Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Staging is an important part of evaluating prognosis and treatment options.
FIGO Staging of Gestational Trophoblastic Disease (GTD)
Stage I
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Description
- Tumor is located only in the uterus.
Stage II
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Description
- Tumor has spread outside of the uterus into nearby structures such as the ovaries or vagina. Tumor has not spread outside of the pelvis.
Stage III
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Description
- Tumor has spread to lungs, with or without involvement of the uterus, pelvis, or vagina.
Stage IV
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Description
- Tumor has spread to distant organs such as the brain, liver, kidneys, spleen, or gastrointestinal tract.
World Health Organization (WHO) Risk Score of Gestational Trophoblastic Disease (GTD)
Tumors may also be classified by WHO risk score. A score is assigned to each of the following areas, and then added together to determine the overall risk group. A score of 6 or less is considered low-risk, and a score greater than 6 is considered high-risk.
Collapsed WHO Risk Score Criteria
Age at time of diagnosis
- Younger than 40: 0
- 40 and older: 1
Outcome of last pregnancy
- Molar pregnancy: 0
- Abortion or miscarriage: 1
- Birth (full term pregnancy): 2
Time since last pregnancy
- Less than 4 months: 0
- At least 4 months but less than 7 months: 1
- 7 to 12 months: 2
- More than 12 months: 4
Level of hCG in the blood before treatment
- Under 1,000 IU/L: 0
- 1,000 – 9,999 IU/L: 1
- 10,000 – 99,999 IU/L: 2
- 100,000 IU/L or more: 4
Size of the largest tumor
- Less than 3 cm in diameter: 0
- Greater than or equal to 3 cm but less than 5 cm in diameter: 1
- 5 cm or greater: 2
Location of metastases, where tumor has spread
- Lung: 0
- Kidney, Spleen: 1
- Gastrointestinal Tract: 2
- Brain, Liver: 4
Number of metastases / new tumors
- 0 metastases: 0
- 1 to 4 metastases: 1
- 5 to 8 metastases: 2
- More than 8 metastases: 4
Number of failed chemotherapy drugs
- None: 0
- Single drug: 2
- 2 or more drugs: 4
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These numbers are added up and the overall score determines the risk group:
- Score of 6 or less: Low risk. Tumor usually responds well to chemotherapy. Single-agent chemotherapy may be able to cure the disease.
- Score greater than 6: High risk. Tumor may not respond well to chemotherapy and may need more intensive chemotherapy. Multi-agent chemotherapy may be recommended.
