The following information is intended to explain to you the importance of monitoring and the treatments proposed to you by your doctor. You can listen to all the texts of the answers by clicking on the button: Listen to the text ▶︎
Malignant gestational trophoblastic diseases (or gestational trophoblastic neoplasias) include several diseases of the placenta. The main diseases are called choriocarcinoma or invasive mole. The frequency of choriocarcinomas is estimated at around 1 in 20,000 pregnancies. They are due to a proliferation and eventual spread of a gestational trophoblastic disease more commonly known as a mole. Moles are abnormalities in the fertilization of the egg by the sperm for an undetermined reason. The placenta then develops abnormally. There are 2 types of moles. It can be a "complete" mole in which there is no embryo or a "partial" mole in which the embryo develops, but cannot survive. The placenta is abnormal in both cases.
Even if done with care, after evacuation of the mole by curettage and aspiration, there is a risk of persistence of molar tissue in the uterus, which is difficult to see. This tissue can proliferate and spread, it is then called malignant trophoblastic gestational disease (or gestational trophoblastic neoplasia). This risk justifies monitoring by blood tests which are the regular dosage of the pregnancy hormone (ßhCG). In 85% of patients, the hormone level returns to normal (negativation) without any problem.
Trophoblastic gestational neoplasms can spread to other organs, which is why you will need to receive treatment, which will be chemotherapy in the majority of cases. You will first need to complete a series of radiological examinations (X-ray, ultrasound, CT-Scan, MRI) and various blood tests to be able to decide on the best treatment for you. Each patient must be assessed individually to determine the level of risk that her disease represents (low or high risk).
Most patients are 'low risk' and only need one type of drug in their chemotherapy. Sometimes, when the risk of the disease is higher, several drugs must be administered at the same time. These treatments are given by injection into the muscles or into the veins. The majority of treatments take place on an outpatient basis and rarely require hospitalization. About 20% of patients will need to change medication, due to insufficient response or intolerance to treatment.
The duration varies from patient to patient and depends on how quickly the disease responds to treatment. In general, it takes a few weeks to 2-3 months. The treatment is continued until the level of βhCG becomes normal and this for a few more weeks for safety.
It is usual to feel a bit depressed and sad to have to deal with this disease. These feelings can vary over time and according to each individual. Your spouse may also feel depressed and anxious. It is important to ask all the questions that worry you and if that is not enough to call on our psycho-oncologist.
Chemotherapy can make your body image feel altered. The majority of patients receive monochemotherapy (one drug) and will have few side effects. They will not (or very rarely) lose their hair, will be able to continue their usual activities and will have very little nausea. For patients who must receive polychemotherapy (several drugs), we will offer them drugs to reduce the side effects as much as possible (nausea, fatigue, hair loss). We do not recommend exposure to the sun and UV lamps during the duration of the treatments.
Taking the pill is strongly recommended (in the absence of a contraindication) for the entire βhCG monitoring period. The reason for this is that in the event of a new pregnancy, we would be unable to differentiate, at the beginning, between a normal pregnancy and a recurrence of gestational trophoblastic neoplasia because βhCG increases in both cases.
Sometimes there is no interruption of menstruation. Otherwise, menstruation generally returns within 4-6 weeks after the end of chemotherapy, then will be regular if you take the pill. The appearance of abnormal bleeding outside of menstruation requires that you speak to your doctor.
This monitoring will be done by taking a blood test (βhCG) every month for 12 to 24 months.
Chemotherapy generally does not affect your fertility or your risk of miscarriage. You can consider a new pregnancy as soon as the monitoring of βhCG is completed, either 12 or 24 months after their negativation. The risk of mole recurrence at this time is very low and estimated at around 0.5 to 1%. It is important to perform an ultrasound at the beginning of pregnancy to make sure that everything is going well and a βhCG assay 6 weeks after delivery to check that there is no recurrence.
Gestational trophoblastic neoplasms are malignant diseases, which means they can spread and spread throughout the body if left untreated. The risk of recurrence is 2-4% (low-risk neoplasia) and 10% (high-risk neoplasia) within an average period of 6 months. They correspond in this to the definition of a cancer, but fortunately the cure rate, for the most frequent diseases, is almost 100% if they are treated quickly and according to current guidelines.
Your entourage can sometimes give you, unwittingly, inaccurate or partially accurate information. The rarity of this disease means that it is often poorly understood. It is important to obtain information from your doctor, from doctors specialized in this field or from websites of teams used to treating these patients. You can contact us if you want advice or information about your surveillance. We also invite you to visit our links .
Modified on 12/24/2023