Gtd

773 views
514 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
773
On SlideShare
0
From Embeds
0
Number of Embeds
71
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Gtd

  1. 1. Gestational Trophoblastic Neoplasia Khalid Sait FRCSC /Gynecologic Oncologist/Ass. Prof Faculty of Medicine King Abdulaziz University
  2. 2. Key Words n  Group of disease with wide range of neoplastic potential n  Create a lot of challenge for us in term of diagnosis and treatment n  Diagnosis and management will depends on the history, HCG level and metastasis work up
  3. 3. Clinical pathology of gestational trophoblastic disease n  1- Cytotrophoblast and syncytiotrophoblast cells proliferation Moler pregnancy Invasive mole Choriocarcinoma n  2- Intermediate trophoblastic cells derivative Placental – site tumor
  4. 4. Risk Factors for Moler pregnancy n  Extremes of reproductive years n  Prior moler mole n  Prior spontaneous abortion n  Vit A deficiency n  Race ( Indonesia 1:85, USA 1:1500)
  5. 5. Diandric diploidy
  6. 6. Diandric triploidy
  7. 7. Clinical Features n  Large for date 50 % n  Hyper emesis 20 % n  Early PIH 5% n  Abscent FH ( except in partial mole or twin pregnancy) n  Hyperthyroidism symptom and sign 5% n  Rarely presented with metastasis symptom and sign
  8. 8. Management of molar pregnancy Risk of Persistent GTT Procedure 20 %Suction Evacuation 5%Hysterectomy
  9. 9. Follow up of patient with molar pregnancy after evacuation n  HCG weekly serum determination until normal for two values ,then monthly for 6 to 12 months n  Contraception for 1 year n  Pelvic examination every 2 weeks until normal,then every 3 months n  Check histopathology
  10. 10. If no proper decrease or BHCG start to increase
  11. 11. Persistent GTD
  12. 12. Indication for initiating treatment during post mole follow up n  Serum BHCG values rising more than 10 % for 2 wk ( 3 weekly titre) n  Serum BHCG values on plateau for 3 wk or decline of less than 10 % n  Presence of metastasis n  Significant elevation of serum BHCG values after reaching normal levels n  Choriocarcinoma or invasive mole on histopathology n  HCG level still elevated 6 months after molar evacuation n  HCG > 20000 miu/ml 4 weeks after evacuation
  13. 13. Work up of gestational trophoblastic neoplasia n  History and physical examination n  chest XR ( if neg è CT ) n  Pretreatment HCG titre n  Hematological survey n  Serum chemistries n  CT of brain n  Ultrasound of pelvis n  Liver scan ( u/s or CT )
  14. 14. CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DIS n  Benign 1) complete mole 2) Partial mole n  Malignant (invasive mole and choriocarcinoma) 1) nonmetastatic 2) metastatic a) low risk b) high risk
  15. 15. Risk factors (malignant GTD) 1.Disease present more that 4m(long duration) or 2.pretreatment B-HCG greater than 40,000mlu/ml or 3.presence of met to sites other than lungs or vagina i,e liver or brain etc.. 4. prior chemo 5 following Term pregnancy
  16. 16. CHEMOTHERAPY FOR GTN NON METASTATIC or GOOD PROGNOSIS METASTATIC *Single agent chemotherapy *survival 90-100% METASTATIC POOR PROGNOSIS *Combined chemotherapy * survival 50 %
  17. 17. REMISSION OF GTN DISEASE REMISSION NON METASTATIC 100 % GOOD PROGNOSIS METASTATIC 100 % POOR PROGNOSIS METASTATIC 66 % TOTAL 92 %
  18. 18. SUMMARY GTD IS A RARE ENTITY THAT IS HIGHLY CURABLE , EVEN IN THE PRESENCE OF WIDESPREAD METASTASES
  19. 19. GTN Khalid Sait FRCSC Prof of Gynecologic Oncology Faculty of Medicine King Abdulaziz University Q&A

×