Gestational Trophoblastic Disease (GTD) includes a spectrum of tumors related to abnormal proliferation of trophoblastic cells, including hydatidiform mole (HM), invasive mole (IM), and choriocarcinoma. HM is usually benign but can develop into IM or choriocarcinoma. Diagnosis involves hCG levels, ultrasound, and biopsy. Treatment of HM is surgical evacuation, while IM and choriocarcinoma often require chemotherapy like methotrexate and actinomycin D due to their malignant potential and ability to metastasize. Close monitoring of hCG levels after treatment is important to detect recurrence or persistence of trophoblastic tissue.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
endometrial stromal tumours review article
These tumours are very less in number. They are classified into endometrial stromal tumour, low grade endometrial stromal sarcoma, high grade stromal sarcoma and undifferentiated uterine sarcoma according to the 2014 WHO classification.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
endometrial stromal tumours review article
These tumours are very less in number. They are classified into endometrial stromal tumour, low grade endometrial stromal sarcoma, high grade stromal sarcoma and undifferentiated uterine sarcoma according to the 2014 WHO classification.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
I believe pregnancy is a long and difficult process for every mum in the world. Through a better diet planning for pregnant women, they can have a healthier body to welcome their beloved baby.
16-Aug-2021-"Gestational trophoblastic disease (GTD) is a spectrum of abnormal growth and proliferation of the trophoblasts of the placenta that continue even beyond the end of pregnancy of the placenta".
Molar pregnancy is one of the sub types of gestational trophoblastic diseases characterized by abnormal trophoblastic proliferation . These are significant due to the risk of development of gestational trophoblastic neoplasia
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Introduction
What is GTD ?
It is a clinical term used to indicate closely
related conditions characterized by active
abnormal proliferation of trophoblastic cells
It is too among the rare human
malignancies that can be cured
even in the presence of widespread
metastases
4. Which does it include?
It includes a spectrum of interrelated
tumors, including
hydatidiform mole (HM) 80 % of cases
invasive mole (IM) 12-15%
Choriocarcinoma (CH) 5-8%
Placental-site trophoblastic tumor
(PSTT, borderline, very rare)
5. Relationship of HM. IM. CH
hydatidiform therapeutic or
mole spontaneous abortion
term pregnancy
ectopic
invasion mole choriocarcinoma.
8. Hydatidiform mole
It is a neoplastic
proliferation of
the trophoblast
in which the
terminal villi
are
transformed
into vesicles
filled with clear
viscid material.
9. It is usually benign but has
malignant potentiality.
Incidence:
south east Asia is 1/500-600
the US and Europe:1/500-2000
China:1/1238
13. Etiology
Though it is not known a number of
associated factors have been noted:
age:>45 years women are 10 times
more likely to develop HM than
those younger.
Previous hx of HM
Previous misscarriage
Excessive smoking
14. abnormal fertilization process:
the fertilization of a normal ovum
with a duplicated haploid
sperm:46XX
the fertilization of an empty egg by
two sperms(dispermy):46XY
22. partial hydatidiform mole
It are characterized by the following
pathologic features :
Chorionic villi if varying size with
focal hydatidiform swelling and
cavitation.
It contain identifiable embryonic or
fetal tissues.
23. Gross
we see a
mass of
vesicles,
vary in size,
grape-like
and
identifiable
embryonic
or fetal
tissues.
25. Fetal hand demonstrating syndactyly. The fetus had a triploid karyotype, and the chorionic
tissues were a partial mole
26.
27. Feature Partial mole Complete mole
Karyotype
Most commonly
69, XXX or - XXY
Most commonly
46, XX or -,XY
Pathology
Fetus Often present Absent
Amnion, fetal RBC Usually present Absent
Villous edema Variable, focal Diffuse
Trophoblastic proliferation Focal, slight-moderate Diffuse, slight-severe
Clinical presentation
Diagnosis Missed abortion Molar gestation
Uterine size Small for dates 50% large for dates
Theca lutein cysts Rare 25-30%
Medical complications Rare 10-25%
Features Of Partial And Complete Hydatidiform Moles
31. Diagnosis
suspicion:
abnormal bleeding after amenorrhea
inappropriately enlarged uterus;
absence of fetal heart sounds or
could not feel fetal parts by palpation
between 16-20th week
hyperemesis gravidarum
bilateral ovarian cysts
32. Hydatidiform Mole
Diagnosis:
• Serum hCG levels:
Serum hCG levels of greater than 92 000
IU/l associated with absent fetal heart beat
indicate a diagnosis of complete
hydatidiform moles (Romero et al, 1985)
Serum hCG level decreases quickly if the
patient has an abortion, but it does not in
molar pregnancy
33. Ultrasonography:
It is a reliable and sensitive technique for the
diagnosis of complete molar pregnancy. Because
the chorionic villi exhibit diffuse hydatidiform
swelling. Complete moles produce a characteristic
vesicular sonographic pattern, usually referred to
as a “snowstorm” pattern.
