Current management of gestational trophoblastic disease

Abstract

© 2014 Elsevier Ltd. Gestational trophoblastic disease is a rare pregnancy-related disorder. It comprises of partial mole, complete mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. Novel immunohistochemical technologies have helped in the diagnosis of the disease and some of the genes may also serve as prognostic markers. Partial and complete moles can be treated by suction evacuation and most patients do not require further treatment. However, 10-20% of them may develop gestational trophoblastic neoplasia. The International Federation of Obstetrics and Gynaecology has adopted a staging system with incorporation of the modified World Health Organization scoring system. Low-risk disease is treated by single-agent chemotherapy while high-risk disease is treated by multi-agent chemotherapy. The overall cure rate is more than 90% and most patients can preserve fertility and anticipate normal pregnancy outcomes. Nevertheless, the disease can recur. Referral to a specialist centre is important to ensure proper monitoring and management.