Gestational trophoblastic neoplasia natural history, complications and prognosis

Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural history

• Patient has early symptoms like 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
• nausea and vomiting, and absent fetal movement during pregnancy.
• As the tumor grows larger, patient may notice symptoms like unusual bleeding or discharge from the lesion, large mass on the vulva, dysuria, and dyspareunia.
• In advanced disease, metastases may be present in the abdomen and lungs.
• The patient may present with dyspnea, cough with blood-stained sputum, persistent pain or discomfort in the chest, edema hands/feet, and inguinal lymphadenopathy.
• Once the cancer spreads to the other organs, it is most likely fatal.

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.
• 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 metastases
• Nature of antecedent pregnancy
• Extent of prior treatment

Complications

• Recurrance
• Anemia