7 - Gestational trophoblastic disease

Abstract

This chapter reviews the current evaluation and management of gestational trophoblastic disease. Gestational trophoblastic disease encompasses complete and partial hydatidiform moles and trophoblastic neoplasia. It is important to manage molar pregnancies properly to minimize acute complications and to identify gestational trophoblastic neoplasia promptly. Current International Federation of Gynecology and Obstetrics (FIGO) guidelines for making the diagnosis and staging of gestational trophoblastic neoplasia allow uniformity for reporting results of treatment. Gestational trophoblastic neoplasia includes postmolar disease identified by human chorionic gonadotropin (hCG) surveillance, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. It is important to individualize treatment of gestational trophoblastic neoplasia based upon risk factors, using less toxic, single-agent chemotherapy for patients with low-risk disease and aggressive multiagent therapy for patients with high-risk disease. Most women with gestational trophoblastic disease can be successfully managed with preservation of reproductive function, but hysterectomy, other surgical resections, or radiation therapy may be required in selected patients. The rare placental site and epithelioid trophoblastic tumors are more likely to be resistant to simple chemotherapy, and hysterectomy is often required for treatment. Patients with gestational trophoblastic neoplasia should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients.