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Gestational Trophoblastic Neoplasia. Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia khalidsait@yahoo.com. Key Words. Group of disease with wide range of neoplastic potential Create a lot of challenge for us in term of diagnosis and treatment
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Gestational Trophoblastic Neoplasia Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia khalidsait@yahoo.com
Key Words • Group of disease with wide range of neoplastic potential • Create a lot of challenge for us in term of diagnosis and treatment • Diagnosis and management will depends on the history, HCG level and metastasis work up
Clinical pathology of gestational trophoblastic disease • 1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma • 2- Intermediate trophoblastic cells derivative Placental – site tumor
Risk Factors for Moler pregnancy • Extremes of reproductive years • Prior moler mole • Prior spontaneous abortion • Vit A deficiency • Race ( Indonesia 1:85, USA 1:1500)
Clinical Features • Large for date 50 % • Hyper emesis 20 % • Early PIH 5% • Abscent FH ( except in partial mole or twin pregnancy) • Hyperthyroidism symptom and sign 5% • Rarely presented with metastasis symptom and sign
Follow up of patient with molar pregnancy after evacuation • HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months • Contraception for 1 year • Pelvic examination every 2 weeks until normal,then every 3 months • Check histopathology
Indication for initiating treatment during post mole follow up • Serum BHCG values rising more than 10 % for 2 wk ( 3 weekly titre) • Serum BHCG values on plateau for 3 wk or decline of less than 10 % • Presence of metastasis • Significant elevation of serum BHCG values after reaching normal levels • Choriocarcinoma or invasive mole on histopathology • HCG level still elevated 6 months after molar evacuation • HCG > 20000 miu/ml 4 weeks after evacuation
Work up of gestational trophoblastic neoplasia • History and physical examination • chest XR ( if neg CT ) • Pretreatment HCG titre • Hematological survey • Serum chemistries • CT of brain • Ultrasound of pelvis • Liver scan ( u/s or CT )
CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS • Benign 1) complete mole 2) Partial mole • Malignant (invasive mole and choriocarcinoma) 1) nonmetastatic 2) metastatic a) low risk b) high risk
Risk factors(malignant GTD) 1.Disease present more that 4m(long duration) or 2.pretreatment B-HCG greater than 40,000mlu/ml or 3.presence of met to sites other than lungs or vagina i,e liver or brain etc.. 4. prior chemo 5 following Term pregnancy
NON METASTATIC or GOOD PROGNOSIS METASTATIC *Single agent chemotherapy *survival 90-100% METASTATIC POOR PROGNOSIS *Combined chemotherapy * survival 50 % CHEMOTHERAPY FOR GTN
REMISSION OF GTN DISEASE REMISSION NON METASTATIC 100 % GOOD PROGNOSIS METASTATIC 100 % POOR PROGNOSIS METASTATIC 66 % TOTAL 92 %
SUMMARY GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES
Q&A GTN Dr Khalid Sait FRCSC Ass. Prof of Gynecologic Oncology KAUH,Jeddah Saudi Arabia khalidsait@yahoo.com