Gestational trophoblastic disease

She bled at ten weeks, the scan was reported as a missed miscarriage, and the registrar evacuated her and sent the tissue. Histology came back five days later as partial mole. The fellowship question is not whether you can name the tumour — it is whether you closed the loop: registered her, plotted the hCG, and named the surveillance that protects the next pregnancy. Gestational trophoblastic disease is one of oncology's curable success stories, and it stays curable only when the surveillance is not lost between the scan and the letter.^[1][19]

Overview and definition — the spectrum that turns on hCG

Gestational trophoblastic disease encompasses the premalignant disorders — complete and partial hydatidiform mole — and the malignant forms, collectively termed gestational trophoblastic neoplasia: invasive mole, choriocarcinoma, and the rare placental-site and epithelioid trophoblastic tumours. Improvement in management and centralised follow-up mean overall cure rates now exceed 98 per cent with fertility retention.^[1]

• Hydatidiform mole is the premalignant lesion — trophoblastic proliferation with swollen villi. Most never progresses.^[1]
• Gestational trophoblastic neoplasia is the disease that needs chemotherapy or excision because hCG persists or metastases appear. The commonest antecedent is a molar pregnancy, but choriocarcinoma can follow any pregnancy — term, abortion, or ectopic.^[3][19]
• The unifying principle: trophoblast makes human chorionic gonadotropin, so hCG is simultaneously the tumour marker that tracks every form of the disease and the hormone that drives its complications.^[1]

References21ShowHide

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2. [2]Kohorn EI The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment Int J Gynecol Cancer, 2001.PMID 11285037
3. [3]Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Braga A, Garrett A Diagnosis and management of gestational trophoblastic disease: 2025 update Int J Gynaecol Obstet, 2025.PMID 40631439
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