Trophoblastic disease. Concepts of management

Trophoblastic tumors are a notoriously unpredictable group in which metastasis may occur from histologically benign tumors and cause death, whereas a histologically malignant tumor may spontaneously disappear. Additional problems are created by the inability to accurately establish a diagnosis before abortion of molar tissue or development of metastasis.In recent years chemotherapy has dramatically improved the prognosis of patients with choriocarcinoma. This fact, plus the importance of the time interval between onset of disease and the beginning of chemotherapy, makes close follow-up of patients with trophoblastic tumors imperative.Concepts of therapy for trophoblastic tumors are rapidly changing. Indications for chemotherapy are broadening, especially in the areas of persistent and metastatic trophoblastic disease. As surgical intervention in the form of hysterectomy is becoming less important, the reproductive capacity of these young women is being preserved. Astute diagnosis, appropriate therapy and active life-long follow-up are the essentials in the management of patients with trophoblastic disease.