Summary about Disease
Gestational Trophoblastic Disease (GTD) is a group of rare conditions in which abnormal cells grow inside the uterus after conception. It encompasses both benign (non-cancerous) and malignant (cancerous) forms. The most common type is a hydatidiform mole (molar pregnancy), where abnormal placental tissue develops. Other forms include invasive mole, choriocarcinoma, placental-site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). GTD is generally highly treatable, even in its cancerous forms.
Symptoms
Symptoms of GTD can mimic those of a normal pregnancy, but often include:
Abnormal vaginal bleeding (often dark brown or bright red)
Severe nausea and vomiting (hyperemesis gravidarum)
Rapid uterine enlargement
Pelvic pain or pressure
Symptoms of hyperthyroidism (e.g., rapid heart rate, heat intolerance)
Passing grape-like cysts from the vagina (in molar pregnancies)
Early onset of pre-eclampsia (high blood pressure and protein in urine)
Causes
GTD is caused by genetic errors during fertilization that lead to abnormal development of the trophoblastic cells (cells that normally form the placenta).
Complete molar pregnancy: Occurs when an egg without genetic material is fertilized by one or two sperm. The resulting tissue only contains paternal chromosomes.
Partial molar pregnancy: Occurs when a normal egg is fertilized by two sperm, resulting in 69 chromosomes instead of the normal 46. There may be some fetal development in partial moles, but the fetus is not viable and will not survive.
The causes for the other types of GTD (invasive mole, choriocarcinoma, PSTT, and ETT) are not completely understood, but they can develop after a molar pregnancy, a normal pregnancy, a miscarriage, or an ectopic pregnancy.
Medicine Used
Treatment for GTD depends on the type and stage of the disease. Common medications include:
Methotrexate: A chemotherapy drug often used to treat non-metastatic or low-risk GTD.
Actinomycin-D: Another chemotherapy drug, often used as an alternative or in combination with methotrexate.
Multi-agent chemotherapy: Regimens like EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) are used for high-risk or metastatic GTD.
Other Chemotherapy agents: platinum-based regimens (BEP)
Is Communicable
? No, GTD is not a communicable or contagious disease. It is not caused by an infection and cannot be spread from person to person.
Precautions
While GTD is not communicable, precautions following treatment are essential to prevent recurrence and ensure the best possible outcome:
Contraception: Avoid pregnancy for a specified period (usually 6-12 months) after completing treatment, as pregnancy can make it difficult to detect recurrent GTD. Effective contraception methods should be discussed with a healthcare provider.
Regular monitoring: Undergo regular blood tests to monitor hCG (human chorionic gonadotropin) levels, a hormone produced by trophoblastic cells. This helps detect any persistent or recurrent disease.
Follow-up appointments: Attend all scheduled follow-up appointments with your healthcare provider to assess your overall health and monitor for any signs of GTD recurrence.
How long does an outbreak last?
GTD isn't an "outbreak" in the traditional sense of an infectious disease. The duration of the disease depends on the type, stage, and response to treatment.
Molar pregnancy: Once the mole is removed (usually by dilation and curettage (D&C) or suction curettage), the active disease is technically resolved. However, follow-up is crucial to monitor hCG levels and ensure no persistent or malignant disease develops.
Invasive mole and choriocarcinoma: These forms can last until effective treatment is administered. Treatment duration varies depending on the individual case.
hCG monitoring is essential for 6-12 months following the normalization of hCG levels
How is it diagnosed?
Diagnosis of GTD typically involves:
Pelvic exam: To assess uterine size and any abnormalities.
Ultrasound: To visualize the uterus and identify any abnormal tissue, such as a molar pregnancy.
hCG blood tests: To measure levels of hCG, which are typically very high in GTD.
Dilation and Curettage (D&C): If a molar pregnancy is suspected, a D&C is performed to remove the abnormal tissue, which is then sent for pathological examination to confirm the diagnosis.
Chest X-ray or CT scan: To check for metastasis (spread) of the disease to the lungs or other organs, particularly if choriocarcinoma is suspected.
Timeline of Symptoms
The timeline of symptoms can vary significantly.
Early signs (weeks 4-12 of expected pregnancy): Abnormal bleeding, severe nausea, rapid uterine growth.
Diagnosis: Often made in the first trimester during a routine ultrasound or due to abnormal bleeding.
Post-molar pregnancy: Symptoms should resolve after the mole is removed. Persistent bleeding or elevated hCG levels indicate persistent or malignant disease.
Choriocarcinoma/Invasive Mole: Can develop weeks, months, or even years after a pregnancy.
Important Considerations
GTD, even the cancerous forms, is often highly curable with appropriate treatment.
Early diagnosis and treatment are crucial for the best possible outcome.
Long-term follow-up with hCG monitoring is essential to detect any recurrence.
Contraception is necessary after treatment to avoid pregnancy and allow for accurate monitoring of hCG levels.
If you experience any symptoms suggestive of GTD, especially abnormal bleeding or severe nausea during pregnancy, seek immediate medical attention.
Patients with GTD should be managed by a specialist, generally a gynecologic oncologist or a physician with expertise in treating GTD.