Gestational Trophoblastic Neoplasia

Gestational trophoblastic neoplasia (GTN) refers to a group of cancers that develop from an abnormal growth of cells normally found in the placenta. It can be diagnosed after a pregnancy, a miscarriage, or a complete or partial molar pregnancy, which is when the placenta does not develop normally and forms a tumor made of small cysts.

GTN is more commonly diagnosed in patients over age 40 and/or those of Southeast Asian descent.

There are different types of gestational trophoblastic neoplasia, including:

• Invasive mole: Occurs when a complete or partial molar pregnancy penetrates the muscular or vascular layer of the uterus
• Choriocarcinoma: A fast-growing type of GTN that develops from trophoblastic cells, specifically the cytotrophoblasts and syncytiotrophoblasts, which should have formed a part of a normal placenta
• Placental site trophoblastic tumor (PSTT): A very rare condition that originates from the intermediate trophoblast layer. Roughly 70% are benign (noncancerous), but 30% are malignant (cancerous).
• Epithelioid trophoblastic tumor (ETT): This tumor is similar in behavior and prognosis to PSTT, but is even more rare. Most patients are diagnosed 15-20 years after a prior pregnancy.

Symptoms and Diagnosis

• Persistent bleeding after a miscarriage, termination (abortion) or delivery
• Persistent lack of menstruation following miscarriage, termination (abortion) or delivery
• Abdominal pain or cramping
• Enlarged uterus and/or ovarian cysts
• Persistently positive pregnancy test
• Pelvic pain or pressure
• Cough, shortness of breath
• Headaches or seizures

Often, the diagnosis of gestational trophoblastic disease is first made by a general obstetrician-gynecologist after a patient undergoes a miscarriage, termination or dilation and curettage (D&C) to remove a molar pregnancy. The physician will watch the levels of the pregnancy hormone β-HCG until the hormone is no longer detectable. If the hormone level does not decrease and normalize, patients are usually referred to a gynecologic oncologist for further evaluation. 

Based on exams, tissue samples, bloodwork and imaging studies, a definitive diagnosis of gestational trophoblastic neoplasia (GTN) can be made.

Our gynecologic pathologists at UChicago Medicine assist us in making an accurate diagnosis by reviewing tissue samples under a microscope. This also allows our gynecologic oncologists to tailor a treatment plan that best fits a patient’s disease. 

Important parts of the diagnosis include:

• Pelvic examination
• Blood tests
• Pelvic ultrasound
• Chest X-ray

Initial Treatment

Depending on both the stage and risk level, treatments may include a second D&C to remove affected tissue from the uterus, followed by systemic chemotherapy, systemic chemotherapy alone, or surgery in the form of a hysterectomy. GTN generally responds well to chemotherapy.

Treatments for advanced stages of GTN may involve one or more chemotherapy drugs given through the veins. It is important that you follow the prescribed timing of the chemotherapy regimen and undergo treatment with oncologists who are experienced in treating this disease. These cancers are at risk for becoming resistant to the treatment, so adherence to the treatment regimen is essential. 

The blood levels of the pregnancy hormone β-HCG are used to follow the tumor’s response to treatment. Once the β-HCG level is undetectable, these levels are monitored for at least six to 12 months to ensure there is no evidence of recurrent disease. The use of contraception for patients who do not undergo a hysterectomy is critical, so a new pregnancy is not confused with a recurrence of GTN.

Treatment for Persistent or Recurrent Disease

If the initial tumor returns or does not go away with treatment, a full work-up to restage the tumor is performed. This usually includes more bloodwork and a physical exam. Patients also undergo a CT scan or MRI to investigate whether the disease has spread. 

If the tumor recurs, patients can receive single-drug chemotherapy treatment, but many recurrent tumors require a multi-drug chemotherapy regimen. Even still, many patients can be cured of their disease with the use of the appropriate chemotherapy drugs. Our team works closely with patients to identify and prescribe remedies to counteract the side effects of chemotherapy.

Why choose UChicago Medicine for gestational trophoblastic neoplasia treatment? 

UChicago Medicine is a nationally recognized leader in the treatment of gynecologic cancers, from rare to common diagnoses. Factors that set us apart include:

• A large, dedicated team of experts in gynecologic cancer diagnosis, treatment and supportive care. Our team is made up of specialists in several areas, including gynecologic oncology, gynecologic pathology, radiology, radiation oncology, oncofertility, supportive oncology, nursing and more.
• An active research community conducting both clinical and laboratory research into gynecologic cancer. Search our database of clinical trials.
• Coordination of supportive oncology services, including social work, physical therapy, nutrition, wellness and psychosocial support
• Access to PRISM, a specialized program in sexual health for gynecologic cancer survivors