Gestational trophoblastic neoplasia natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Depending on the extent of the [[tumor]] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<ref name="abc">General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015</ref>  
Depending on the extent of the [[tumor]] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<ref name= abc> General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015</ref>  


==Natural history==
==Natural History, Complications, and Prognosis==
* For choriocarcinoma, the average age of presentation is 33 years for Asian women and 28 years for American women. A history of multiple pregnancies (or molar pregnancy) carries an increased risk for the development of choriocarcinoma.
===Natural History===
* Patient has early symptoms such as [[vaginal bleeding]], passing of tissue resembling a “bunch of grapes” from the vagina, the abdomen may grow at a much faster rate than with a normal pregnancy.<ref name="urlGestational Trophoblastic Disease | SpringerLink">{{cite web |url=https://link.springer.com/chapter/10.1007/978-0-387-26321-2_4 |title=Gestational Trophoblastic Disease &#124; SpringerLink |format= |work= |accessdate=}}</ref>
*Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding.<ref name="pmid22838240">{{cite journal |vauthors=Killick S, Cook J, Gillett S, Ellis L, Tidy J, Hancock BW |title=Initial presenting features in gestational trophoblastic neoplasia: does a decade make a difference? |journal=J Reprod Med |volume=57 |issue=7-8 |pages=279–82 |date=2012 |pmid=22838240 |doi= |url=}}</ref>
* [[Nausea]] and [[vomiting]], and absent fetal movement during pregnancy are typical features of patients suffering from gestational trophoblastic neoplasia.  
*The vaginal bleeding can also be associated with elevation of βhCG.<ref name="pmid12477457">{{cite journal |vauthors=Meydanli MM, Kucukali T, Usubutun A, Ataoglu O, Kafkasli A |title=Epithelioid trophoblastic tumor of the endocervix: a case report |journal=Gynecol. Oncol. |volume=87 |issue=2 |pages=219–24 |date=November 2002 |pmid=12477457 |doi= |url=}}</ref>
* As the tumor grows larger, patient may notice symptoms like  lump in the vagina, [[hemoptysis]], [[chest pain]], trouble breathing, [[headache]], [[dizziness]], [[jaundice]], [[paralysis]], [[seizure]], [[dysarthria]], and [[dysphasia]].
*In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs.<ref name="pmid28411623">{{cite journal |vauthors=Zhang W, Liu B, Wu J, Sun B |title=Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series |journal=J Med Case Rep |volume=11 |issue=1 |pages=110 |date=April 2017 |pmid=28411623 |doi=10.1186/s13256-017-1256-9 |url=}}</ref>
*Patients can experience nausea and vomiting similar to the course of normal pregnancy.
*The increase in the level of βhCG is anomalous and can be a major sign in diagnosis making.
*Abdominal growth may be at a faster rate than in normal pregnancy.
*If left untreated, patients with gestational trophoblastic neoplasia may develop metastatic lesions in different organs and can result in death.<ref name="pmid30571055">{{cite journal |vauthors=Bishop BN, Edemekong PF |title= |journal= |volume= |issue= |pages= |date= |pmid=30571055 |doi= |url=}}</ref>
 