34. Ultrasonography may also
contribute to the diagnosis of
partial molar pregnancy by
demonstrating focal cystic spaces
in the placental tissues and an
increase in the transverse
diameter of the gestational sac.
37. Hydatidiform Mole
Management:
• History and physcal examination:
Should aim to rule out the classic
symptoms and signs that would lead to a
diagnosis of:
• severe anemia
• dehydration
• preeclampsia
• thyrotoxicosis
The patient should be stabilized
hemodynamically
40. Hydatidiform Mole
Management: Surgical care:
Suction curettage (with
oxytocin or prostaglandin
infusion)
Hysterectomy
•The method of choice
•Increased risk of medical
complications
•Associated with a markedly
decreased rate of malignant
sequelae (3.5%) when compared
with suction evacuation.
41. Mangement
suction & curretage
Under GA.
Cervix dilation till 12mm.and S&C induced
to the uterine cavity.
I.V oxytocin infusion is started .
S&C started by negative pressure of about
60 to 70cmHg.
The curette is genteelly rotated to ovoid
perforation of the soft uterus, and the
majority of the molar tissue is evacuated
rapidly ,and the uterine size decreases
42.
43. F0llow-up
After the uterus has been evacuated :
About 90% of cases ,the trophoblastic tissue
die out completely.
About 10% of cases the trophoblastic tissue
does not die out completely and may persist
or recur as : invasive mole or
choriocarcinoma.
44. Follow-up
So it is important that women who
have had a hydatidiform mole:
should have close follow-up by serum
hCG levels after the evacuation of the
uterus,
To ensure early recognition of persistent
trophoblastic tissue .
45. F0llow-up
After a molar pregnancy ,the hCG
levels will usually have returned to non
pregnant levels by 4 to 6 weeks after
evacuation.
The follow-up is recommended for 2
years in cases of complete moles, and 6
months of cases of partial moles after
the evacuation of uterus.
46. F0llow-up
Serial quantitative measurement of
serum hCG level at weekly
intervals, after evacuation of moles
till 4 to 5 weeks when the hCG
become normal. Then every other
week .When the titer gets negative
the measurements are done every
month fore 1 year.
47. chemotherapy
Indication of chemotherapy after
the evacuation of the hydatidiform
mole in:
Serum hCG >20000 i.u/L , at any
time after evacuation of mole.
Raised hCG at 4 to 6 weeks after
evacuation of mole.
48. F0llow-up
Evidence of metastases
,hepatic,brain,and pulmonary.
Persistent uterine hemorrhage
after evacuation of mole with
raised hCG levels.
49. pregnancy
To achieve effective follow-up ,the
pregnancy is better to be avoided ,and also
the use of oral contraceptive pills until the
hCG levels returns to normal after the
evacuation of the mole.
Early diagnosis of persistent trophoblastic
disease ensures a good prognosis and an
effective system of follow-up.
51. Introduction
Invasion Mole arises from HM
it has malignant potentialities,
invades the myometrium and
penetrates the uterine wall,
extends into the broad ligament
or peritoneal cavity.
52. in half or more of all cases
invasive mole metastasizes
through the peripheral
circulation to distant sites,
mostly to the lung.
53. Pathologic findings
excessive trophoblastic
proliferation and
invasiveness
the degree of anaplasia is
variable: completely benign-
--highly malignant
54. differentiation between invasive
mole and choriocarcinoma lies in
whether the villous pattern is
preserved:
if we see villi, it must be
invasion mole;
if we can’t see villi, it is
choriocarcinoma.
55. Clinical course
Symptoms caused by primary lesions
vaginal bleeding
pelvic examination reveals delayed
involution of the uterus, persisting
cyst .
abdominal pain
intra-abdominal hemorrhage,
penetration of the uterus .
56. Metastatic symptoms
• cough, hemoptysis---positive X-ray
signs
• profuse vaginal bleeding---vaginal
or cervical metastasis, we can see
bluish nodule in vaginal
• headache, nausea, vomit, paralysis
or coma—it is caused by cerebral
lesion.
57. Diagnosis
history and clinical manifestation
hCG assay:
diagnosis suspected if hCG titers
persist to be high 12 weeks after
evacuation of a HM, or once
regress to normal range but rise
rapidly.
