Gestational Trophoblastic Disease (GTD): What You Need to Know
Gestational Trophoblastic Disease (GTD) is a rare condition that affects the development of the placenta during pregnancy. The placenta is the organ that connects the mother and the foetus, providing oxygen and nutrients to the baby. The placenta is made of cells called trophoblasts, which normally grow and multiply in a controlled way. However, in GTD, the trophoblasts grow abnormally and form tumours or masses in the uterus.
Types of Gestational Trophoblastic Disease
There are different types of GTD, depending on how the trophoblasts behave and whether they are benign (non-cancerous) or malignant (cancerous). The most common type of GTD is a hydatidiform mole, also known as a molar pregnancy. This occurs when there is a problem with the fertilisation of the egg, resulting in an abnormal mass of trophoblasts that resembles a bunch of grapes. There are two subtypes of hydatidiform moles: partial and complete. A partial mole happens when there is an extra set of paternal chromosomes in the fertilised egg, leading to an abnormal embryo and an abnormal placenta. A complete mole happens when there is no maternal chromosome in the fertilised egg, leading to no embryo and only an abnormal placenta.
Most hydatidiform moles are benign and can be treated by removing them from the uterus. However, some hydatidiform moles can become invasive or persistent, meaning they grow into the muscle layer of the uterus or remain in the uterus after treatment. These moles can be cancerous or have the potential to become cancerous, and they may require chemotherapy or surgery to treat them.
Another type of GTD is choriocarcinoma, which is a rare and aggressive form of cancer that develops from trophoblast cells. Choriocarcinoma can occur after a normal pregnancy, a molar pregnancy, a miscarriage or an abortion. It can spread quickly to other organs, such as the lungs, liver, brain or kidneys. Choriocarcinoma is usually treated with chemotherapy, sometimes combined with surgery or radiation therapy.
Other rare types of GTD include placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT), which develop from trophoblast cells that remain in the uterus after a normal pregnancy. These tumours are slow-growing and have a low risk of spreading, but they can be difficult to diagnose and treat. They may require surgery, chemotherapy or radiation therapy.
Symptoms of Gestational Trophoblastic Disease
The symptoms of GTD vary depending on the type and stage of the disease. Some common symptoms include:
- Abnormal vaginal bleeding during or after pregnancy
- Severe nausea and vomiting
- Abdominal pain or swelling
- High blood pressure
- Shortness of breath or chest pain
- Headache or vision problems
Diagnosis of Gestational Trophoblastic Disease
The diagnosis of GTD is based on a combination of tests, such as:
- A urine or blood test to measure the level of human chorionic gonadotropin (hCG), a hormone produced by trophoblast cells
- A pelvic exam to check for any abnormal growths in the uterus
- An ultrasound scan to visualise the uterus and the placenta
- A biopsy to take a sample of tissue from the uterus for microscopic examination
- A chest X-ray or a CT scan to look for any signs of spread to other organs
Treatment of Gestational Trophoblastic Disease
The treatment of GTD depends on several factors, such as:
- The type and stage of GTD
- The patient's age and general health
- The patient's desire to have children in the future
The main goals of treatment are to remove or destroy all abnormal trophoblast cells, prevent them from spreading or recurring, and preserve fertility if possible. The main options for treatment are:
- Surgery: This involves removing the abnormal tissue from the uterus, either by suction curettage (a procedure that uses a vacuum device to suck out the tissue) or by hysterectomy (a surgery that removes the entire uterus). Surgery is usually effective for treating benign hydatidiform moles, but it may not be enough for treating malignant or invasive GTD.
- Chemotherapy: This involves using drugs that kill cancer cells or stop them from growing. Chemotherapy is usually given through a vein (intravenously) or as pills (orally). Chemotherapy is often used for treating malignant or invasive GTD, such as choriocarcinoma, persistent mole, PSTT or ETT. Chemotherapy can also be used as a preventive measure after surgery to reduce the risk of recurrence.
- Radiation therapy: This involves using high-energy rays to damage cancer cells or stop them from growing. Radiation therapy is usually delivered by a machine that aims beams at specific areas of the body. Radiation therapy is rarely used for treating GTD, but it may be helpful for treating choriocarcinoma that has spread to the brain or other organs.
Prognosis of Gestational Trophoblastic Disease
The prognosis of GTD depends on the type and stage of the disease, as well as the response to treatment. Most cases of GTD can be cured, especially if diagnosed and treated early. The cure rate for benign hydatidiform moles is over 90%, and the cure rate for malignant or invasive GTD is over 80%. However, some cases of GTD may recur or become resistant to treatment, requiring more aggressive or experimental therapies.
The follow-up care for GTD is very important to monitor the patient's recovery and detect any signs of recurrence. The follow-up care may include:
- Regular blood tests to measure the level of hCG, which should return to normal after treatment
- Regular pelvic exams and ultrasound scans to check for any abnormal growths in the uterus
- Regular chest X-rays or CT scans to check for any signs of spread to other organs
- Contraception to avoid pregnancy until the hCG level is normal and stable for at least six months
- Genetic counselling to discuss the risk of having another molar pregnancy or a child with chromosomal abnormalities
GTD is a rare and complex condition that can affect women's health and fertility. However, with proper diagnosis and treatment, most women can overcome GTD and have healthy pregnancies in the future.
Sources
- Debbo Africa: https://debbo.africa
- Gestational Trophoblastic Disease | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/gestational-trophoblastic-disease
- Gestational Trophoblastic Disease: Symptoms & Treatment - Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/6130-gestational-trophoblastic-disease
- Gestational trophoblastic disease - Cancer Treatment Centers of America. https://www.cancercenter.com/cancer-types/gestational-trophoblastic-disease-gtd
- Gestational Trophoblastic Disease (GTD) - Dana-Farber Cancer Institute. https://www.dana-farber.org/cancer-care/types/gestational-trophoblastic-disease
- Gestational trophoblastic disease (GTD) | Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd