Source: Cancer Resource Room

What are Gestational Trophoblastic Tumors?
Gestational trophoblastic tumor, a rare cancer in women, is a disease in which cancer (malignant) cells grow in the tissues that are formed following conception (the joining of sperm and egg). Gestational trophoblastic tumors start inside the uterus, the hollow, muscular, pear-shaped organ where a baby grows. This type of cancer occurs in women during the years when they are able to have children. There are two types of gestational trophoblastic tumors:

• hydatidiform mole
• choriocarcinoma

If a patient has a hydatidiform mole (also called a molar pregnancy), the sperm and egg cells have joined without the development of a baby in the uterus. Instead, the tissue that is formed resembles grape-like cysts. Hydatidiform mole does not spread outside of the uterus to other parts of the body.

If a patient has a choriocarcinoma, the tumor may have started from a hydatidiform mole or from tissue that remains in the uterus following an abortion or delivery of a baby. Choriocarcinoma can spread from the uterus to other parts of the body. A very rare type of gestational trophoblastic tumor starts in the uterus where the placenta was attached. This type of cancer is called placental-site trophoblastic disease.

What are the symptoms of gestational trophoblastic tumor?
Gestational trophoblastic tumor is not always easy to find. In its early stages, it may look like a normal pregnancy. A doctor should be seen if the there is vaginal bleeding (not menstrual bleeding) and if a woman is pregnant and the baby hasn’t moved at the expected time.

How is cancer of the gestational trophoblastic tumor diagnosed?
If there are symptoms, a doctor may use several tests to see if the patient has a gestational trophoblastic tumor. An internal (pelvic) examination is usually the first of these tests. The doctor will feel for any lumps or strange feeling in the shape or size of the uterus. The doctor may then do an ultrasound, a test that uses sound waves to find tumors. A blood test will also be done to look for high levels of a hormone called beta HCG (beta human chorionic gonadotropin) which is present during normal pregnancy. If a woman is not pregnant and HCG is in the blood, it can be a sign of gestational trophoblastic tumor.

The chance of recovery (prognosis) and choice of treatment depend on the type of gestational trophoblastic tumor, whether it has spread to other places, and the patient’s general state of health.

Stages of gestational trophoblastic tumors
Once gestational trophoblastic tumor has been found, more tests will be done to find out if the cancer has spread from inside the uterus to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for gestational trophoblastic tumor:

Hydatidiform mole
Cancer is found only in the space inside the uterus. If the cancer is found in the muscle of the uterus, it is called an invasive mole (choriocarcinoma destruens).

Placental-site gestational trophoblastic tumors
Cancer is found in the place where the placenta was attached and in the muscle of the uterus.

Nonmetastatic
Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following an abortion or delivery of a baby. Cancer has not spread outside the uterus.

Metastatic, good prognosis
Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following an abortion or delivery of a baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered good prognosis or poor prognosis.

Metastatic gestational trophoblastic tumor is considered good prognosis if all of the following are true:

1. The last pregnancy was less than 4 months ago.
2. The level of beta HCG in the blood is low.
3. Cancer has not spread to the liver or brain.
4. The patient has not received chemotherapy earlier.

Metastatic, poor prognosis
Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following an abortion or delivery of a baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered good prognosis or poor prognosis.

Metastatic gestational trophoblastic tumor is considered poor prognosis if any the following are true:

1. The last pregnancy was more than 4 months ago.
2. The level of beta HCG in the blood is high.
3. Cancer has spread to the liver or brain.
4. The patient received chemotherapy earlier and the cancer did not go away.
5. The tumor began after the completion of a normal pregnancy.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the uterus or in another part of the body.

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