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Gestational Trophoblastic Tumors Treatment (PDQ®)
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Description
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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.
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Stage Explanation
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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). A doctor needs to know the stage of the disease to plan
treatment.The following stages are used for gestational trophoblastic tumor:
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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).
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Placental-site gestational trophoblastic tumors
Cancer is found in the place where the placenta was attached and in the muscle
of the uterus.
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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.
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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.
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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.
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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.
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Treatment Option Overview
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How gestational trophoblastic tumor is treated
There are treatments for all patients with gestational trophoblastic tumor.
Two kinds of 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).
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Treatment by stage
Treatment of gestational trophoblastic tumor depends on the stage of the
disease, and the patient’s age and overall condition.
Standard treatment may be considered because of its effectiveness in patients
in past studies, or participation in a clinical trial may be considered. Not
all patients are cured with standard therapy and some standard treatments may
have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the
most up-to-date information. Clinical trials are ongoing in most parts of the
country for most stages of gestational trophoblastic tumor. To learn more
about clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
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Hydatidiform Mole
Treatment may be one of the following:
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).
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with hydatidiform mole.
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Placental-Site Gestational Trophoblastic Tumors
Treatment will probably be surgery to remove the uterus (hysterectomy).
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with placental-site gestational trophoblastic tumor.
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Nonmetastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with nonmetastatic gestational trophoblastic tumor.
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Good Prognosis Metastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with good prognosis metastatic gestational trophoblastic tumor.
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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.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with poor prognosis metastatic gestational trophoblastic tumor.
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Recurrent Gestational Trophoblastic Tumors
Treatment will probably be chemotherapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent gestational trophoblastic tumor.
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Changes to This Summary (06/30/2005)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Links to the NCI Dictionary of Cancer Terms were added to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
