Gestational Trophoblastic Neoplasia Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia [email protected].
Download ReportTranscript Gestational Trophoblastic Neoplasia Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia [email protected].
Gestational Trophoblastic Neoplasia Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia [email protected] Key Words Group of disease with wide range of neoplastic potential Create a lot of challenge for us in term of diagnosis and treatment Diagnosis and management will depends on the history, HCG level and metastasis work up Clinical pathology of gestational trophoblastic disease 1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma 2- Intermediate trophoblastic cells derivative Placental – site tumor Risk Factors for Moler pregnancy Extremes of reproductive years Prior moler mole Prior spontaneous abortion Vit A deficiency Race ( Indonesia 1:85, USA 1:1500) Clinical Features Large for date 50 % Hyper emesis 20 % Early PIH 5% Abscent FH ( except in partial mole or twin pregnancy) Hyperthyroidism symptom and sign 5% Rarely presented with metastasis symptom and sign Management of molar pregnancy Procedure Risk of Persistent GTT Suction Evacuation 20 % Hysterectomy 5% Follow up of patient with molar pregnancy after evacuation HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months Contraception for 1 year Pelvic examination every 2 weeks until normal,then every 3 months Check histopathology If no proper decrease or BHCG start to increase Persistent GTD Indication for initiating treatment during post mole follow up Serum BHCG values rising more than 10 % for 2 wk ( 3 weekly titre) Serum BHCG values on plateau for 3 wk or decline of less than 10 % Presence of metastasis Significant elevation of serum BHCG values after reaching normal levels Choriocarcinoma or invasive mole on histopathology HCG level still elevated 6 months after molar evacuation HCG > 20000 miu/ml 4 weeks after evacuation Work up of gestational trophoblastic neoplasia History and physical examination chest XR ( if neg CT ) Pretreatment HCG titre Hematological survey Serum chemistries CT of brain Ultrasound of pelvis Liver scan ( u/s or CT ) CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS Benign 1) complete mole 2) Partial mole Malignant (invasive mole and choriocarcinoma) 1) nonmetastatic 2) metastatic a) low risk b) high risk Risk factors (malignant GTD) 1.Disease present more that 4m(long duration) or 2.pretreatment B-HCG greater than 40,000mlu/ml or 3.presence of met to sites other than lungs or vagina i,e liver or brain etc.. 4. prior chemo 5 following Term pregnancy CHEMOTHERAPY FOR GTN NON METASTATIC or GOOD PROGNOSIS METASTATIC *Single agent chemotherapy *survival 90-100% METASTATIC POOR PROGNOSIS *Combined chemotherapy * survival 50 % REMISSION OF GTN DISEASE REMISSION NON METASTATIC 100 % GOOD PROGNOSIS METASTATIC 100 % POOR PROGNOSIS METASTATIC 66 % TOTAL 92 % SUMMARY GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES Q&A GTN Dr Khalid Sait FRCSC Ass. Prof of Gynecologic Oncology KAUH,Jeddah Saudi Arabia [email protected]