Gestational Trophoblastic Disease (GTD)
Types of Gestational Trophoblastic
Benign – Non Cancer
Molar pregnancy – when sperm and an egg
join without resulting in a pregnancy. It
instead develops into a cluster of cysts. In
about 1 out of 5 women GTD will become
malignant (women’s cancer network.org)
Cancer—abnormal, rapidly reproducing
The myometrium is the outside muscle
layer of the uterus. The abnormal cells
from the placenta (hydatidiform mole) can
invade this layer which is called an
invasive mole. Most often women have
symptoms when this occurs. Some of the
symptoms are: irregular vaginal bleeding,
cysts on your ovaries, an enlarged uterus,
or constantly raised hCG levels.
Sometimes, this can be seen on ultrasound
These cancerous placental tumor cells grow
fast. They will attack blood vessels early
which means it is more likely to spread to
other organs such as lung, liver, and brain.
These cancerous cells are very fragile.
They often cause bleeding. Symptoms of
this type of GTD are most often related to
bleeding in the affected organ or organs.
Placental-site Trophoblastic Tumor
PSTT is an uncommon form of GTD. This
type is caused by a different type of
placenta or trophoblastic cell called an
intermediate trophoblast. These cells make
very little hCG. The blood level of the
pregnancy hormone is very low or normal.
These tumors most often remain within the
uterus. PSTT does not respond very well to
chemotherapy. It is most often treated with
Stage I — All patients with persistently
elevated beta-hCG levels and
tumor confined to the uterus.
Stage II — The presence of tumor outside
of the uterus, but limited to the vagina
Stage III — Pulmonary metastases with or
without uterine, vaginal, or pelvic
Stage IV — All other metastatic sites (e.g,
brain, liver, kidneys, gastrointestinal tract).
Modified WHO prognostic scoring system as adapted by FIGO (International Federation
(Gynecology and Obstetrics)
Format for reporting to FIGO Annual Report: In order to stage and allot a risk factor score, a
patient's diagnosis is allocated to a stage as represented by a roman numeral I, II, III, and IV.
This is then separated by a colon from the sum of all the actual risk factor scores expressed in
arabic numerals; e.g., stage 11:4, stage IV:9. This stage and score will be allotted for each
patient. (Berkowtiz, R.S. & Goldstein, D.S.)
Scores 0 1 2 4
Age <40 >40
Antecedent pregnancy Mole Abortion Term
Interval months from index
<4 4–7 7–13 >13
Pretreatment Serum hCG
<1000 <10,000 <100,000 >100,000
Largest tumor size (including
3–<5 cm >5 cm
Site of metastases Lung Spleen/kidney GI Liver/brain
Number of metastases – 1–4 5–8 >8
Previous failed chemotherapy Single drug 2 or more
Treatment will be based on the size and
location of the tumor, the results of hCG
levels, the stage of the disease, your age,
general health, and your wishes about
Single Agent Chemotherapy
The single agent drugs most often used are
methotrexate injection into the vein or
muscle or actinomycin-D injection in the
vein. Single agent chemotherapy is used for
treatment of persistent GTD.
Multi Agent Chemotherapy
Multi agent chemotherapy is used when
patients are resistant to single agent drugs, in
high risk patients who are stage II or III or in
patients who have stage IV disease. The
most common drugs are etoposide/VP-16,
methotrexate, actinomycin-D, vincristine,
and cyclophosphamide. All of these are
given as injections into the vein.
Hysterectomy (removal of the uterus) is a
treatment for various forms of GTD if the
woman does not wish to preserve fertility.
This is generally used to treat metastases
(cancer that has spread) to the brain.
Berek & Hacker. (2010). Gynecologic Oncology. 5th Ed. Lippincott Williams and Wilkins,
Berkowitz, R.S., Goldstein, G.P. (2009). Current management of gestational trophoblastic
diseases. Gynecologic Oncology, 112, pp 654-662.
Women’s Cancer Network, Retrieved at www.wcn.org. Educational Materials: GTD, 2009
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