Carol Aghajanian, Chief of Gynecologic Medical Oncology, discusses lab results with a nurse. Gestational trophoblastic disease is a rare but often highly treatable cancer.
At Memorial Sloan-Kettering Cancer Center, we have a sophisticated program for the diagnosis and management of women with high-risk GTD.
Almost all forms of nonmetastatic GTD — disease that is confined to the uterus and has not spread to another part of the body — can be cured with prompt management. Even advanced GTD can be extremely responsive to carefully monitored chemotherapy. Effective multidrug chemotherapy regimens have vastly improved the outlook for patients with metastatic disease, with cure rates currently as high as 80 to 90 percent.
The two primary approaches for treating GTD are surgery and chemotherapy. Radiation therapy is rarely used and is usually reserved for use in combination treatment for patients whose GTD has spread to the brain.
Diagnosis
To diagnose GTD, your doctor will start by performing a pelvic examination of your uterus. In addition, a simple blood test for a common hormone is most often used to diagnose GTD. Hydatidiform moles and other forms of GTD often release an extraordinary amount of the hormone human chorionic gonadotropin (HCG), which is produced in the early stages of pregnancy. Because GTD tumors usually release far more HCG than normal placenta, a woman’s HCG level is a useful indicator of this form of cancer. In women with GTD, blood HCG levels can reach or exceed 100,000 mIU/ml.
If very high levels of HCG are found, your doctor will usually perform an ultrasound (an imaging process that uses sound waves) to look for tumors and to support the diagnosis. To determine whether the disease has spread beyond the uterus, your doctor may perform other imaging tests such as x-rays, CT scans, and/or MRI of the chest, abdomen, pelvis, and brain.
Surgery
Hydatidiform moles are most commonly removed by dilation and suction curettage (D&C), which is usually performed as an outpatient procedure. Sometimes, women with GTD may be treated with surgery to completely remove the uterus (hysterectomy). However, especially for young women of child-bearing age, the surgeon will try to preserve the uterus whenever possible. After surgery, your doctor will measure your HCG level to verify that the mole was completely removed.
Chemotherapy
If the GTD has spread beyond the uterus or into the uterus, your doctor may recommend chemotherapy. Women who have had hydatidiform moles removed and whose tumors persist but have not spread may receive the drugs methotrexate or actinomycin-D.
Chorioadenomas and choriocarcinomas are both highly responsive to prompt management with newer multidrug regimens. Drugs commonly used to treat these cancers include methotrexate, cyclophosphamide, etoposide, vincristine, and actinomycin-D. The drug regimen is repeated after several days or weeks until HCG tests indicate that the disease has gone into remission.
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