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Gestational Trophoblastic Disease

Misty Freeman


Cancer affects everyone. From the woman who has it, to the children who depend on her, everyone involved feels the repercussions from this terrible illness. To the woman diagnosed with cancer, in any of its' many forms, her life is changed forever. She may be consumed with confusion and fear, asking herself "How will I tell my children? Will I be able to continue caring for them? Will I live through this?" Luckily, in today's medical world, more and more women continue to live through-and beat-cancer.

Gestational Trophoblastic Disease affects women in their childbearing years, and often times, beyond. As women and mothers, we are naturally attuned to every minute change in our bodies. We have to be, because we realize there is only one of us, and we have families that rely on us to be there for them, for care and support. It is we, the women and mothers, that unite families as a whole unit. As women so often do, we rely on faith, hope, and a thirst for information. This should not change, after being diagnosed with Gestational Trophoblastic Disease. Become informed and aware of the various types of this disease, as well as treatment options. This article will share some of the more common, and important, aspects of this disease-and its' treatments.


Dr. William M. Rich, M.D., describes this disease in a very understandable way, for those of us who have trouble relating to medical terminology. He says there are two types of this disease: hydatidiform mole (or molar pregnancy), and choriocarcinoma. If a molar pregnancy (hydatidiform mole) is found to be present, it normally does not present a threat to life, in its early stages. He says it consists of cells from the egg and sperm that have joined, without the development of a baby in the uterus. The tissue that forms from this resembles grape-like cysts. It does not spread outside of the uterus to other parts of the body, during this stage.

Dr. Rich states, "Molar pregnancies and their management is the easy part. The problem is when they are ignored, not followed adequately, or inadequately treated, because then major problems occur." Rich says that if a last pregnancy was a normal, full-term pregnancy and delivery, then a choriocarcinoma would not be being searched for, or expected to appear. Dr. Rich also notes the fact that it can happen, and sometimes does, taking root anywhere in the body it chooses, lying in wait, and not being diagnosed promptly. "When a molar pregnancy is not found in a reasonable, time it has the ability to quickly change to a choriocarcinoma. The choriocarcinoma can start from leftover tissue from a previous pregnancy or abortion. It is very aggressive, and bleeds profusely. The most common signs of it in the uterus are irregular bleeding, and excessive morning sickness," says Dr. Rich. It will initially develop where the placenta was attached to the uterine wall. This form of the disease is known as Placental site Trophoblastic.

Diagnosis and Symptoms

This is not an easily diagnosable illness. In actuality, in its beginning stages, it takes on the characteristics of a normal pregnancy. It is upon an examination that the first signs of abnormalities might be encountered. "The majority of women with this disease usually always have irregular uterine growth. It is found to be quite larger than normal for the stage of pregnancy that they might be in," Dr. Rich says.

If, after the initial eight-week mark, there is still no audible fetal heartbeat, molar pregnancy is taken into consideration, and proper tests are then initiated. At this point, specific tests may be recommended by your doctor, such as the routine urine and blood tests. "The prognosis depends on the extent of disease, and the aggressiveness of treatment. If a molar pregnancy is managed properly, the cure rate is about 100%. If non-metastatic trophoblastic disease is vigorously treated, the cure rate is about 100%. Widely metastatic disease, if recognized promptly and treated aggressively with multi-agent chemotherapy, surgery, and radiation, if necessary, is curable in about 80% of the cases," states Dr. Rich.

Often times, after the basic tests have been performed, they will come back indicating a slightly elevated hormone level known as "hCG" (Human Chorionic Gonadotropin), which is a fluid that is secreted by cells in the placenta during pregnancy. Another test that may be performed is an internal pelvic examination. This will enable your doctor to more thoroughly feel for lumps, or any unusual size or shape of the uterus. If your doctor finds your hCG levels above normal, but you are not pregnant, most likely a Gestational Trophoblastic Tumor will be suspected, and evaluated through further testing.

Peg Plumbo, who has been a certified nurse-midwife since 1976 states that, "Molar pregnancy is somewhat uncommon, but not rare. In the US, it occurs in about 1/1000 to 1/1500 pregnancies. It occurs predominantly in older women, or the chance of recurrence increases with each affected pregnancy (risk for subsequent molar pregnancy is 1-2% and the risk of a 3rd after two is about 25%). Sometimes an embryo is present in a molar pregnancy, but the fetus is often non-viable with chromosomal abnormalities--but some do survive." Plumbo also noted that the choriocarcinoma, which is a rare malignancy, can still take place, even after the evacuation of the molar pregnancy. To try and prevent this from occurring, weekly beta hCG levels are drawn and monitored, until they drop within normal limits, for a consecutive 3 week period.

Explanation of Stages

According to the American Cancer Society, once the tumor is found, specific tests will be utilized in aiding and extracting the cancer. Some tests will also be used in determining if the cancer has spread outside of the uterus. This is known as "staging". In order to plan for the best quality care and treatment for you, your doctor must know how advanced the disease is. Below is an outline, detailing the various stages of the illness.

Hydatidiform mole
Cancer is found stationary in the uterus. If the cancer is also discovered in the muscle of the uterus, it is called an invasive mole. (Choriocarcinoma destruens.)

Placental-site gestational trophoblastic tumor
Cancer is located in area where placenta had attached, and in the muscle of the uterus as well.

Cancer cells have developed and multiplied following the treatment of a hydatidiform mole, or after an abortion or delivery of a baby. Cancer has not spread outside of the uterus.

Metastatic, good prognosis
This stage is very similar to the Nonmetastatic stage, in that it also develops from prior treatment for a hydatidiform mole, abortion or delivery of a baby in a normal pregnancy. The only notable difference is that the cancer has spread from outside of the uterus to various parts of the body. The prognosis can sway from good to poor, depending on its stage. Good prognosis is highly likely if all items listed below are true:Last pregnancy was less than 4 months ago;The level of beta HCG in the blood is low;Cancer has not spread to liver or brain;You have not received chemotherapy earlier.

Metastatic, poor prognosis
This follows the same pattern in stages, as does the good prognosis, only this is the opposite.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;You have received chemo earlier with no benefit;The tumor began after the completion of a normal pregnancy.

Treatment Options

The treatment options available include surgical removal, Chemotherapy, Radiation therapy and Total Hysterectomy, which is the complete removal of all female organs.

The treatment involved with this illness is always concurrent with the stage of the cancer. In addition, your age and overall health are taken into full consideration. There are clinical trials that are also available researching and testing for the cure and recovery for this disease. The cancer information service is always available and is free to call. The number to reach this service is: 1-800-4-CANCER or, 1-800-332-8615.

Personally, I feel anyone who has recently been diagnosed with some form of cancer needs an adequate communication outlet to express his or her feelings. Sometimes family is not so easy to turn to, or perhaps you don't want to cause your loved ones extra concern or pain. There are outreaches available that can put you in touch with support organizations in your area. A few are listed below, along with links you may find useful, in your personal research of this disease.

Cancer Outreach

Mayo clinic
Women's Cancer Center
Women To Women
Shared Experiences

It is also important to note that this article is for informational purposes only, and should not be substituted to the opinions of a medical professional. If you are concerned that you may be suffering from this condition, it is important to seek the advice and care of a physician, immediately.

About the Author: Misty Freeman is a freelance writer and stay at home mom of three.

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