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Gestational Trophoblastic Disease (GTD) 101

From the GYN Cancer Articles List

GTD 101What is gestational trophoblastic disease (GTD)?

Gestational trophoblastic disease (GTD) is a rare condition in which tumors develop in the uterus in conjunction with a pregnancy. Gestational refers to the development of an embryo.Trophoblast is the layer of cells that surround the embryo. "Tropho" refers to nutrition, and "blast" means early developmental cell. And neoplasia is tumor growth or formation. In the United States, GTD occurs in about 1 in 1,000 pregnancies, and most cases are benign. If you have had a GTD tumor in the past, there is a slight increase in your risk for having another one.

These tumors are made up of abnormal cells that normally make up the placenta during a pregnancy. GTD is treatable, even the cancerous forms, and most women will be cured. Most forms do respond to chemotherapy, but two of them do not. When GTD invades or metastasizes, it is referred to as gestational trophoblastic neoplasia (GTN) and is almost always malignant.

There are five main types of gestational trophoblastic disease (GTD):

HYDATIDIFORM MOLE (HM)
This is the most common type of gestational trophoblastic disease. It is sometimes known as a molar pregnancy. Hydatidiform moles can be either complete (fertilized egg contains no DNA from the mother) or partial (fertilized egg contains two sets of DNA from the father), but neither are viable pregnancies. Though these moles are benign, they can sometimes become cancerous. Surgery, usually a suction dilation and curettage (D&C), can completely remove most moles.

According to the National Cancer Institute (NCI), having an hydatidiform mole with the following risks factors can increase your chances of it becoming cancer:
  • Pregnancy before age 20 or after age 35.
  • Very high hCG (beta human chorionic gonadotropin) levels
  • Large tumor in the uterus
  • Ovarian cyst greater than 6 centimeters
  • High blood pressure during pregnancy
  • Overactive thyroid gland
  • Severe nausea and vomiting during pregnancy
  • Trophoblastic cells in the blood
  • Serious blood clotting problems caused by the HM

INVASIVE MOLE
This type of mole invades the muscular layer of the uterus and is usually malignant. It begins as either a complete or partial mole, though a complete mole is much more likely to become invasive than a partial mole. This type of tumor can penetrate through the uterine wall and cause dangerous bleeding into the abdomen.

The American Cancer Society (ACS) states that risk of developing an invasive mole increases for women with these factors:
  • Over 4 months since the last period and treatment
  • Uterus is enlarged
  • Over 40 years of age
  • Previous GTD

UTERINE CHORIOCARCINOMA
Uterine choriocarcinoma is an uncommon, malignant form of gestational trophoblastic disease. It is very aggressive and much more likely to grow quickly and spread to other organs, but it is usually curable with a good prognosis. This cancer usually occurs within one year of a pregnancy. Half of all uterine choriocarcinomas are believed to begin as a complete molar pregnancy, 25% develop following a miscarriage, abortion, or tubal pregnancy, and the remaining 25% percent may develop following a normal pregnancy. This type of cancer typically responses very well to chemotherapy, so surgery may not be necessary.

The following symptoms can increase your risk for uterine choriocarcinoma:
  • Complete hydatidiform mole
  • Pregnancy
  • Tubal pregnancy
  • Miscarriage
  • Abortion
  • Prior HM
  • Younger than 20 and older than 40

PLACENTAL-SITE TROPHOBLASTIC TUMOR (PSTT)
This rare tumor develops where the placenta attaches to the wall of the uterus. It invades the myometrium and spreads into blood vessels. Though it can also metastasize to other parts of the body, it usually does not. This tumor is slow growing and may appear months or years following a pregnancy. PSTT makes up only about 1% of all GTD. This type of tumor does not respond to chemotherapy, so a type of surgery, like a hysterectomy, is needed to remove it completely.

Risk factors for PSTT include:
  • Pregnancy
  • Miscarriage
  • Abortion
  • Prior HM
  • Younger than 20 and older than 40

EPITHELIOID TROPHOBLASTIC TUMOR (ETT)
This tumor is the rarest of all gestational trophoblastic neoplasia (GTN) and may be benign or malignant. It occurs most often after a normal pregnancy, but it may not show up for several years. As result, it may have already spread by the time it has been diagnosed. Like PSTT, this type of tumor does not respond to chemotherapy; instead, some type of surgery, like a hysterectomy, is necessary to remove it completely.

Risk factors for PSTT include:
  • Pregnancy
  • Miscarriage
  • Abortion
  • Prior HM
  • Younger than 20 and older than 40


This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

03-18-2014 - 02:55 PM


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