Gestational trophoblastic disease (GTD) are tumors that start in your uterus (womb) related to pregnancy. The tumors start off as cells called trophoblasts, which typically develop into the placenta of pregnancy. The placenta is an organ that connects your unborn baby to your uterus (and you), providing all the oxygen and nutrients the baby needs to grow. With gestational trophoblastic disease, the trophoblasts (placenta-like cells) grow abnormally, instead of a healthy placenta.
Most cases of GTD occur early in pregnancy, soon after sperm fertilizes an egg, and are called molar pregnancies. Despite being called pregnancies, these cells don’t develop into a fetus that will develop into a baby. They’re typically non-cancerous (benign), although some can be cancerous and spread to nearby tissues or organs. Most importantly, GTD is treatable and curable, and most people can go on to have healthy pregnancies in the future.
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While most common during the beginning of a pregnancy, GTD can also occur:
There are several types of gestational trophoblastic disease. Symptoms vary depending on the type.
Hydatidiform moles are the most common form of GTD. Commonly called a molar pregnancy, it happens when grape-like cysts grow in your uterus instead of a placenta or a fetus. You may feel pregnant and get a positive pregnancy test, but find no baby growing during a prenatal ultrasound. The positive pregnancy test is due to the pregnancy hormone made inside the placenta. Hydatidiform moles also come in two forms, complete or partial hydatidiform moles. Mostmolar pregnancies are not cancer.
Common symptoms of a molar pregnancy include abnormal vaginal bleeding early in a suspected pregnancy, which can be red or watery brown, and sometimes abdominal pain.
Considered a result of a molar pregnancy, an invasive mole may grow into your uterine muscle. Unlike other types of molar pregnancy, invasive moles are typically cancerous. The cancer cells usually stay in the muscles of your uterus but may spread to other body parts or tissue without treatment.
Choriocarcinoma is a form of cancerous GTD that grows and spreads quickly. It may spread from your uterine muscles to your vagina, lung and other organs like your kidneys, liver or brain. While still very rare, it’s more common in people who’ve already had a molar pregnancy.
Some people don’t have any symptoms, but in those that do, the most common is abnormal vaginal bleeding after pregnancy, miscarriage or molar pregnancy. Some people have abdominal pain or blood in their pee or poop.
A placental-site trophoblastic tumor (PSTT) is an extremely rare type of GTD that forms where the placenta attaches to your uterus. A PSTT grows very slowly, and symptoms may appear years after pregnancy. PSTTs may spread into the muscles of your uterus and your blood vessels, lungs, pelvis and lymph nodes and require aggressive treatment.
This is also a very rare type of GTD that is cancerous. As with PSTT, it can spread to your lungs. ETT may also develop years after pregnancy.
GTD occurs in about 1 in every 1,000 pregnancies in the United States. Most cases of GTD are hydatidiform moles (molar pregnancy). More serious cases of GTD like choriocarcinoma occur in less than 1 in 20,000 pregnancies.
Most GTD cases are treated and cured, especially when diagnosed early. Cases of advanced GTD can be fatal.
Some people have no symptoms of GTD. Others have symptoms that mimic pregnancy or other conditions/diseases. Contact your healthcare provider if you have any of these symptoms:
Gestational trophoblastic disease may cause an overactive thyroid. Signs of overactive thyroid include:
In a normal pregnancy, an egg is fertilized by sperm and it contains all the information it needs to make an embryo and a placenta. This initial collection of cells is called a blastocyst. The embryo eventually becomes a fetus, while layers of a trophoblast cell become part of the placenta and help connect the blastocyst to your uterine wall. In molar pregnancies, given that fertilization did not happen correctly, the embryo does not develop correctly and the trophoblastic cells grow into tumors instead of a healthy placenta.
Your healthcare provider diagnoses GTD after a complete review of your medical history, a physical exam and other tests that look at the inside of your uterus. Diagnosing GTD may include:
Once GTD is diagnosed, your provider may order additional tests to see if the cancer cells have spread to other parts of your body. Finding out how far or how much cancer has spread is called staging. The results tell providers what stage of cancer you may have. Stages of cancer are written in Roman numerals as I, II, III and IV. The higher the number, the more cancer has spread.
The tests used to determine stages of GTD could include:
Gestational trophoblastic disease treatment varies depending on several factors such as:
Your healthcare provider will determine what course of treatment makes the most sense based on your condition. Specific treatment methods for GTD include:
You and your healthcare provider should discuss possible treatments and risks and side effects of treatment.
Yes, gestational trophoblastic disease can come back. You're at a slightly higher risk depending on the type you originally had and your response to treatment.
There is no way to prevent gestational trophoblastic disease.
Gestational trophoblastic disease is rare, but certain factors beyond your control may increase your risk. These factors include:
Yes, most people with a history of GTD can expect to have normal pregnancies afterward. Your provider may recommend extra testing during any subsequent pregnancies depending on your history.
A note from Cleveland Clinic
Finding out you have gestational trophoblastic disease (GTD) may leave you scared, confused and sad. It may be tough to digest the loss of your pregnancy and a complicated diagnosis at the same time. Your healthcare provider will use diagnostic tests to better understand your condition and how to treat it. Just know that in most cases, GTD is treatable and curable. You're chances of having another pregnancy (if you wish) are good. Seek help from your family, friends and healthcare providers during this difficult time and don’t be afraid to ask questions.
Last reviewed by a Cleveland Clinic medical professional on 06/14/2022.
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