Asian approaches in the treatment of trophoblastic disease

The cure of trophoblastic disease depends on early recognition and appropriate chemotherapy. In many areas in Asia, doctors face the problems of insufficient funds and poor patient compliance with follow-up. In such situations, the maximum returns for the minimum input would consist of: 1. Routine ultrasound diagnosis for irregular vaginal bleeding associated with amenorrhea; 2. In hydatidiform mole, hysterectomy for women above 40 and those who have completed their families; prostaglandin and suction curettage for evacuation; 3. Prophylactic methotrexate-folinic acid, or dactinomycin or 5-FU for high-risk cases; 4. Follow-up by the simplified regimen using hCG test kits; 5. Chemotherapy with hysterectomy for choriocarcinoma, whether localized in the uterus or metastatic: if the uterus is to be conserved, there must be a good reason; 6. Multiagent chemotherapy as first line in all high-risk cases; and 7. In view of the excellent results with 5-FU in China, investigation of this drug elsewhere, initially in metastatic mole.