What are gestational trophoblastic tumors?
Gestational trophoblastic tumor, a rare cancer in women, is a disease in which
cancer (malignant) cells grow in the tissues that are formed following
conception (the joining of sperm and egg). Gestational trophoblastic tumors
start inside the uterus, the hollow, muscular, pear-shaped organ where a baby
grows. This type of cancer occurs in women during the years when they are able
to have children. There are two types of gestational trophoblastic tumors:
hydatidiform mole and choriocarcinoma.
If a patient has a hydatidiform mole (also called a molar pregnancy), the sperm
and egg cells have joined without the development of a baby in the uterus.
Instead, the tissue that is formed resembles grape-like cysts. Hydatidiform mole
does not spread outside of the uterus to other parts of the body.
If a patient has a choriocarcinoma, the tumor may have started from a
hydatidiform mole or from tissue that remains in the uterus following an
abortion or delivery of a baby. Choriocarcinoma can spread from the uterus to
other parts of the body. A very rare type of gestational trophoblastic tumor
starts in the uterus where the placenta was attached. This type of cancer is
called placental-site trophoblastic disease.
Gestational trophoblastic tumor is not always easy to find. In its early stages,
it may look like a normal pregnancy. A doctor should be seen if the there is
vaginal bleeding (not menstrual bleeding) and if a woman is pregnant and the
baby hasn’t moved at the expected time.
If there are symptoms, a doctor may use several tests to see if the patient has
a gestational trophoblastic tumor. An internal (pelvic) examination is usually
the first of these tests. The doctor will feel for any lumps or strange feeling
in the shape or size of the uterus. The doctor may then do an ultrasound, a test
that uses sound waves to find tumors. A blood test will also be done to look for
high levels of a hormone called beta-HCG (beta human chorionic gonadotropin)
which is present during normal pregnancy. If a woman is not pregnant and HCG is
in the blood, it can be a sign of gestational trophoblastic tumor.
The chance of recovery (prognosis) and choice of treatment depend on the type of
gestational trophoblastic tumor, whether it has spread to other places, and the
patient’s general state of health.
Stage Explanation
Stages of gestational trophoblastic tumors
Once gestational trophoblastic tumor has been found, more tests will be done to
find out if the cancer has spread from inside the uterus to other parts of the
body (staging). Treatment of gestational trophoblastic tumor depends on the
stage of the disease and the patient’s age and general health. The following
stages are used for gestational trophoblastic tumor:
Hydatidiform mole
Cancer is found only in the space inside the uterus. If the cancer is found in
the muscle of the uterus, it is called an invasive mole (choriocarcinoma
destruens).
Placental-site gestational trophoblastic tumors
Cancer is found in the place where the placenta was attached and in the muscle
of the uterus.
Nonmetastatic
Cancer cells have grown inside the uterus from tissue remaining following
treatment of a hydatidiform mole or following an abortion or delivery of a baby. Cancer has not spread outside the uterus.
Metastatic, good prognosis
Cancer cells have grown inside the uterus from tissue remaining following
treatment of a hydatidiform mole or following an abortion or delivery of a baby.
The cancer has spread from the uterus to other parts of the body. Metastatic
gestational trophoblastic tumors are considered good prognosis or poor
prognosis.
Metastatic gestational trophoblastic tumor is considered good prognosis if all
of the following are true:
- The last pregnancy was less than 4 months ago.
- The level of beta-HCG in the blood is low.
- Cancer has not spread to the liver or brain.
- The patient has not received chemotherapy earlier.
Metastatic, poor prognosis
Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following an abortion or delivery of a baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered good prognosis or poor prognosis.
Metastatic gestational trophoblastic tumor is considered poor prognosis if any the following are true:
- The last pregnancy was more than 4 months ago.
- The level of beta-HCG in the blood is high.
- Cancer has spread to the liver or brain.
- The patient received chemotherapy earlier and the cancer did not go away.
- The tumor began after the completion of a normal pregnancy.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the uterus or in another part of the body.
Treatment Option Overview
How gestational trophoblastic tumor is treated
Different types of treatment are available for patients with gestational
trophoblastic tumor. Some treatments are standard (the currently used
treatment), and some are being tested in clinical trials. A treatment clinical
trial is a research study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the new
treatment may become the standard treatment. Patients may want to think about
taking part in a clinical trial. Some clinical trials are open only to patients
who have not started treatment.
Two kinds of standard treatment are used: surgery (taking out the cancer) and
chemotherapy (using drugs to kill cancer cells). Radiation therapy (using
high-energy x-rays to kill cancer cells) may be used in certain cases to treat
cancer that has spread to other parts of the body.
The doctor may take out the cancer using one of the following operations:
Dilation and curettage (D & C) with suction evacuation is stretching the opening
of the uterus (the cervix) and removing the material inside the uterus with a
small vacuum-like device. The walls of the uterus are then scraped gently to
remove any material that may remain in the uterus. This is used only for molar
pregnancies.
Hysterectomy is an operation to take out the uterus. The ovaries usually are not
removed in the treatment of this disease.
Chemotherapy uses drugs to kill cancer cells. It may be taken by pill or put
into the body by a needle in a vein or muscle. It is called a systemic treatment
because the drugs enter the bloodstream, travel through the body, and can kill
cancer cells outside the uterus. Chemotherapy may be given before or after
surgery or alone.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink
tumors. Radiation may come from a machine outside the body (external-beam
radiation therapy) or from putting materials that produce radiation
(radioisotopes) through thin plastic tubes into the area where the cancer cells
are found (internal radiation).
Treatment in a clinical trial
For some patients, taking part in a clinical trial may be the best treatment
choice. Clinical trials are part of the cancer research process. Clinical trials
are done to find out if new cancer treatments are safe and effective or better
than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical
trials. Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will
be treated in the future. Even when clinical trials do not lead to effective new
treatments, they often answer important questions and help move research
forward.
Some clinical trials only include patients who have not yet received treatment.
Other trials test treatments for patients whose cancer has not gotten better.
There are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side effects of cancer treatment.
Hydatidiform Mole
Treatment may be one of the following:
- Removal of the mole using dilation and curettage (D & C) and suction evacuation.
- Surgery to remove the uterus (hysterectomy).
Following surgery, the doctor will follow the patient closely with regular blood
tests to make sure the level of beta-HCG in the blood falls to normal levels. If
the blood level of beta-HCG increases or does not go down to normal, more tests
will be done to see whether the tumor has spread. Treatment will then depend on
whether the patient has nonmetastatic disease or metastatic disease (see the
treatment sections on metastatic or nonmetastatic disease).
Placental-Site Gestational Trophoblastic Tumors
Treatment will probably be surgery to remove the uterus (hysterectomy).
Nonmetastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
Chemotherapy
Surgery to remove the uterus (hysterectomy) if the patient no longer wishes to have children.
Good Prognosis Metastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
- Chemotherapy
- Surgery to remove the uterus (hysterectomy) followed by chemotherapy.
- Chemotherapy followed by hysterectomy if cancer remains following chemotherapy.
Poor Prognosis Metastatic Gestational Trophoblastic Tumors
Treatment will probably be chemotherapy. Radiation therapy may also be given to
places where the cancer has spread, such as the brain.
Recurrent Gestational Trophoblastic Tumors
Treatment will probably be chemotherapy.
For more information on NCI's Clinical Trials Registry, go to www.cancer.gov/clinicaltrials.
Source: National Institutes of Health; National Cancer Institute
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/26/2008...#6130
