HomeHealth articlesgestational trophoblastic neoplasiaWhat Is Gestational Trophoblastic Neoplasia?

Gestational Trophoblastic Neoplasia - Risk Factors, Types, and Treatment

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Gestational trophoblastic neoplasia is a group of rare tumors that can occur during or after pregnancy. Read this article to know more about it.

Written by

Dr. Ramji. R. K

Medically reviewed by

Dr. Sanap Sneha Umrao

Published At May 23, 2023
Reviewed AtMay 30, 2023

What Is Gestational Trophoblastic Neoplasia?

Gestational trophoblastic neoplasia refers to a group of gestational trophoblastic diseases that are almost always malignant. It is a rare disease characterized by the abnormal growth of trophoblast cells inside the uterus after conception. The trophoblast cells are a thin layer of cells that help attach a developing embryo to the uterus wall, provide nutrients to the embryo, and form a large part of the placenta.

Women who earlier had molar pregnancies (a benign gestational trophoblastic disease) are at high risk of developing gestational trophoblastic neoplasia. It can invade nearby structures and metastasize to different body parts such as the liver, kidney, vagina, lungs, and brain. Treatment options depend on the stage and type of the tumor. Standard treatment options for gestational trophoblastic disease include surgery, chemotherapy, and radiation therapy. The cure rate of metastatic gestational trophoblastic neoplasia is comparatively lower than the localized tumor.

What Are the Risk Factors for Gestational Trophoblastic Neoplasia?

The risk factors for gestational trophoblastic neoplasia include;

  • Women who had a pregnancy before 20 and after 35 years.

  • Previous molar pregnancy.

  • Women who earlier had a miscarriage.

  • A diet low in vitamin A and carotene.

  • Specific blood types such as A and AB.

What Are the Different Types of Gestational Trophoblastic Neoplasia?

The different types of gestational trophoblastic neoplasia include;

  • Choriocarcinoma: Choriocarcinoma is an aggressive gestational trophoblastic neoplasia that develops in the woman's uterus. It usually develops when growths from molar pregnancy become malignant. It is fast-growing and can spread to other body parts such as the liver, kidney, vagina, spleen, intestines, pelvis, lungs, or brain.

  • Invasive Mole: Invasive neoplasia is a type of gestational trophoblastic neoplasia that develops into the muscular wall of the uterus. It looks similar to a hydatiform mole but invades deep into the myometrium, the middle layer of the uterine wall. It develops from a benign hydatiform mole. The significant difference between an invasive mole and choriocarcinoma is invasive mole rarely spreads outside the uterus, whereas choriocarcinoma often spreads outside the uterus to different body parts. Chemotherapy is the best treatment option for an invasive mole, but sometimes, it may disappear without treatment.

  • Placental-Site Trophoblastic Tumors: It is a rare form of gestational trophoblastic neoplasia that forms where the placenta attaches to the uterine wall. It accounts for one to two percent of all trophoblastic tumors. It develops from the trophoblast cells and spreads to the muscle of the uterus and into blood vessels. It may also metastasize to the lungs, lymph nodes, or pelvis. It is a slow-growing tumor that often exhibits signs and symptoms after a full-term pregnancy.

  • Epithelioid Trophoblastic Tumors: An epithelioid trophoblastic tumor is a rare type of gestational trophoblastic neoplasia that may be cancerous or noncancerous. A cancerous epithelioid trophoblastic tumor can metastasize to the lungs. Hemorrhage, ulceration, necrosis, and fistula formation are common clinical features of this condition.

What Are the Signs and Symptoms of Gestational Trophoblastic Neoplasia?

The signs and symptoms of gestational trophoblastic neoplasia often correlate with other gestational trophoblastic diseases and pregnancy-related conditions. The signs and symptoms include;

  • Irregular vaginal bleeding unrelated to menstruation.

  • An enlarged uterus that is larger than expected during pregnancy.

  • Pressure or pain in the pelvis.

  • Nausea and vomiting.

  • High blood pressure.

  • Swelling of hands and feet early in the pregnancy.

  • Fatigue.

  • Dizziness.

  • Shortness of breath.

  • Arrhythmia (irregular heartbeat).

If gestational trophoblastic neoplasia has metastasized, then the following signs and symptoms are noted;

  • Abdominal metastasis can cause abdominal tenderness and pain.

  • Metastasis to the liver can cause jaundice.

  • Neurologic deficits occur from brain metastasis.

  • Metastasis to the genital tract may present as purple to blue-black nodules or papules.

