Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a rare group of tumors that develop early in pregnancy. It occurs when abnormal cells grow in the "trophoblastic" tissue which typically surrounds the fertilized egg. This tissue normally develops into the placenta to support the pregnancy. Hydatidiform mole or "mole" is the term used to describe the most common of these tumors.

Most GTDs are benign, or noncancerous, however some forms may become invasive and spread to other parts of the body.

All forms of the disease can be treated and in most cases, are cured.

While the exact cause is not known, factors that may increase a woman's risk of having a molar pregnancy include:

• Becoming pregnant before age 20 or after age 40
• Race - Asian women are at increased risk
• Prior history of gestational trophoblastic disease
• Dietary deficiencies

The main types of gestational trophoblastic disease are:

Hydatidiform mole. The most common form, also called a molar pregnancy, occurs when the sperm and egg cells join but do not develop into a fetus. Instead, tissue forms that resembles small clusters of grapes. These moles are not cancerous, but they may develop into invasive GTDs.

Invasive mole. A hydatidiform mole that has grown into the muscle layer of the uterus

Choriocarcinoma. A cancerous tumor that develops from a hydatidiform mole, or from tissue that remains in the uterus following an abortion, miscarriage or delivery. Choriocarcinoma can grow quickly and spread from the uterus to other parts of the body.

Placental-site or epithelioid trophoblastic tumor. Very rare forms of GTD that develop where the placenta attaches to the lining of the uterus, usually after a normal pregnancy or an abortion. These tumors may invade the muscle layer of the uterus.

Symptoms vary based on the type of GTD but may include:

• Unusual abdominal swelling
• Unusual vaginal bleeding during pregnancy
• Severe nausea
• Severe vomiting
• Anemia
• Overactive thyroid gland
• No fetal movement or heartbeat

In addition to a thorough medical history and physical exam, diagnosis may include:

• Pelvic exam - to feel for any lumps or abnormalities
• Ultrasound - to look at the uterine tumor and for spread to surrounding organs 
• Blood test - to look for high or persistent levels of hCG (human chorionic gonadotropin), a hormone present during normal pregnancy

Treatment depends on the individual patient, the type of tumor and whether it has spread, but may include:

• Surgery - to remove the cancer, typically either a dilation and curettage (D&C) procedure, which involves gently scraping or suctioning the walls of the uterus, or in some cases, a hysterectomy to remove the uterus
• Chemotherapy - the use of drugs giving intravenously (into the vein) to destroy cancer cells
• Rarely, radiation therapy, the use of high-energy X-rays to kill cancer cells and shrink tumors, may be used