Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a rare group of conditions that develop from trophoblast cells, which normally form the placenta during pregnancy.

The placenta supplies oxygen and nutrients to a developing baby. In GTD, these cells grow abnormally and form abnormal tissue inside the uterus. Some forms of GTD are noncancerous, while others can invade nearby tissue or spread to other parts of the body if left untreated.

GTD may occur after:

• A molar pregnancy
• A miscarriage
• An ectopic pregnancy
• A full-term pregnancy

Although the diagnosis can be frightening, most people with GTD are successfully treated, especially when the condition is identified early and monitored carefully.

What Is Gestational Trophoblastic Disease?

Gestational trophoblastic disease includes several different conditions, including:

• Complete molar pregnancy
• Partial molar pregnancy
• Invasive mole
• Choriocarcinoma
• Placental site trophoblastic tumor
• Epithelioid trophoblastic tumor

Each type behaves differently. Your care team will explain your diagnosis and recommend the treatment that is most appropriate for your condition.

What Are the Types of Gestational Trophoblastic Disease?

Types of GTD include:

• Complete molar pregnancy
• Partial molar pregnancy
• Invasive mole
• Choriocarcinoma
• Placental site trophoblastic tumor
• Epithelioid trophoblastic tumor

Your care team will explain which type you have and what treatment may be needed.

What Causes Gestational Trophoblastic Disease?

Gestational trophoblastic disease develops when cells that normally form the placenta grow abnormally after conception. In a molar pregnancy, the fertilized egg does not develop normally, and abnormal placental tissue grows instead of a healthy pregnancy.

Doctors do not always know why GTD develops. In most cases, it occurs randomly and is not caused by anything a patient did during pregnancy.

What Are the Risk Factors for Gestational Trophoblastic Disease?

Risk factors for GTD may include:

• A previous molar pregnancy
• Pregnancy before age 20 or after age 35
• A history of miscarriage
• Certain genetic or pregnancy-related factors

Having one or more risk factors does not mean you will develop GTD. Most people diagnosed with GTD have no identifiable risk factors.

What Are the Symptoms of Gestational Trophoblastic Disease?

Symptoms of GTD may include:

• Vaginal bleeding during or after pregnancy
• Severe nausea or vomiting
• Pelvic pain or pressure
• A uterus that is larger than expected for the stage of pregnancy
• High levels of the pregnancy hormone hCG
• Ovarian cysts
• Symptoms that continue after miscarriage, delivery, or treatment for pregnancy loss

Sometimes GTD is discovered during a routine ultrasound or after tissue is examined following a miscarriage or molar pregnancy.

When Should I See a Doctor?

You should see a healthcare provider if you have unusual vaginal bleeding during or after pregnancy, severe nausea or vomiting, pelvic pain, or symptoms that continue after miscarriage, delivery, or treatment for pregnancy loss.

If you have had a molar pregnancy, regular follow-up appointments and blood tests are important to make sure your hCG levels return to normal and remain normal over time.

How Is Gestational Trophoblastic Disease Diagnosed?

Gestational trophoblastic disease is diagnosed using blood tests, imaging studies, and tissue evaluation.

Tests may include:

• Blood tests to measure hCG levels
• Pelvic ultrasound
• Dilation and curettage (D&C)
• Laboratory examination of tissue
• Chest X-ray
• CT scan or MRI when appropriate

Monitoring hCG levels is an important part of diagnosis and treatment. These blood tests help your care team determine whether treatment has been successful or whether additional therapy is needed.

How Is Gestational Trophoblastic Disease Treated?

Treatment depends on the type of GTD, your hCG levels, whether the disease has spread, your overall health, and whether you wish to have children in the future. Your care team will develop a personalized treatment plan based on your specific diagnosis.

Treatment may include:

• Dilation and curettage (D&C)
• Regular hCG blood tests
• Chemotherapy
• Surgery in selected cases
• Hysterectomy in selected cases
• Long-term follow-up

For many patients, a D&C is the first treatment used to remove abnormal tissue from the uterus. After treatment, regular blood tests are essential to monitor hCG levels and confirm that the disease has resolved completely.

Some patients require chemotherapy if hCG levels remain elevated, if the disease spreads beyond the uterus, or if cancer develops. In selected situations, surgery, including hysterectomy, may be recommended.

Because many people diagnosed with GTD wish to have children in the future, fertility preservation and future pregnancy planning are important parts of care whenever possible.