58. possible reasons : retained HM
pregnancy
huge theca-lutein cyst persist
when we remove these reasons
we can diagnosis invasive mole
other measurement
ultrasound
X-ray
59. Prophylaxis
respond well to chemotherapeutic
agents
main causes of death:
hemorrhage, metastasis and
infection
61. Choriocarcinoma
It is highly malignant GTT
It may follow HM,
invasion mole, abortion,
normal pregnancy, ectopic
pregnancy.
62. Pathologic findings
Gross inspection
irregular or circumscribed
hemorrhagic growth in the uterine
wall
ulcerating surface opens into the
endometrial cavity (rarely
embedded in myometrium)
penetration into broad ligament or
the peritoneal cavity
dark red blood:.it is filled
metastatic nodules
64. Histologic findings
we see masses of anaplastic
trophblastic cells in microscopy;
invasion into the uterine wall,
destroying vessels, muscle tissue
prominent necrosis and
hemorrhage
villi can not be recognized
spread through circulation
65. Clinical Manifestations
irregular bleeding after
preceding gestation;
malignant tumor cells enter the
circulation through the open
blood vessels and are
transported to lungs, brain or to
other distant sites.
66. metastatic symptoms
pulmonary lesions
cerebral lesions
metastatic nodule in the vagina,
vulva or cervix ,it is bluish
nodule filled dark red blood.
67. Diagnosis
Diagnosis must be suspected as
a possible reason for continued
(irregular) bleeding after any
form of pregnancy.
we assay hCG , the time of hCG
change into normal is different in
various diseases.
68.
69. FIGO Staging
STAGE
I. Confined to the uterus
II. Outside of uterus, limited to genital structures
III. Extends to lungs +- genital tract involvement
IV. All other metastatic sites
70. Who Orgnaization prognostic scoring system for gestational trophoblastic neoplasia
Prognostic factor 0 1 2 4
Age <39 >39 _ -
Antecedent pregnancy Hydatidiform Abortion , ectipic Term pregnancy -
Interval (months) <4 4-6 7-12 >12
hCG level (IU/liter) <10 10-10 10-10 >10
ABO blood groups
(female/male)
O/A B A/O AB
Largest tumor (cm) <3 3-5 >5 _
Site of metastasis _ Spleen, kidney Gastrointestinal tract, liver Brain
Number of metastases _ 1-3 4-8 >8
Prior chemotherapy _ _ Single drug Multiple
druge
The total score is obtained by adding the individual scores for each prognostic factor . Total score
:<4 , low risk ; 5-7 , intermediate risk ;>8 , high risk .
Interval :between antecedent pregnancy and start of chemotherapy.
71. Treatment
highly sensitive to chemotherapy,
which is invariably the treatment
choice.
surgery has little place (because of
the high vascularity and the
effectiveness of chemotherapy). it is
indicated for tumor resistant to
chemotherapy and single metastases
persisting despite chemotherapy.
72. Chemotherapy
most often used drugs
methotrexate (MTX)
actinomycin D (Act-D)
5-fluorouracil (5-Fu)
vincristine (VCR)
cyclophosphamide (CTX)
chlo-ranbucil, etc
73. principles
low-risk patients are usually treated with a
single agent
medium-risk patients are usually treated
with ABACA regimen with 80-90% survival
rate. (Etoposide,
Methotrexate,Hydroxyurea,6-
mercaptopurine,Actinomycin-d,Folinic acid)
High-risk No. of regimens are used.most
common
EMA/CO(etoposide,methotrexate,actinomy
cin-d,cyclophosphamide,vincristine)
74. Operation
unresponsive or drug fails to
reach the tumor;
if the tumor can be eradicated
by drug therapy, esp.in young
women, there is no reason to
remove the uterus;
the ovaries need not be
removed.
75. Follow-up examinations
at 1-month interval for 1 year:
at 3-month interval for 2 years
at 1-year interval for 3 years
at 2-year interval afterwards.
pelvic examination
chest X-ray film
hCG
76. Placental-Site Trophoblastic Tumor
(PSTT)
Originate from intermediate cytotrophoblast
cells
Secrete human placental lactogen (hPL)
B-hCG often normal
Less vascular invasion, necrosis and
hemorrhage than choriocarcinoma
Lymphatic spread
Arise months to years after term pregnancy
but can occur after spontaneous abortion or
molar pregnancy
77. Placental-Site Trophoblastic Tumor
(PSTT)
Most common symptom is vaginal bleeding
Tend to:
- Remain in uterus
- Disseminate late
- Produce low levels of B-hCG compared to
other GTN
- Be resistant to chemotherapy (treat with
surgery)