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Gestational Trophoblastic Disease (GTD)

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A group of rare diseases, which are characterized by the formation of abnormal trophoblast cells in the uterus after conception or fertilization, is called gestational trophoblastic disease. It develops during the early stages of pregnancy. Adolescents and women of advanced maternal age (40 to 50 years) are more likely to develop gestational trophoblastic disease. Most gestational trophoblastic diseases are benign (non-cancerous). However, some are malignant and can spread to other areas.

Types of Gestational Trophoblastic Disease

The common types of gestational trophoblastic diseases are:

  • Hydatidiform mole: It is the most common type of gestational trophoblastic disease that originates and stays in the uterus. It is also called a molar pregnancy.
  • Choriocarcinoma: It is the most aggressive form of gestational trophoblastic disease. It spreads throughout the pelvis and other sites, such as the kidneys, liver, brain, and lungs.
  • Invasive moles: Invasive moles rarely spread outside the uterus and develop from the hydatidiform moles.
  • Placental-site trophoblastic tumor (PSTT): PSTT develops from the placenta and is very slow-growing.

Symptoms of Gestational Trophoblastic Disease

The general symptoms of gestational trophoblastic disease are:

  • Pain, pressure, and swelling in the pelvis
  • Unusual discharge from the vagina
  • Headache
  • Swelling of feet and hands during pregnancy
  • Severe nausea and vomiting
  • A larger uterus than expected during the pregnancy
  • Shortness of breath 
  • Dizziness
  • Fatigue

Causes of Gestational Trophoblastic Disease

The following factors enhance the risk of gestational trophoblastic disease, such as:

  • A large tumor in the uterus
  • High blood pressure during pregnancy
  • Early pregnancy (before 20 years) and late pregnancy (after 35 years)
  • Increased levels of hCG (beta-human chorionic gonadotropin) hormone
  • A larger ovarian cyst (more than 6 centimeters)
  • Severe nausea and vomiting during pregnancy
  • Serious blood clotting problems
  • Trophoblastic cells in the blood cause a blockage in small blood vessels.
  • An overactive thyroid gland
  • A history of miscarriage

Diagnosis of Gestational Trophoblastic Disease

The common tests performed for the diagnosis of gestational trophoblastic tumors are:

  • Pelvic Examination: The gynecologist examines the uterus for any lumps or changes in its shape.
  • Serum Tumor Marker Test: It measures the level of beta-human chorionic hormone produced during pregnancy. An increased level of hCG may indicate gestational trophoblastic disease.
  • Pap Smear: A sample of tissue is collected from the cervix and examined under the microscope to check for gestational trophoblastic disease, infection, or inflammation.
  • Ultrasonography: A small instrument called a transducer is placed in the vagina to look at the uterus and nearby tissues and help detect the gestational trophoblastic tumor.
  • Urine Test: The gestational trophoblastic disease alters the amount of protein, sugar, and certain hormones in the urine.
  • Spinal Tap: This test helps check for the spread of gestational trophoblastic disease in the brain and spinal cord. The doctor examines the cerebrospinal fluid from the sample of liquid collected from the spinal column.
  • Blood Tests: Doctors use blood samples to determine the levels of certain hormones that may be affected by the presence of gestational trophoblastic disease.
  • Chest X-ray: Chest X-rays check if the gestational trophoblastic disease has spread to your lungs.
  • Computerized Tomography: CT scan helps detect the gestational trophoblastic disease and its metastasis outside the uterus.
  • Magnetic Resonance Imaging: The MRI is used to look at gestational trophoblastic disease, a tumor in the uterus wall, and its metastasis to the lungs, brain, and spinal cord.
  • Positron Emissions Tomography Scan: PET scans look for a gestational trophoblastic disease that has spread outside the uterus or a gestational trophoblastic tumor that comes back after treatment.

Treatment of Gestational Trophoblastic Disease

The three standard procedures used for the treatment of gestational trophoblastic disease are:

Surgery: The doctor performs surgery for gestational trophoblastic disease based on the stage of the tumor. In this, the irregular cells and tissues are removed from the uterus. Common surgical operations for gestational trophoblastic disease include:

  • Dilation and Curettage: The doctor dilates the cervix and removes the abnormal tissue from the uterus and cervical canal using the curettage.
  • Hysterectomy: The doctor removes the complete uterus along with the cervix.

Chemotherapy: Chemotherapy is a type of systematic therapy used to treat gestational trophoblastic disease. It is very effective in treating molar pregnancy and gestational trophoblastic neoplasia. In addition, a multidrug chemotherapy regimen is currently in use for the treatment of gestational trophoblastic disease, vastly improving women’s fertility options and survival rate.

Radiation therapy: It is used for advanced-stage gestation trophoblastic disease when chemotherapy is not working or when the tumor recurs after treatment. It can be administered internally or externally. The radiation therapy given depends on the location and type of gestational trophoblastic disease being treated. It works by killing or preventing the growth of rapidly developing and diving cells of trophoblastic tumors. 

Frequently Asked Questions

1. What is the prognosis of gestational trophoblastic disease?

The prognosis of the gestational trophoblastic disease is very good, even if it has spread to other areas. The cure rate of high-risk gestational trophoblastic disease is almost 75% with chemotherapy.

2. Is it possible to prevent gestational trophoblastic disease?

Gestational trophoblastic disease is very rare, and most risk factors cannot be avoided. However, if you have a high risk of developing this condition, get a consultation from a genetic counselor. 

3. Is gestational trophoblastic disease cancerous?

It can be cancerous or non-cancerous. Most gestational trophoblastic diseases are benign but are at great risk of becoming malignant.

4. Can I get pregnant after gestational trophoblastic disease treatment?

Pregnancy after gestational trophoblastic disease depends on the type of treatment you had. You could try to get pregnant if you had dilation and curettage surgery. However, it is not possible if the complete uterus is removed during a hysterectomy.

5. What to expect after the GTD treatment?

After the treatment, you will have regular follow-ups with doctors for almost two years to check for the recurrence of GTD. You also need to undergo certain tests and physical exams every 3 to 6 months to check how the treatment is working.

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