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

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===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>  
 
* The probability of cure depends on the following:
'''Modified WHO prognostic scoring system as adapted by Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)'''<ref name="pmid14763174">{{cite journal |vauthors=Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S |title=Gestational trophoblastic neoplasia, FIGO 2000 staging and classification |journal=Int J Gynaecol Obstet |volume=83 Suppl 1 |issue= |pages=175–7 |date=October 2003 |pmid=14763174 |doi= |url=}}</ref>
:* [[Histologic]] type (invasive mole or choriocarcinoma)
 
:* Extent of spread of the disease/largest [[tumor]] size
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
:* Level of serum [[beta-hCG]]
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Score'''}}
:* Duration of disease from the initial [[pregnancy]] event to start of treatment
! style="background: #4479BA;" | {{fontcolor|#FFF|'''0'''}}
:* Number and specific sites of [[metastasis]]
! style="background: #4479BA;" | {{fontcolor|#FFF|'''1'''}}
:* Nature of antecedent [[pregnancy]]
! style="background: #4479BA;" | {{fontcolor|#FFF|'''3'''}}
:* Extent of prior treatment
! style="background: #4479BA;" | {{fontcolor|#FFF|'''4'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; | Age|| style="padding: 5px 5px; background: #F5F5F5;" |<40|| style="padding: 5px 5px; background: #F5F5F5;" |40||style="padding: 5px 5px; background: #F5F5F5;"|-||style="padding: 5px 5px; background: #F5F5F5;"|-
|-
| style="padding: 5px 5px; background: #DCDCDC; |Antecedent pregnancy|| style="padding: 5px 5px; background: #F5F5F5;" |Mole|| style="padding: 5px 5px; background: #F5F5F5;" |Abortion||style="padding: 5px 5px; background: #F5F5F5;"|Term||style="padding: 5px 5px; background: #F5F5F5;"|-
|-
| style="padding: 5px 5px; background: #DCDCDC; | Interval months from index pregnancy|| style="padding: 5px 5px; background: #F5F5F5;" |<4|| style="padding: 5px 5px; background: #F5F5F5;" |4 - <7||style="padding: 5px 5px; background: #F5F5F5;"|7 - <13||style="padding: 5px 5px; background: #F5F5F5;"|≥ 13
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Pretreatment serum hCG (iu/l)|| style="padding: 5px 5px; background: #F5F5F5;" |<10<sup>3</sup> || style="padding: 5px 5px; background: #F5F5F5;" |10<sup>3</sup> - <10<sup>4</sup>||style="padding: 5px 5px; background: #F5F5F5;"|10<sup>4</sup> - <10<sup>5</sup>||style="padding: 5px 5px; background: #F5F5F5;"|≥10<sup>5</sup>  
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Largest tumor size (including uterus)|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |3 - <5 cm||style="padding: 5px 5px; background: #F5F5F5;"|≥ 5cm||style="padding: 5px 5px; background: #F5F5F5;"|-
|-
| style="padding: 5px 5px; background: #DCDCDC; | Site of metastases|| style="padding: 5px 5px; background: #F5F5F5;" |Lung|| style="padding: 5px 5px; background: #F5F5F5;" |Spleen, Kidney||style="padding: 5px 5px; background: #F5F5F5;"|Gastrointestinal||style="padding: 5px 5px; background: #F5F5F5;"|Liver, Brain
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Number of metastases|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |1 - 4||style="padding: 5px 5px; background: #F5F5F5;"|5 - 8||style="padding: 5px 5px; background: #F5F5F5;"|>8
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Previous failed chemotherapy|| style="padding: 5px 5px; background: #F5F5F5;" |- || style="padding: 5px 5px; background: #F5F5F5;" |-||style="padding: 5px 5px; background: #F5F5F5;"|1 drug||style="padding: 5px 5px; background: #F5F5F5;"|2 or more drugs
|}


==References==
==References==

Revision as of 23:10, 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

Modified WHO prognostic scoring system as adapted by Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)[13]

Score 0 1 3 4
Age <40 40 - -
Antecedent pregnancy Mole Abortion Term -
Interval months from index pregnancy <4 4 - <7 7 - <13 ≥ 13
Pretreatment serum hCG (iu/l) <103 103 - <104 104 - <105 ≥105
Largest tumor size (including uterus) - 3 - <5 cm ≥ 5cm -
Site of metastases Lung Spleen, Kidney Gastrointestinal Liver, Brain
Number of metastases - 1 - 4 5 - 8 >8
Previous failed chemotherapy - - 1 drug 2 or more drugs

References

  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.
  13. ↑ Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S (October 2003). "Gestational trophoblastic neoplasia, FIGO 2000 staging and classification". Int J Gynaecol Obstet. 83 Suppl 1: 175–7. PMID 14763174.

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