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Gestational trophoblastic disease in 2005
1Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University.
Abstract:
Gestational trophoblastic diseases are still problematic in our practice. Event the incidence is in generally decreasing. And the development of Medicine in this decade can elucidate some parts of pathophysiology at cellular and molecular levels. However, malignant changes still can not be prevented. Approximately 20% of patients will develop malignant sequelae requiring administration of chemotherapy after evacuation of hydatidiform moles. Most patients with postmolar gestational trophoblastic disease will have non-metastatic molar proliferation or invasive moles, but gestational choriocarcinomas and metastatic disease can develop in this setting. Gestational choriocarcinoma occurs approximately 50% after term pregnancies, 25% after molar pregnancies, and the remainder after other gestational events. Although much rarer than hydatidiform moles or gestational choriocarcinomas, placental site trophoblastic tumors can develop after any type of pregnancy. For optimal management, practicing obstetrician-gynecologists should be able to diagnose and manage primary molar pregnancies, diagnose and stage malignant gestational trophoblastic neoplasia, and assess risk in women with malignant gestational trophoblastic neoplasia. This chapter views some points which may be useful for evidence-based practice in modern Medicine.
Insights
Gestational trophoblastic diseases, though decreasing, still pose challenges. Malignant changes can occur in about 20% of patients post-molar pregnancy, necessitating chemotherapy and careful management.
Area of Science:
- Obstetrics and Gynecology
- Oncology
- Pathophysiology
Background:
- Gestational trophoblastic diseases (GTDs) remain a clinical concern despite decreasing incidence.
- Advances in medicine are clarifying the cellular and molecular pathophysiology of GTDs.
- Malignant transformation remains a challenge, affecting approximately 20% of patients post-hydatidiform mole evacuation.
Purpose of the Study:
- To provide insights for evidence-based practice in managing gestational trophoblastic diseases.
- To highlight the importance of diagnosing and staging malignant gestational trophoblastic neoplasia.
- To guide risk assessment for women with malignant gestational trophoblastic neoplasia.
Main Methods:
- Review of current medical literature and clinical practice guidelines.
- Analysis of pathophysiology at cellular and molecular levels.
- Discussion of diagnostic and management strategies for various GTD subtypes.
Main Results:
- Most post-molar GTDs are non-metastatic, but choriocarcinomas and metastatic disease can arise.
- Gestational choriocarcinoma incidence varies, occurring after term pregnancies, molar pregnancies, and other gestational events.
- Placental site trophoblastic tumors are rare but can follow any pregnancy.
Conclusions:
- Optimal management requires accurate diagnosis and staging of GTDs and neoplasia.
- Risk assessment and appropriate intervention are crucial for patients with malignant GTDs.
- Continued research into pathophysiology may lead to improved prevention and treatment strategies.
