Gynecologic Cancer Treatment Center
Diseases Treated
Gestational Trophoblastic Disease/Molar Pregnancy
What is gestational trophoblastic disease?
Gestational trophoblastic disease begins with conception. The fertilized egg develops by dividing into two groups of cells, which ultimately form the placenta and the fetus. The placenta is the organ that is attached to the wall of the uterus and provides nourishment for the developing fetus. Gestational trophoblastic disease develops as a result of abnormal development of the placenta. The most common form of gestational trophoblastic disease is molar pregnancy in which the placenta develops into a mass of cysts instead of its normal cake-like structure. Because the placenta is abnormal the fetus either does not develop or develops abnormally.
The next most common form of gestational trophoblastic disease is invasive mole. This condition results from an excessive invasion or ingrowth into the uterine wall by the molar pregnancy. Although this is usually regarded as a benign condition, some of this invading tissue can enter the uterine blood vessels and spread to vital organs, thus becoming a malignant disease. When this occurs prompt treatment is necessary to prevent serious consequences.
The least common but most dangerous form of gestational trophoblastic disease is choriocarcinoma, a malignant tumor that develops in the placenta. This form of disease can follow any type of pregnancy, including molar pregnancy, miscarriage, tubal pregnancy or normal delivery.
Since gestational trophoblastic disease begins in the placental tissue, it produces the same hormones as does a normal pregnancy. The most important of these is human chorionic gonadotropin (hCG). The accurate measurement of hCG is extremely important in the diagnosis, treatment, and follow-up of your trophoblastic tumor. When hCG level is positive, you are either pregnant or have some form of gestational trophoblastic disease.
What is persistent trophoblastic disease?
Persistent trophoblastic disease occurs following a molar pregnancy, spontaneous abortion, ectopic pregnancy, or normal delivery when abnormal trophoblastic tissue from the placenta continues to grow in the uterus (called "nonmetastatic") or spreads to other organs (called "metastatic").
We divide all patients with persistent trophoblastic disease into four stages:
Stage I: Tumor confined to the uterus (non-metastatic)
Tumor tissue continues to grow locally in the uterus following a molar pregnancy, miscarriage or normal pregnancy. The level of hCG in the blood is elevated. The uterus is usually enlarged and vaginal bleeding is common. The ovaries are often cystic due to the elevated hormone levels.
Stage II: Tumor involving the pelvic organs and/or vagina
Tumor tissue has spread beyond the uterus to the tubes, ovaries, broad ligament and/or adjacent structures, or has spread to the vagina. The level of hCG in the blood is elevated. The uterus usually is enlarged and vaginal bleeding is common. The ovaries are often cystic due to the elevated hormone levels.
Stage III: Tumor involving the lungs, with or without involving the pelvic structures and/or vagina
Tumor tissue has spread via the blood stream to the lungs where it can be seen on a chest x-ray. These lesions usually cause no symptoms although patients occasionally cough up small amounts of blood-tinged sputum. The uterus, pelvic structures and vagina may be free of disease. The level of hCG in blood is elevated.
Stage IV: Tumor involving distant organs
Tumor tissue has spread to the brain, liver and/or the bowel as well as other organs. The hCG titer is elevated and the duration of disease before therapy is usually more than four months. Patients in this group most commonly develop their disease following a term pregnancy.
Learn more about gestational trophoblastic disease
