1 / 17

Gestational Trophoblastic Neoplasia

Gestational Trophoblastic Neoplasia. Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia khalidsait@yahoo.com. Key Words. Group of disease with wide range of neoplastic potential Create a lot of challenge for us in term of diagnosis and treatment

deanna
Télécharger la présentation

Gestational Trophoblastic Neoplasia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Gestational Trophoblastic Neoplasia Dr Khalid Sait FRCSC/Gynecologic Oncologist/Ass. Prof KAUH/Jeddah / Saudi Arabia khalidsait@yahoo.com

  2. Key Words • Group of disease with wide range of neoplastic potential • Create a lot of challenge for us in term of diagnosis and treatment • Diagnosis and management will depends on the history, HCG level and metastasis work up

  3. Clinical pathology of gestational trophoblastic disease • 1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma • 2- Intermediate trophoblastic cells derivative Placental – site tumor

  4. Risk Factors for Moler pregnancy • Extremes of reproductive years • Prior moler mole • Prior spontaneous abortion • Vit A deficiency • Race ( Indonesia 1:85, USA 1:1500)

  5. Clinical Features • Large for date 50 % • Hyper emesis 20 % • Early PIH 5% • Abscent FH ( except in partial mole or twin pregnancy) • Hyperthyroidism symptom and sign 5% • Rarely presented with metastasis symptom and sign

  6. Management of molar pregnancy

  7. Follow up of patient with molar pregnancy after evacuation • HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months • Contraception for 1 year • Pelvic examination every 2 weeks until normal,then every 3 months • Check histopathology

  8. If no proper decrease or BHCG start to increase

  9. Persistent GTD

  10. Indication for initiating treatment during post mole follow up • Serum BHCG values rising more than 10 % for 2 wk ( 3 weekly titre) • Serum BHCG values on plateau for 3 wk or decline of less than 10 % • Presence of metastasis • Significant elevation of serum BHCG values after reaching normal levels • Choriocarcinoma or invasive mole on histopathology • HCG level still elevated 6 months after molar evacuation • HCG > 20000 miu/ml 4 weeks after evacuation

  11. Work up of gestational trophoblastic neoplasia • History and physical examination • chest XR ( if neg  CT ) • Pretreatment HCG titre • Hematological survey • Serum chemistries • CT of brain • Ultrasound of pelvis • Liver scan ( u/s or CT )

  12. CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS • Benign 1) complete mole 2) Partial mole • Malignant (invasive mole and choriocarcinoma) 1) nonmetastatic 2) metastatic a) low risk b) high risk

  13. Risk factors(malignant GTD) 1.Disease present more that 4m(long duration) or 2.pretreatment B-HCG greater than 40,000mlu/ml or 3.presence of met to sites other than lungs or vagina i,e liver or brain etc.. 4. prior chemo 5 following Term pregnancy

  14. NON METASTATIC or GOOD PROGNOSIS METASTATIC *Single agent chemotherapy *survival 90-100% METASTATIC POOR PROGNOSIS *Combined chemotherapy * survival 50 % CHEMOTHERAPY FOR GTN

  15. REMISSION OF GTN DISEASE REMISSION NON METASTATIC 100 % GOOD PROGNOSIS METASTATIC 100 % POOR PROGNOSIS METASTATIC 66 % TOTAL 92 %

  16. SUMMARY GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES

  17. Q&A GTN Dr Khalid Sait FRCSC Ass. Prof of Gynecologic Oncology KAUH,Jeddah Saudi Arabia khalidsait@yahoo.com

More Related