Gestational trophoblastic neoplasia (including hydatidiform mole)

A 34-year-old woman had a suction evacuation for a complete hydatidiform mole six weeks ago. She has been well, using reliable contraception, but her serial hCG values have plateaued — 820, 845, 810 and 830 IU/L across four weekly tests. This is post-molar GTN by the FIGO hCG-plateau criterion. Your job is to confirm the hCG is real, stage and score her with the FIGO 2000 system, register her with the regional trophoblast centre, and start single-agent chemotherapy for what is almost certainly low-risk disease that will be cured with fertility preserved.[1][5]

Overview and definition

Gestational trophoblastic disease (GTD) is a spectrum of interrelated disorders originating from the placenta. Its premalignant forms are the complete and partial hydatidiform moles; its malignant forms — invasive mole, choriocarcinoma, and the rare placental-site and epithelioid trophoblastic tumours — are termed gestational trophoblastic tumours or gestational trophoblastic neoplasia (GTN).[14]

What makes GTN unusual among cancers is that it is always driven by trophoblast, so human chorionic gonadotropin (hCG) is both the tumour marker that tracks every form of the disease and the hormone that drives its complications. It is exquisitely chemosensitive, produces hCG proportionate to tumour burden, and metastasises haematogenously to the lungs (commonest), vagina, brain and liver. Centralised registration and risk-stratified treatment are the reasons the overall cure rate now exceeds 95% with fertility retained.[5][14]

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