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Home > Cancers We Treat > Gynecologic Cancer > Gestational Trophoblastic Disease

Gestational Trophoblastic Disease

Definition

Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. This tissue is made of trophoblast cells and normally surrounds the fertilized egg in the uterus. Trophoblast cells help connect the fertilized egg to the wall of the uterus and form part of the placenta (the organ that passes nutrients from the mother to the fetus).

Sometimes there is a problem with the fertilized egg and trophoblast cells. Instead of a healthy fetus developing, a tumor forms. Until there are signs or symptoms of the tumor, the pregnancy will seem like a normal pregnancy. Most GTD is benign (not cancer) and does not spread, but some types become malignant (cancer) and spread to nearby tissues or distant parts of the body.

Gestational trophoblastic disease (GTD) is a general term that includes different types of disease:

  • Hydatidiform Moles (HM)
  • Complete HM
  • Partial HM
    • Gestational Trophoblastic Neoplasia (GTN)
    • Invasive moles
    • Choriocarcinomas
    • Placental-site trophoblastic tumors (PSTT; very rare)
    • Epithelioid trophoblastic tumors (ETT; even more rare)

Hydatidiform mole (HM) is the most common type of GTD. They are slow-growing tumors that look like sacs of fluid. An HM is also called a molar pregnancy. The cause of hydatidiform moles is not known.

HMs may be complete or partial:

  • A complete HM forms when sperm fertilizes an egg that does not contain the mother’s DNA. The egg has DNA from the father and the cells that were meant to become the placenta are abnormal.
  • A partial HM forms when sperm fertilizes a normal egg and there are two sets of DNA from the father in the fertilized egg. Only part of the fetus forms and the cells that were meant to become the placenta are abnormal.

Having any of these increases the risk that a hydatidiform mole will become cancer:

  • A pregnancy before 20 or after 35 years of age
  • A very high level of beta human chorionic gonadotropin (β-hCG), a hormone made by the body during pregnancy
  • A large tumor in the uterus
  • An ovarian cyst larger than 6 centimeters
  • High blood pressure during pregnancy
  • An overactive thyroid gland (extra thyroid hormone is made)
  • Severe nausea and vomiting during pregnancy
  • Trophoblastic cells in the blood, which may block small blood vessels
  • Serious blood clotting problems caused by the HM

Gestational trophoblastic neoplasia (GTN) includes the following:

  • Invasive moles
  • Choriocarcinomas
    • Molar pregnancy, especially with a complete hydatidiform mole
    • Normal pregnancy
    • Tubal pregnancy (the fertilized egg implants in the fallopian tube rather than the uterus)
    • Miscarriage
  • Placental-site trophoblastic tumors
  • Epithelioid trophoblastic tumors

Risk

Risk factors for GTD include the following:

  • Being pregnant when you are younger than 20 or older than 35 years of age
  • Having a personal history of hydatidiform mole

Symptoms

Signs of GTD include abnormal vaginal bleeding and a uterus that is larger than normal:

  • Vaginal bleeding not related to menstruation
  • A uterus that is larger than expected during pregnancy
  • Pain or pressure in the pelvis
  • Severe nausea and vomiting during pregnancy
  • High blood pressure with headache and swelling of feet and hands early in the pregnancy
  • Vaginal bleeding that continues for longer than normal after delivery
  • Fatigue, shortness of breath, dizziness, and a fast or irregular heartbeat caused by anemia

GTD sometimes causes an overactive thyroid. Signs and symptoms of an overactive thyroid include the following:

  • Fast or irregular heartbeat
  • Shakiness
  • Sweating
  • Frequent bowel movements
  • Trouble sleeping
  • Feeling anxious or irritable
  • Weight loss

Diagnosis

The following tests and procedures may be used:

  • Physical exam and history
  • Pelvic exam
  • Ultrasound exam of the pelvis
  • Lumbar puncture
  • Blood chemistry studies
  • Serum tumor marker test
  • Urinalysis

Treatment

Different types of treatment are available for patients with gestational trophoblastic disease:

  • Surgery
    • Dilatation and curettage (D&C) with suction evacuation
    • Hysterectomy
  • Chemotherapy
  • Radiation Therapy

National Cancer Institute: PDQ® Gestational Trophoblastic Disease Treatment. Bethesda, MD: National Cancer Institute. Date last modified <12/02/2013>. Available at:https//cancer.gov/cancertopics/pdq/treatment/gestationaltrophoblastic/Patient. Accessed <07/11/2014>.

 

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.