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Gestational trophoblastic disease (GTD) is a rare group of tumors that involves abnormal cell growth in a woman’s uterus. Unlike other reproductive cancers, the abnormal cells do not develop in a reproductive organ; instead, the tumors develop from cells that would normally grow into the placenta during a pregnancy. GTD always occurs in women of childbearing age.
GTDs include hydatidiform mole (or molar pregnancy), choriocarcinoma and placental site trophoblastic tumors. Most GTDs are non-cancerous, although some develop into cancer. All are highly treatable.
Symptoms and Diagnosis
The classis signs of GTD are an abnormal ultrasound and elevated HCG levels. HCG is often called the pregnancy hormone; it’s the hormone that is detected by home pregnancy tests. Typically, a woman with GTD will miss her menstrual period and think she’s pregnant. When she goes in for her first ultrasound, however, the image does not show a normally progressing pregnancy. Her HCG levels will also be abnormally elevated.
If a GTD is suspected, a physician will perform a dilation and curettage, also known as a “D and C.” (Dilation means to stretch the opening of the cervix to make it wider. Curettage involves removing a sample of the endometrium to be examined later.) The abnormal tissue will be removed from the uterus and sent to the lab for analysis. Although GTD is rare, our Gynecologic Cancer Program includes specialists with extensive experience diagnosing GTD. Chest imaging may be ordered as well, since GTD occasionally spreads to the lungs.
Some cases of GTD resolve on their own; after the removal of the abnormal tissue, the patient’s HCG level continues to decline until it’s within normal limits. If the HCG level remains elevated, additional treatment may be required. Treatment almost always produces a complete cure.
Surgery. A suction dilation and curettage usually removes all abnormal tissue and preserves the patients’ fertility. A hysterectomy (removal of the uterus) may be performed if a woman has GTD and is absolutely sure she does not want any more children.
Chemotherapy. GTD is extremely sensitive to anti-cancer drugs. If a woman’s HCG level fails to decrease, chemotherapy will be ordered. GTD is one of the few cancers that can almost always be cured by chemotherapy, no matter how advanced the disease is at the time of diagnosis.