==Complications==
*Disseminated disease<ref name="pmid25118474">{{cite journal |vauthors=Piura E, Piura B |title=Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature |journal=Eur. J. Gynaecol. Oncol. |volume=35 |issue=4 |pages=359–67 |date=2014 |pmid=25118474 |doi= |url=}}</ref><ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref>
*Hemorrhagic shock<ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref>
*Massive hemoptysis<ref name="pmid29969941">{{cite journal |vauthors=Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK |title=Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner |journal=Med Sci Law |volume=58 |issue=3 |pages=189–193 |date=July 2018 |pmid=29969941 |doi=10.1177/0025802418786120 |url=}}</ref><ref name="pmid28411623">{{cite journal |vauthors=Zhang W, Liu B, Wu J, Sun B |title=Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series |journal=J Med Case Rep |volume=11 |issue=1 |pages=110 |date=April 2017 |pmid=28411623 |doi=10.1186/s13256-017-1256-9 |url=}}</ref>
*Acute abdomen<ref name="pmid29353908">{{cite journal |vauthors=Yadav RS, Shrestha S, Sharma S, Singh M, Bista KD, Ojha N |title=Partial Invasive Mole with Bilateral Torsion of Theca Lutein Cysts |journal=J Nepal Health Res Counc |volume=15 |issue=3 |pages=298–300 |date=January 2018 |pmid=29353908 |doi= |url=}}</ref>
*Ovarian hyperstimulation<ref name="pmid27399862">{{cite journal |vauthors=Alhalabi K, Lampl BS, Behr G |title=Ovarian hyperstimulation syndrome as a complication of molar pregnancy |journal=Cleve Clin J Med |volume=83 |issue=7 |pages=504–6 |date=July 2016 |pmid=27399862 |doi=10.3949/ccjm.83a.15036 |url=}}</ref>
*Spontaneous renal hemorrhage<ref name="pmid27352577">{{cite journal |vauthors=Xiao S, Mu Q, Wan Y, Xue M |title=Spontaneous renal hemorrhage caused by invasive mole: a case report |journal=Eur. J. Gynaecol. Oncol. |volume=37 |issue=3 |pages=417–9 |date=2016 |pmid=27352577 |doi= |url=}}</ref>
*Severe hyperthyroidism<ref name="pmid26559442">{{cite journal |vauthors=Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF |title=An unusual cause of cardiothyreosis |journal=Gynecol. Endocrinol. |volume=32 |issue=2 |pages=107–9 |date=2016 |pmid=26559442 |doi=10.3109/09513590.2015.1111328 |url=}}</ref><ref name="pmid30116304">{{cite journal |vauthors=Simes BC, Mbanaso AA, Zapata CA, Okoroji CM |title=Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma |journal=Thyroid Res |volume=11 |issue= |pages=12 |date=2018 |pmid=30116304 |pmc=6086074 |doi=10.1186/s13044-018-0056-7 |url=}}</ref>
*Cardiothyreosis<ref name="pmid26559442">{{cite journal |vauthors=Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF |title=An unusual cause of cardiothyreosis |journal=Gynecol. Endocrinol. |volume=32 |issue=2 |pages=107–9 |date=2016 |pmid=26559442 |doi=10.3109/09513590.2015.1111328 |url=}}</ref>
*Death<ref name="pmid30571055">{{cite journal |vauthors=Bishop BN, Edemekong PF |title= |journal= |volume= |issue= |pages= |date= |pmid=30571055 |doi= |url=}}</ref>


==Prognosis==
==Prognosis==
* The prognosis for cure of patients with GTDs is good even when the disease has spread to distant organs, especially when only the [[lungs]] are involved.<ref name="abc">General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015</ref> <ref name="pmid9475153">{{cite journal |vauthors=Rodabaugh KJ, Bernstein MR, Goldstein DP, Berkowitz RS |title=Natural history of postterm choriocarcinoma |journal=J Reprod Med |volume=43 |issue=1 |pages=75–80 |date=January 1998 |pmid=9475153 |doi= |url=}}</ref>
* The prognosis for cure of patients with GTDs is good even when the disease has spread to distant organs, especially when only the [[lungs]] are involved.<ref name= abc> General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015</ref>  
* The probability of cure depends on the following:
* The probability of cure depends on the following:
:* [[Histologic]] type (invasive mole or choriocarcinoma)
:* [[Histologic]] type (invasive mole or choriocarcinoma)
Line 22: Line 37:
:* Nature of antecedent [[pregnancy]]
:* Nature of antecedent [[pregnancy]]
:* Extent of prior treatment
:* Extent of prior treatment
:* Disease duration greater than four months from delivery, pretreatment hCG level > 100,000 mIU/mL, presence of liver or brain metastases, and a WHO score > 8 were all important predictors of outcome in patients with postterm choriocarcinoma
==Complications==
Gestational trophoblastic neoplasia maybe associated with the following complications:<ref name="pmid28411623">{{cite journal |vauthors=Zhang W, Liu B, Wu J, Sun B |title=Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series |journal=J Med Case Rep |volume=11 |issue=1 |pages=110 |date=April 2017 |pmid=28411623 |doi=10.1186/s13256-017-1256-9 |url=}}</ref>
* Metastasis
* Recurrent pregnancy loss
* Hemoptysis
* Pneumothorax
*[[ Anemia]]
*Hyperthyroidism
*Pre-eclampsia


==References==
==References==

Revision as of 21:37, 7 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Overview

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.[1]

