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Gestational Trophoblastic Tumor (GTT) 

 

Gestational trophoblastic disease (GTD) is a rare pathological development which can lead to pregnancy-related tumors. The gestational trophoblastic tumor (GTT) is a malignant form of gestational trophoblastic disease, which always follows a pregnancy. There are at least four different histological types: invasive mole, a condition wherein a complete hydatidiform mole invades the wall of the uterus; gestational choriocarcinoma, a quick-growing form of cancer that occurs in a woman's reproductive system during pregnancy; placental site trophoblastic tumor, a tumor that forms where the placenta attaches to the uterus; and epithelioid trophoblastic tumor, a very rare form of GTT that affects women of child-bearing age. GTT is a rare disease and the exact annual incidence is unknown, but it can be about 1 / 1,000,000 women.  

 

Gestational Trophoblastic Tumor Symptoms 

The TTG occur in the aftermath of a partial or complete hydatidiform mole (15 % complete moles and 3% of partial moles) of a spontaneous miscarriage (1/150) or delivery (1/40 000). The telltale signs are a lack of normalization or re- rise of total serum choriogonadotropin (hCG) after evacuation of a hydatidiform mole (more than 60 % of cases), persistent unexplained bleeding after a spontaneous abortion or voluntary termination of a pregnancy (approximately 30% of cases) and very occasionally, unexplained bleeding in the weeks and months following a normal delivery or ectopic pregnancy (about 10% of cases). Exceptionally, metastases are revealing in a woman of childbearing age. 

Gestational Trophoblastic Tumor Causes

The causes of gestational trophoblastic tumors are not well known. The etiologic search for a TTG is based on Blood Human Chorionic Gonadotropin ( hCG) Assays. The procedure is recommended in the aftermath of a hydatidiform mole before any persistent metrorrhagia (uterine bleeding at irregular intervals) more than six weeks after a pregnancy, and any patient of childbearing age with metastases (in the lung, liver, brain, kidney or vaginal) with no known primary cancer. It is important to know that even if the causes of the disease are not well known a healthy lifestyle can prevent it as most other cancers.  


Gestational Trophoblastic Tumor Treatment  

Gestational Trophoblastic Tumor should not be confused with hydatidiform moles, and for choriocarcinoma, with non-gestational choriocarcinoma which is most often ovarian.  Once the diagnosis is done, staging techniques should be performed to search for frequent metastatic locations. These procedures include a transvaginal pelvic Color Doppler ultrasound, pelvic MRI and Thoraco-abdominal CT scanner. Chest X-ray should be performed to calculate the FIGO 2000 staging and risk factor in case the scanner has revealed lung metastases. This score can distinguish TTG low risk (less than or equal to 6 score), TTG at high risk (greater than or equal to 7 score). The therapeutic monitoring and decision should be done by an expert in a special medical center after discussion with patient.   

 

Low-risk tumors are treated with systemic single-agent chemotherapy (methotrexate for instance), and high-risk tumors are treated first-line systemic chemotherapy. Hysterectomy should not be recommended in first intention in a woman with the desire to give birth (procreate), except in exceptional cases where the surgery is required the save the life of the patient. Placental site trophoblastic tumors and epithelioid trophoblastic tumors have a particular behavior; the FIGO score is not suitable and total hysterectomy is the basic treatment for these tumors that are usually chemoresistant. The overall cure rate is about 99 %.  But this prognosis is closely linked to early diagnosis, the level of risk of the tumor (low or high stage) and the adequacy of treatment