Gestational trophoblastic disease

Abstract

Gestational trophoblastic disease composed of a spectrum of abnormal trophoblastic proliferation. The benign end is molar pregnancy. Changes in the incidence, clinical presentation and criteria for ultrasonic diagnosis were observed over the years. With the help of cytogenetics, differentiation of hydropic degeneration, partial and complete mole is possible but still confined to research setting. Suction evacuation remained the main stay of treatment. Serum human chorionic gonadotrophin (hCG) monitor has to be performed in all post-molar pregnancy and the right choice of assay kit is mandatory to avoid false negative or positive results. The criteria for diagnosing persistent gestational trophoblastic neoplasia (GTN) has been agreed and reported in the FIGO 2000 Gynecologic Oncology Committee Report. Investigative tools were also recommended in the same report. The revised FIGO 2000 staging and classification in GTN has incorporated both anatomical staging and risk score classification modified from WHO. A cutoff of six inclusive was recommended to allocate patients into low and high risk groups. Appropriate treatment using single agent such as methotrexate in low risk group and multiple agents such as EMA-CO in high risk group usually resulted in a high cure rate. In drug resistant disease, multiple agents chemotherapy with and without adjuvant surgery or radiotherapy can salvage over 80% of patients. However, patients with both liver and brain metastasis stands a lower chance of survival. To achieve the best outcome for patients with gestational trophoblastic disease, patients should be managed in centers with experience. © 2003 Elsevier Science B.V. All rights reserved.