How Is Gestational Trophoblastic Neoplasia Diagnosed?

To diagnose gestational trophoblastic neoplasia, the healthcare provider primarily performs a physical examination to look for signs and symptoms of the condition. Enquiring the patient’s medical history is critical in diagnosing the condition. The healthcare provider might recommend further tests to have a precise diagnosis.

Laboratory Tests:

  • Serum Quantitative hCG Test: Pregnant women with gestational trophoblastic neoplasia may have higher hCG levels. Therefore healthcare providers recommend a serum quantitative human chorionic gonadotropin (hCG) test helps to detect abnormal hCG levels in the body.

  • Complete Blood Count (CBC) Test: A CBC test helps detect anemia caused by excessive bleeding in gestational trophoblastic neoplasia.

  • Liver Enzyme Test: A liver enzyme test helps detect elevated liver enzyme levels in patients with gestational trophoblastic neoplasia metastasis to the liver.

Pelvic Examination: In a pelvic examination, the healthcare provider inserts gloved fingers into the vagina, looks for signs of the disease, such as lump formations, and determines the size of the uterus.

Ultrasound: Ultrasound is an imaging test that uses sound waves to provide detailed images of internal body structures. For example, a transvaginal ultrasound detects tumors in the pelvis and the uterus associated with the disease.

Once the condition is diagnosed, healthcare providers suggest further imaging tests to determine the stages of the disease. The imaging tests used to determine stages of gestational trophoblastic neoplasia include;

What Are the Stages of Gestational Trophoblastic Neoplasia?

The FIGO (International Federation of Gynecology and Obstetrics) staging system for gestational trophoblastic neoplasia includes;

  • Stage 1: Tumor growth is confined to the uterus.

  • Stage 2: Tumor growth extends outside the uterus but is limited to genital structures such as the vagina, broad ligament, and adnexa.

  • Stage 3: Tumor growth extends to the lungs with or without genital tract involvement.

  • Stage 4: Tumor growth involving all other metastatic sites.

How Is Gestational Trophoblastic Neoplasia Treated?

The treatment options for gestational trophoblastic neoplasia depend on the following factors;

  • Size, type, and location of the tumor.

  • Tumor metastasis.

  • Whether the tumor occurred during or after pregnancy.

  • Patient’s overall health.

  • Planning for pregnancy in the future or not.

The treatment options include;

Surgery: The doctor may remove the tumor using one of the following surgical procedures;

  • Dilation and Curettage: It is a common surgical procedure for gestational trophoblastic neoplasia to remove abnormal tissues and cells from the uterus. In this procedure, a speculum (a small vacuum-like device) is initially inserted into the vagina to dilate the cervix. A curette is then inserted into the dilated cervix to scrape out the abnormal tissue inside the uterus.

  • Hysterectomy: Hysterectomy is a surgical procedure to remove the uterus. Other organs, such as the ovaries and the fallopian tubes, may also be removed in this surgical procedure. It is not possible to become pregnant after a hysterectomy. Therefore, it is only considered in women who are not planning for pregnancy in the future. Sometimes the patient may be given chemotherapy after a hysterectomy to kill the remaining cancer cells.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It can be administered in the form of pills or by injecting into a vein or muscle. The chemotherapy regime may vary with the type and stage of the disease. For example, in the chemotherapy regimen for high-risk gestational trophoblastic neoplasia, a combination of Methotrexate, Etoposide, and Actinomycin D was administered in the first week for a two-week cycle, followed by Vincristine and Cyclophosphamide in the second week.

Radiation Therapy: Radiation therapy uses high-energy X-rays to destroy abnormal tissues and cells. It plays a vital role in managing gestational trophoblastic neoplasia.

Can Gestational Trophoblastic Neoplasia Be Prevented?

There is no sure way to prevent gestational trophoblastic neoplasia. However, having genetic counseling with a genetic counselor can help determine the patient's risk for developing the disease.

Conclusion:

The prognosis of gestational trophoblastic neoplasia varies with the stage and severity of the disease. The cure rate for low-risk gestational trophoblastic neoplasia is almost 100 percent with chemotherapy. Even high-risk and metastatic gestational trophoblastic neoplasia has a cure rate of approximately 75 percent. Normal pregnancies are possible after gestational trophoblastic neoplasia only if the patient has not undergone a hysterectomy.

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Dr. Sanap Sneha Umrao
Dr. Sanap Sneha Umrao

Obstetrics and Gynecology

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