually Higher than Normal or Ectopic pregnancies of same gestational age A complete history, physical examination,
and Lab Workup will be key Complete mole —
The absence of an embryo or fetus
No amniotic fluid
"snowstorm pattern" Partial mole —
A fetus is present, may be viable, and is often growth restricted
Amniotic fluid is present, but may be reduced
Often misdiagnosed as missed or incomplete abortion Choriocarcinoma
mass enlarging the uterus,
heterogeneous appearance that correlates with areas of necrosis and hemorrhage
usually markedly hypervascular on color Doppler 3 Diagnosis -

histologic examination of tissue
Monitor b-HCG Management
and Treatment Molar Pregnancy Initial management is suction curettage
pathologic confirmation of the diagnosis,
relief of symptoms
prevent complications
definitive therapy for most patients
may opt for hysterectomy Post-Molar Monitoring for signs of persistent GTN

Occurs in 18-28% of Pts.


Looking for 3 normal values (+6mos) Choriocarcinoma Highly sensitive to chemotherapy
>90% remission for Stage I
>80% for Low risk Stage II & III but can require combo therapy
78% for High risk Stage II &III but require 5 agent combo Stage I
All patients with persistently elevated beta-hCG levels and tumor confined to the uterus.
Stage II
The presence of tumor outside of the uterus, but limited to the vagina and/or pelvis.
Stage III
Pulmonary metastases with or without uterine, vaginal, or pelvic involvement.
Stage IV
All other metastatic sites (eg, brain, liver, kidneys, gastrointestinal tract) (MTX is most common, Dactinomycin is alternative) etoposide, methotrexate, and dactinomycin followed by cyclophosphamide and vincristine (EMA/CO) 45-60% for Stage IV with EMA/CO Surgery
excise sites of bulky and/or resistant tumor
Suction Curettage
Hysterectomy Post Treatment monitoring
again using b-HCG as marker Content Borrowed Heavily from UpToDate

Thank you for your time.

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