Treatment
Treatment for Gestational Trophoblastic Disease (GTD) depends on the type of GTD, the stage of the disease, and the risk group (low-risk or high-risk). The main treatments are surgery, chemotherapy, and active monitoring of hCG levels.
Molar pregnancy
- For most molar pregnancies, the abnormal growth is removed with dilation & curettage (D&C), and the patient is monitored with regular hCG tests. Some patients may need adjuvant chemotherapy after a complete molar pregnancy. The doctor will consult the patient’s risk score to determine the appropriate treatment.
Low-risk Gestational Trophoblastic Neoplasia (GTN) (Risk Group 0-6)
- Low-risk invasive GTDs are usually treated with chemotherapy until the hCG level returns to normal. These tumors usually respond well to chemotherapy and may require only a single chemotherapy drug. Patients who do not respond may be given multi-agent chemotherapy or hysterectomy as a second-line treatment.
High-risk Gestational Trophoblastic Neoplasia (GTN) (Risk Group greater than 6)
- High-risk invasive GTDs are usually treated with multi-agent chemotherapy. Hysterectomy may be recommended for patients who fail chemotherapy, and for patients with placental-site trophoblastic tumors (PSTTs) and epithelioid trophoblastic tumors (ETTs), which are more resistant to chemotherapy.
Surgery
Surgery (Dilation & Curettage) is the primary option for diagnosis and treatment of molar pregnancy. Hysterectomy may be the primary treatment for placental-site trophoblastic tumors (PSTTs) and epithelioid trophoblastic tumors (ETTs), which do not respond well to chemotherapy.
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Dilation & Curettage (D&C)
Dilation & curettage (D&C) may be recommended as the initial treatment for a molar pregnancy. In this procedure, the doctor uses a special instrument called a “curette” to remove the tumor from the uterus and scrape a tissue sample from the uterus. This tissue is examined under a microscope to confirm the diagnosis and determine specific characteristics about the tumor.
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Hysterectomy
A hysterectomy is surgery to remove the uterus and cervix. The doctor may also remove one ovary and one fallopian tube (unilateral salpingo-oopherectomy), both ovaries and fallopian tubes (bilateral salpingo-oopherectomy), and/or nearby tissues and lymph nodes, depending on the extent of the disease. A hysterectomy is the standard treatment for placental site trophoblastic tumors and epithelioid trophoblastic tumors, but is not often used to treat molar pregnancies.
Additional Treatments
The doctor may also recommend any of the following treatments:
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Most Gestational Trophoblastic Disease (GTD) can be cured by chemotherapy alone. The specific drugs used will be determined by the patient’s risk score. Low-risk GTD can often be cured with a single-agent chemotherapy (1 drug), while high-risk GTD may require a combination of drugs (multi-agent chemotherapy). This treatment will be given until the patient’s hCG levels return to normal.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. The doctor aims radiation at the tumor from a large machine outside of the body. Radiation therapy is not often a primary treatment for Gestational Trophoblastic Disease (GTD); however, it may be recommended if the patient does not respond to chemotherapy or if the cancer spreads to distant organs such as the brain or liver. Radiation therapy can shrink tumors in these locations and help relieve symptoms and complications of the disease.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
Birth Control
After completion of treatment, your doctor will recommend that you abstain from becoming pregnant for a period of time. This may be accomplished with a variety of common birth control methods including condoms, hormonal contraception, intrauterine devices, or abstinence.
