Gestational Trophoblastic Disease: Symptoms, Causes, Treatment

What are the symptoms of gestational trophoblastic disease?

Gestational trophoblastic disease (GTD) is a group of rare tumors that develop in the cells that form the placenta during pregnancy. The symptoms of GTD can vary depending on the specific type of GTD and whether it is benign (non-cancerous) or malignant (cancerous). Common symptoms of GTD may include:

1. Vaginal Bleeding: This is the most common symptom of GTD and may range from light spotting to heavy bleeding.
2. Abnormal Uterine Size: The uterus may be larger than expected for the stage of pregnancy or may continue to grow after a normal pregnancy would have ended.
3. Pelvic Pain or Pressure: Some women with GTD may experience pelvic pain or a feeling of pressure in the pelvis.
4. Hyperemesis Gravidarum: Severe nausea and vomiting, known as hyperemesis gravidarum, can occur in women with GTD.
5. Anemia: Prolonged or heavy vaginal bleeding can lead to anemia, which can cause symptoms such as fatigue and weakness.
6. Preeclampsia or High Blood Pressure: Some women with GTD may develop preeclampsia, a condition characterized by high blood pressure and protein in the urine.
7. Ovarian Cysts: Some types of GTD, such as a complete mole, may cause the ovaries to develop cysts.
8. Respiratory Symptoms: In rare cases, GTD can spread to the lungs, causing symptoms such as coughing, shortness of breath, or chest pain.

It’s important to note that these symptoms can also be caused by other conditions, and most women with these symptoms do not have GTD. However, if you experience any of these symptoms during or after pregnancy, it’s important to see a healthcare provider for evaluation and diagnosis. Gestational trophoblastic disease is a treatable condition, especially when diagnosed early.

What are the causes of gestational trophoblastic disease?

Gestational trophoblastic disease (GTD) is caused by abnormal growth of the cells that would normally develop into the placenta during pregnancy. There are several types of GTD, each with its own causes:

1. Hydatidiform Mole (Molar Pregnancy): A complete hydatidiform mole occurs when a sperm fertilizes an empty egg, resulting in a tumor with no fetal tissue. A partial hydatidiform mole occurs when two sperm fertilize a single egg, resulting in a tumor with some fetal tissue. The exact cause of hydatidiform moles is not well understood, but it is thought to be related to abnormalities in the genetic material of the egg or sperm.
2. Gestational Trophoblastic Neoplasia (GTN): GTN includes invasive moles, choriocarcinomas, and placental site trophoblastic tumors. These tumors develop from abnormal placental tissue and are thought to occur when the cells that form the placenta grow and multiply uncontrollably. The exact cause of GTN is unknown, but it may be related to genetic factors or hormonal imbalances.
3. Molar Pregnancy Aftermath (Post-Molar GTN): In some cases, a molar pregnancy (either complete or partial) may be followed by the development of GTN. This occurs when some of the abnormal placental tissue is left behind after the molar pregnancy is removed and begins to grow and multiply uncontrollably.

Risk factors for GTD include:

• Prior molar pregnancy
• Age (women under 20 or over 35 are at higher risk)
• History of miscarriage or infertility
• Asian ethnicity

While the exact causes of GTD are not fully understood, early detection and treatment can lead to successful outcomes in most cases.

How is the diagnosis of gestational trophoblastic disease made?

The diagnosis of gestational trophoblastic disease (GTD) often begins with a physical examination and a review of your medical history and symptoms. To confirm the diagnosis and determine the specific type of GTD, your healthcare provider may recommend several tests, including:

1. Pelvic Exam: A pelvic exam may be performed to check for any abnormalities, such as an enlarged uterus or abnormal growths.
2. Ultrasound: An ultrasound scan uses high-frequency sound waves to create images of the uterus and other pelvic organs. This can help detect the presence of a molar pregnancy or other types of GTD.
3. Blood Tests: Blood tests may be done to measure levels of certain hormones and tumor markers, such as human chorionic gonadotropin (hCG), which is often elevated in women with GTD.
4. Tissue Biopsy: If GTD is suspected, a biopsy may be performed to remove a small sample of tissue from the uterus for examination under a microscope. This can help confirm the diagnosis and determine the specific type of GTD.
5. Chest X-ray or CT Scan: These imaging tests may be done to check for the spread of GTD to the lungs or other parts of the body, especially in cases of more advanced or aggressive disease.

Once a diagnosis of GTD is confirmed, further tests may be done to determine the stage of the disease and plan the appropriate treatment. Treatment options for GTD may include surgery, chemotherapy, or a combination of both, depending on the type and stage of the disease. Early detection and treatment of GTD are important for achieving a successful outcome.

What is the treatment for gestational trophoblastic disease?

The treatment for gestational trophoblastic disease (GTD) depends on several factors, including the type of GTD, the stage of the disease, and the patient’s overall health and desire for future pregnancies. The main treatment options for GTD include:

1. Surgery: Surgery may be used to remove molar tissue from the uterus in cases of hydatidiform mole (molar pregnancy) or to remove tumors in cases of invasive mole or choriocarcinoma. In some cases, a hysterectomy (removal of the uterus) may be recommended, especially for women who do not wish to have more children or who have a high-risk GTD.
2. Chemotherapy: Chemotherapy is often used to treat GTD, especially in cases of high-risk disease or disease that has spread to other parts of the body. Chemotherapy drugs are usually given intravenously and work by killing cancer cells or stopping them from growing and multiplying.
3. Radiation Therapy: Radiation therapy may be used in some cases to treat GTD, especially if the disease is localized to a specific area, such as the uterus or the lungs. Radiation therapy uses high-energy beams to target and destroy cancer cells.
4. Monitoring and Follow-Up: After treatment, regular monitoring and follow-up are important to check for any signs of recurrence or complications. This may include regular physical exams, blood tests, and imaging tests such as ultrasound, CT scans, or chest X-rays.

The specific treatment plan for GTD is determined by a multidisciplinary team of healthcare providers, including gynecologic oncologists, medical oncologists, and radiation oncologists. The goal of treatment is to cure the disease, preserve fertility if desired, and minimize the risk of recurrence. With appropriate treatment, the prognosis for most women with GTD is excellent, especially for those with low-risk disease.