Gestational Trophoblastic Neoplasia

Diagnosis

• Gestational trophoblastic neoplasia primarily occurs in patients with a history of molar pregnancies.
• Approximately 10–15% of patients with complete hydatidiform mole and 5% of patients with partial hydatidiform mole will develop this condition.
• The diagnosis is made by monitoring serum human chorionic gonadotropin (hCG) levels following molar pregnancies.

Assessment

• Once diagnosed with gestational trophoblastic neoplasia, patients undergo a comprehensive workup to determine the disease stage and are assigned a risk score for selecting the appropriate chemotherapy regimen.
• This includes chest X-ray, pelvic and abdominal ultrasound, thyroid function test, serial human chorionic gonadotropin (hCG) level measurements, baseline blood tests and potentially CT scans.

• Chemotherapy is the primary treatment for gestational trophoblastic neoplasia.
• Low-risk patients typically receive single-agent chemotherapy, while high-risk patients require combination chemotherapy.
• Surgical resection is reserved for selected patients, particularly those with chemo-resistant diseases.

After completion of treatment, patients should be followed up regularly to 

• Deal with the side-effects and complications arising from the treatment
• Monitor the disease status 

Side-effects and Complications from Treatment 

• Extensive operation involves the removal of and insults to normal structures, e.g. lower limb oedema after pelvic lymphadenectomy
• Chemotherapy side-effects can be long-lasting, e.g. numbness over extremities after chemotherapy using platinum agents
• Patients who have received radiotherapy can also develop post-treatment complications 

Monitoring of Disease Status 

• Physical examination
• Vaginal cytology
• Blood test for tumour markers
• Repeated imaging studies if necessary. It helps pick up recurrent diseases