1. Gestational trophoblastic disease (GTD)

5. Comparison of partial & complete mole Abortion like, others rare USG Dx, large uterus, thecalutein cysts, pre-eclamsia, etc Clinical < 5% 20% Malignant sequelae Focal hydropic villi and trophoblastic proliferation fetal or fetal RBC present Diffuse hydropic villi and trophoblastic proliferation fetal absent pathology 69,xxx triploid (2 parternal) 46,xx (parternal) Cytogenetics Partial mole Complete mole Characteristics

23. FIGO stage (2000) Anatomical stage All other metastatic sites. IV Disease extend to lung with or without genital tract involvement. III Disease extend outside uterus, but limited to genital structures. II Disease confined to the uterus. I

24. FIGO stage (2000) Risk score (modified WHO) Two or more Single - - Previous failed chemotherapy >8 5-8 1-4 - Number of metastasis Liver, brain Gastro-intestinal Spleen, kidney Lung Site of metastasis - ≥ 5 3-<5 <3 Largest tumor size (cm) ≥ 10 5 10 4 -<10 5 10 3 -<10 4 <10 3 Pre-treatment hCG (IU/l) ≥ 13 7-<13 4-<7 <4 Interval from index preg. (mos) Term Abortion Mole Antecedent pregnancy - - ≥ 40 <40 Age (yrs) 4 2 1 0 score

28. Management of GTN

30. Single drug regimen 14 200 mg/m 2 oral x 5 days Etoposide - 30 mg/kg/d continuous 10 day infusion 5 FU 14 -10 µg/kg IV x 5 days -1.25 mg/m 2 IV Actinomycin D 14 7-14 - 1 mg/kg day 1,3,5,7 with folinic acid 0.1 mg/kg day 2,4,6,8 - 20-25 mg (0.4 mg/kg) IM x 5 days MTX Duration (days) Dose Drug