Gestational Trophoblastic Disease

Gestational trophoblastic diseases (GTD) can be of several forms. Symptoms can differ depending on the type of disease.

Hydatidiform mole or molar pregnancy

The most common form of GTD. It is called molar pregnancy when grape cluster-like shaped cysts develop in the uterus instead of a placenta or fetus. Even though you feel pregnant and a pregnancy test comes back positive, a prenatal ultrasound cannot show any evidence of a growing baby.

A pregnancy test result comes positive because the placenta produces pregnancy hormones. Hydatidiform moles can be complete or partial, and they come in both variations. Most of the time, a molar pregnancy is not cancer.

The most typical symptoms of a molar pregnancy include:

• Abnormal vaginal bleeding (red or watery brown)
• Occasionally, abdominal pain

Gestational trophoblastic neoplasia

A type of gestational trophoblastic disease that almost always results in cancer.

The following are the types of gestational trophoblastic neoplasia:

• Invasive moles: Are composed of trophoblast cells, which eventually form the uterine muscle layer. Compared to invasive moles, hydatidiform moles are less likely to grow and spread. A full or partial hydatidiform mole may rarely develop into an invasive mole. Untreated invasive moles may go away without treatment.
• Choriocarcinoma: A type of cancerous tumor that develops from trophoblast cells and spreads to the uterus' muscular layer and adjacent blood vessels. It can spread to other body organs, such as the brain, lungs, liver, kidney, spleen, intestines, pelvis, or vagina.
• Placental-site trophoblastic tumors: Rare and grow where the placenta attaches to the uterine wall. The tumor forms from trophoblast cells, which later invade the uterine muscle and blood vessels. They may affect the lymph nodes, pelvis, or lungs. The signs or symptoms may begin to appear months or even years after a typical pregnancy.
• Epithelioid trophoblastic tumors: Rare and can be benign or malignant. They may affect the lungs when the tumor is malignant.

Some people with the gestational trophoblastic disease (GTD) do not exhibit any symptoms. Others have signs that resemble pregnancy or other illnesses.

If any of the following symptoms apply to you, contact your doctor:

• Vaginal bleeding is irregular or not related to your period
• Abdominal or pelvic pain
• Prolonged vaginal bleeding following childbirth or a miscarriage
• A uterus that is larger than expected during pregnancy
• Nausea and vomiting during pregnancy
• Fatigue, shortness of breath, dizziness, and a fast or irregular heartbeat are caused by anemia
• Anxiety or irritability, including feeling shaky or experiencing severe sweating
• Sleep problems
• Unexplained weight loss
• High blood pressure at an early point in pregnancy, which may include headaches and/or swelling of the feet and hands
• Can cause overactive thyroid, resulting in:
  • Rapid heart rate
  • Loss of weight
  • Shakiness
  • Unexplained sweating

Hydatidiform moles do not have a staging system. The uterus is the only location for hydatidiform moles, which cannot spread to other body organs.

For gestational trophoblastic neoplasia, the following stages are employed:

1. Stage I: The tumor is exclusively present in the uterus.
2. Stage II: Tumors have progressed from the uterus to the ovary, fallopian tube, vagina, and/or connective tissues surrounding the uterus.
3. Stage III: Tumors have reached the lung and may or may not have spread to the ovary, fallopian tube, vagina, and/or the connective tissues surrounding the uterus.
4. Stage IV: Tumors have moved outside of the lungs to distant areas of the body.

There are three types of standard treatment for the gestational trophoblastic disease.

1. Surgery

Uses one of the following procedures to eliminate cancer:

• Dilatation and curettage with suction evacuation: A surgical treatment to eliminate aberrant tissue and fragments in the uterine lining. The cervix is dilated, and the uterine material is extracted using a tiny vacuum-like apparatus. After that, any debris that might still be inside the uterus is gently scraped off with a curette, a surgical instrument shaped like a spoon. Molar pregnancies could be treated using this method.
• Hysterectomy: Surgical removal of the uterus and occasionally, the cervix through the vagina. Other types of hysterectomies are:
  • Total abdominal hysterectomy is the procedure to remove the uterus and cervix through a significant abdominal incision.
  • Total laparoscopic hysterectomy is the procedure to remove the uterus and cervix through a tiny abdominal incision (cut).

2. Chemotherapy

Uses drugs to either eliminate cancer cells, stop them from increasing or slow their growth. The chemotherapy administration method depends on the type and stage of cancer or whether it is high- or low-risk.

• Systemic chemotherapy is done by administering medications orally, intravenously, and intramuscularly to reach cancer cells throughout the body.
• Regional chemotherapy is used to administer the medication directly into the cerebrospinal fluid, an organ, or a body cavity (such as the abdomen) to destroy cancer cells in those areas.

3. Radiation therapy

Eradicates cancer cells or stops them from proliferating. Radiation therapy uses high-energy X-rays or other forms of radiation.

Radiation therapy is of two types:

1. In external radiation therapy, a device outside the body directs radiation toward the tumor.
2. During internal radiation therapy, an encased radioactive substance in needles, seeds, wires, or catheters is placed into or near the tumor.