Diagnosis and Management of Gestational Trophoblastic Neoplasia

Abstract

Gestational trophoblastic neoplasia (GTN) is the term used for an uncommon group of diseases that originate in the placenta and have the potential to locally invade the uterus and metastasize. The histological entities included in this group are: partial (PHM) and complete hydatidiform mole (CHM), invasive mole (IM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). With the exception of PSTT and ETT, all gestational trophoblastic tumors develop from the cyto- and syncytial cells of the villous trophoblast and produce abundant amounts of human chorionic gonadotropin (hCG), the measurement of which serves as a reliable tumor marker for diagnosis, monitoring treatment response and follow-up to detect recurrence. PSTT and ETT, on the other hand, are gestational trophoblastic tumors that originate from the intermediate cells of extravillous trophoblast and produce hCG sparsely, making its use as a tumor marker less reliable. Prior to the development of effective chemotherapy for GTN in 1956 [1], the majority of patients with disease localized to the uterus were cured with hysterectomy, whereas metastatic disease was almost uniformly fatal. Currently, most women with GTN can be cured and their reproductive function preserved providing they are managed according to well-established guidelines. GTN is an uncommon disease which ideally should be managed at trophoblastic disease centers where concentration of cases provides clinicians with ample experience, opportunities for research, and improved outcomes [2]. Since many patients will be managed locally, it is the purpose of this review to familiarize clinicians who encounter these patients with the latest advances in the field in order to optimize their patient’s outcome.