Gestational Trophoblastic Disease – Symptoms, Diagnosis, Treatment

What is Gestational Trophoblastic Disease?

Gestational Trophoblastic Disease is a rare tumor that occurs during pregnancy. This kind of tumor starts with the trophoblast area, a cell that provides nutrients to the embryo as well as contributing in the formation of the placenta. Normally, when this disease is present, child development is impossible.

Types

There are four main types of Gestational Trophoblastic Disease which are divided into two categories:

A) The Benign Tumor

Molar Pregnancy

It is the most common type of Gestational Trophoblastic Disease where there is an abnormal mass growth inside the uterus. It is a result of having an over-production of tissue in the placenta where the newborn is usually present. This molar pregnancy is divided in to two types:

1. Partial Molar Pregnancy develops when two sperms fertilize the egg. It means that there is abnormal placenta and some development of  the fetus.
2. Complete Molar Pregnancy develops when one or two sperms fertilize the empty egg cell. There is an abnormal placenta but no fetus is formed.

Signs and Symptoms:

1. There is an abnormal growth of the uterus and some women might think they are pregnant
2. Nausea and vomiting
3. During first three months of pregnancy there will be some cases of vaginal bleeding
4. Feeling of restlessness, increased heart rate, heat intolerance and unexplained weight loss.
5. High blood pressure and swelling of the extremities.

B) The Malignant Tumors

B1. Invasive mole

It is a tumor where there is an invasion in the uterus that also spreads and metastasizse in other parts of the body.

Signs and Symptoms:

1. Abdominal swelling
2. Excessive vomiting
3. Fatigue often caused by anemia due to severe vaginal bleeding
4. Abdominal pain
5. Pelvic pain and discharge from the vagina
6. In rare cases, the patient will feel shortness of breathe as well as coughing up blood due to the invasion of cancer cells in the lungs.

B2. Choriocarcinoma

It is a type of cancer that grows rapidly in woman’s uterus. With this cancer, there is a big possibility that even after removing the mole, it can continue to spread and grow again into cancer.

Signs and Symptoms:

1. Vaginal bleeding
2. Uneven swelling of the uterus
3. Abdominal and pelvic pain

B3. Placental-Site Trophoblastic Tumor

It is a rare form of Gestational Trophoblastic Disease that develops in the area where the placenta attaches to the uterus. It is a slow-growing tumor and doesn’t easily invade other parts of the body. It is also a tumor that is easily curable.

Signs and Symptoms:

1. Normally, it is asymptomatic in nature
2. Abnormal vaginal bleeding
3. Enlarged uterus
4. Unusual pain in the abdominal area

Causes

1. The exact cause is unknown
2. It is normally associated with (1) age : women above 40 years old and below 20 years old. (2) Previous molar pregnancy, (3) miscarriage, (4) blood type: RH incompatibility, (5) women who take pills, (6) diet, (7) family history.

Diagnosis

1. Family and medical history including age and history of previous abortions or miscarriages.
2. Physical examination if there is any medical condition that might affect diagnosis of the disease. This includes vaginal bleeding, abdominal and pelvic pain.
3. Urine and blood samples to determine if there are any abnormal hormons present that relate to the formation of the disease.
4. A biopsy is a medical test done by professionals where they will take a tissue sample for examination. The sample is checked through a microscope and helps to determine any diseases.
5. Computed Tomography Scan (CT scan) is an X-ray that can provide sharper and more detailed images of the lungs. It combines a series of X-ray views with different angles that produce cross-sectional images of bones and tissues.
6. MRI or Magnetic Resonance Imaging is also like the CT scan and helps detect any formation or abnormal growth in the body, but it is clearer because it uses a dye to see images.
7. Ultrasound that can also help in viewing internal organs and determine any abnormal tissues.

Treatment

1. Suction Curettage – a procedure that suctions the contents of the uterus through the cervix. Normally, it is used for abortion purposes, but it also aids in regulation of menstruation and is  used to terminate any molar pregnancy
2. Hysterectomy – a surgical procedure where surgeons remove the uterus. Usually, it is recommended to women who don’t want to have future pregnancies. It is recommended if there is no other available treatment available.
3. Chemotherapy – a procedure done usually after surgery to eliminate possible cancer cells that are not removed in surgery. There are two types of chemotherapy done to patients with Appendix Cancer. These are:
4. Local Chemotherapy – this type of chemotherapy focuses on one section of the body and is the common type of chemotherapy used in this disease. Medical professionals normally remove the accumulated fluid inside the patient’s stomach before doing this procedure in order for the chemotherapy to be effective. A tube is inserted after cytoreduction surgery to deliver the chemotherapy procedure. Normally, it is done only once.
5. Systemic Chemotherapy – a type of chemotherapy procedure that is delivered to the bloodstream to reach cancer cells that have scattered in the body. This type of chemotherapy needs many cycles and the effect of this therapy depends on the person and the dose given. The patient often experiences fatigue, nausea, vomiting, and loss of appetite but these symptoms subside eventually after the treatment.
6. Radiation Therapy – a therapy used in patients using high-energy X-rays to kill cancer cells. This type of therapy is not a common treatment for patients with appendix cancer. This type of therapy is delivered in many cycles. It is used to kill cancer cells without affecting the tissues that surround the cancer cells; it can also used as a treatment to reduce the size of tumors and reduce the amount pain.