Treatment of Gestational Trophoblastic Disease
What is gestational trophoblastic disease?
Gestational trophoblastic disease (GTD) are tumors that grow in the uterus (womb) during pregnancy. These tumors typically start as cells, known as trophoblasts, which then develop in the placenta. The placenta is the female organ that connects the fetus to the uterus, ensuring adequate oxygen and nutrients for the fetus to grow and develop. With GTD, the trophoblasts grow abnormally, instead of in the healthy placenta.
Most cases of GTD occur early in pregnancy and are also classified as molar pregnancies. GTD is a rare complication of pregnancy, where a benign (noncancerous) tumor develops from the trophoblast once an egg is fertilized. Some cases end up developing into cancer and spreading; however, GTD is treatable and often curable, and most women end up having healthy pregnancies in the future.
When does gestational trophoblastic disease happen?
While most cases of GTD occur in early pregnancies, GTD can also occur after a miscarriage, abortion, tubal pregnancy (the fertilized egg implants in the fallopian tube), or normal pregnancy.
What are the types of gestational trophoblastic disease?
Numerous types of trophoblastic disease exist, and symptoms are based upon the type of GTD:
- Hydatidiform mole or molar pregnancy: The most common forms of GTD. Commonly referred to as molar pregnancy, this occurs when cysts grow in the uterus, instead of the placenta. Although receiving a positive pregnancy test, no fetus is found in the prenatal ultrasound; the positive pregnancy test is, instead, a result of the pregnancy hormone being made inside the placenta.
- Persistent/invasive molar pregnancy: Often the result of a molar pregnancy, and an invasive molar grows within the uterine muscle. This type of GTD is typically cancerous and can spread to other parts of the body.
- Choriocarcinoma: A cancerous form of GTD that is known for growing and spreadly quickly. Although rare, it’s more common for women who have already experienced a molar pregnancy.
- Placental site trophoblastic tumor (PSTT): An extremely rare type of GTD, where the placenta attaches itself to the uterus. Identified as slow-growing, the symptoms of PSTT can appear years after pregnancy.
- Epithelioid trophoblastic tumors (ETT): Another extremely rare type of GTD, where the cancer can spread to the lungs and develop years post-pregnancy.
What causes gestational trophoblastic disease?
In normal pregnancies, an egg is fertilized by the sperm, and it contains all the right information to create an embryo and placenta. The embryo becomes a fetus, while the trophoblast cell becomes part of the placenta. In molar pregnancies, the fertilization did not happen correctly, and the embryo, therefore, does not develop correctly, and thereafter the trophoblastic cells grow into tumors, instead of into a healthy placenta.
What are the risk factors for gestational trophoblastic disease?
Although rare, gestational trophoblastic disease has certain risk factors that may increase your risk. These risk factors may include:
- People older than 35 years or younger than 20 years old are at a higher risk for GTD.
- Having prior molar pregnancies.
- Strong family history of molar pregnancies.
What are the signs of gestational trophoblastic disease?
While some women do not experience symptoms, others may have symptoms that closely relate to pregnancy and other conditions or diseases. Call your health care provider if you are experiencing any of these symptoms of GTD:
- Irregular vaginal bleeding that’s unrelated to your period.
- A uterus that measures large for your expected pregnancy.
- Pain in the abdominal or pelvic area.
- Nausea or vomiting earlier than expected in pregnancy.
- High blood pressure or swollen hands/feet early in pregnancy.
- Prolonged vaginal bleeding post-childbirth or miscarriage.
Gestational trophoblastic disease can also cause an overactive thyroid. Signs of an overactive thyroid can include:
- Fast heartbeat.
- Shakiness.
- Unexpected weight loss.
- Excessive sweating.
How is gestational trophoblastic disease diagnosed?
After completing a review of your medical history, a physical exam, and other tests to examine your uterus, diagnosing GTD may include one or more of the following:
- Pelvic exam: to check for signs of the disease, like lumps and masses.
- Ultrasound: to create a picture of your internal organs.
- Blood tests: to measure the amount of certain substances in your body, like elevated amounts of human chorionic gonadotropin (hCG) hormone levels.
Once GTD is diagnosed, your health care provider may order additional tests to analyze if the cancer cells have spread to other parts of the body. Some of the tests to stage GTD could include:
- Computed tomography (CT scan): Using a series of X-rays to produce 3D images of tissues and bones.
- Magnetic resonance imaging (MRI): Using magnet and radio waves to make a more detailed picture of the body.
- Chest X-ray: Using focused radiation beams to assess lungs and other organs.
What are treatment options for gestational trophoblastic disease?
For gestational trophoblastic disease, the Gynecologic Oncology Multidisciplinary Team at Karmanos Cancer Institute designs individualized treatment plans based on the GTD type, size, and location, if the tumor has spread, and if the tumor occurred during or after a pregnancy or miscarriage. Speaking with your cancer expert will allow you to find the best treatment option for you.
Early detection is one of the most powerful weapons in the fight against cancer. When it comes to world-class cancer care close to home, look no further than Karmanos.
Information includes gestational trophoblastic disease, causes, risk factors, diagnosis and treatment.