Natural History, Complications, and Prognosis

Natural History

  • Patients with gestational trophoblastic neoplasia (GTN) initially present with abnormal vaginal bleeding.[2]
  • The vaginal bleeding can also be associated with elevation of βhCG.[3]
  • In rare instances, patients can also initially present with symptoms related to distant metastasis to different organs.[4]
  • Patients can experience nausea and vomiting similar to the course of normal pregnancy.
  • The increase in the level of βhCG is anomalous and can be a major sign in diagnosis making.
  • Abdominal growth may be at a faster rate than in normal pregnancy.
  • If left untreated, patients with gestational trophoblastic neoplasia may develop metastatic lesions in different organs and can result in death.[5]

Complications

  • Disseminated disease[6][7]
  • Hemorrhagic shock[7]
  • Massive hemoptysis[7][4]
  • Acute abdomen[8]
  • Ovarian hyperstimulation[9]
  • Spontaneous renal hemorrhage[10]
  • Severe hyperthyroidism[11][12]
  • Cardiothyreosis[11]
  • Death[5]

Prognosis

  • The prognosis for cure of patients with GTDs is good even when the disease has spread to distant organs, especially when only the lungs are involved.[1]
  • The probability of cure depends on the following:
  • Histologic type (invasive mole or choriocarcinoma)
  • Extent of spread of the disease/largest tumor size
  • Level of serum beta-hCG
  • Duration of disease from the initial pregnancy event to start of treatment
  • Number and specific sites of metastasis
  • Nature of antecedent pregnancy
  • Extent of prior treatment

References

  1. ↑ 1.0 1.1 General Information About Gestational Trophoblastic Disease. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq Accessed on October 14, 2015
  2. ↑ Killick S, Cook J, Gillett S, Ellis L, Tidy J, Hancock BW (2012). "Initial presenting features in gestational trophoblastic neoplasia: does a decade make a difference?". J Reprod Med. 57 (7–8): 279–82. PMID 22838240.
  3. ↑ Meydanli MM, Kucukali T, Usubutun A, Ataoglu O, Kafkasli A (November 2002). "Epithelioid trophoblastic tumor of the endocervix: a case report". Gynecol. Oncol. 87 (2): 219–24. PMID 12477457.
  4. ↑ 4.0 4.1 Zhang W, Liu B, Wu J, Sun B (April 2017). "Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series". J Med Case Rep. 11 (1): 110. doi:10.1186/s13256-017-1256-9. PMID 28411623.
  5. ↑ 5.0 5.1 Bishop BN, Edemekong PF. PMID 30571055. Missing or empty |title= (help)
  6. ↑ Piura E, Piura B (2014). "Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature". Eur. J. Gynaecol. Oncol. 35 (4): 359–67. PMID 25118474.
  7. ↑ 7.0 7.1 7.2 Chauhan M, Behera C, Madireddi S, Mandal S, Khanna SK (July 2018). "Sudden death due to an invasive mole in a young primigravida: Precipitous presentation masquerading the natural manner". Med Sci Law. 58 (3): 189–193. doi:10.1177/0025802418786120. PMID 29969941.
  8. ↑ Yadav RS, Shrestha S, Sharma S, Singh M, Bista KD, Ojha N (January 2018). "Partial Invasive Mole with Bilateral Torsion of Theca Lutein Cysts". J Nepal Health Res Counc. 15 (3): 298–300. PMID 29353908.
  9. ↑ Alhalabi K, Lampl BS, Behr G (July 2016). "Ovarian hyperstimulation syndrome as a complication of molar pregnancy". Cleve Clin J Med. 83 (7): 504–6. doi:10.3949/ccjm.83a.15036. PMID 27399862.
  10. ↑ Xiao S, Mu Q, Wan Y, Xue M (2016). "Spontaneous renal hemorrhage caused by invasive mole: a case report". Eur. J. Gynaecol. Oncol. 37 (3): 417–9. PMID 27352577.
  11. ↑ 11.0 11.1 Marchand L, Chabert P, Chaudesaygues E, Grasse M, Bretones S, Graeppi-Dulac J, Aupetit JF (2016). "An unusual cause of cardiothyreosis". Gynecol. Endocrinol. 32 (2): 107–9. doi:10.3109/09513590.2015.1111328. PMID 26559442.
  12. ↑ Simes BC, Mbanaso AA, Zapata CA, Okoroji CM (2018). "Hyperthyroidism in a complete molar pregnancy with a mature cystic ovarian teratoma". Thyroid Res. 11: 12. doi:10.1186/s13044-018-0056-7. PMC 6086074. PMID 30116304.

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