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Malignant gestational trophoblastic diseases (or gestational trophoblastic neoplasms) encompass several placental disorders. The main ones are called choriocarcinoma or invasive mole. The incidence of choriocarcinoma is estimated at approximately 1 in 20,000 pregnancies. They result from the proliferation and potential 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 two types of moles: a "complete" mole, in which there is no embryo, and a "partial" mole, in which the embryo develops but cannot survive. The placenta is abnormal in both cases.
Even when performed carefully, after the evacuation of a molar pregnancy by curettage and aspiration, there is a risk of molar tissue remaining in the uterus, though it may be difficult to see. This tissue can proliferate and spread, a condition known as malignant gestational trophoblastic disease (or gestational trophoblastic neoplasia). This risk justifies monitoring through blood tests, which include regular measurement of the pregnancy hormone (β-hCG). In 85% of patients, the hormone level returns to normal (becomes negative) without any problems.
Gestational trophoblastic neoplasms can spread to other organs, which is why you will need treatment, most often chemotherapy. You will first need to complete a series of radiological examinations (X-ray, ultrasound, CT scan, MRI) and various blood tests to determine the best treatment for you. Each patient must be evaluated individually to determine the risk level of her disease (low or high risk).
Most patients are considered "low risk" and only need one type of chemotherapy drug. 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 veins. The majority of treatments are performed on an outpatient basis and rarely require hospitalization. Approximately 20% of patients will need to change drugs due to an insufficient response or intolerance to the treatment.
The duration of treatment varies from patient to patient and depends on how quickly the disease responds. Generally, it takes from a few weeks to 2-3 months. Treatment is continued until the βhCG level returns to normal, and for a few more weeks as a precaution.
It's normal to feel a little down and sad when facing this illness. These feelings can vary over time and from person to person. Your partner may also feel down and anxious. It's important to ask any questions you may have, and if that's not enough, to consult our psycho-oncologist.
Chemotherapy can cause feelings of altered body image. Most patients receive monotherapy (a single drug) and experience few side effects. They will not (or very rarely) lose their hair, will be able to continue their usual activities, and will experience very little nausea. For patients who require polytherapy (multiple drugs), we will provide medication to minimize side effects (nausea, fatigue, hair loss). We advise against sun exposure and UV lamps during treatment.
Taking the pill is strongly advised (in the absence of a contraindication) for the entire period of βhCG monitoring. This is because, in the event of a subsequent pregnancy, we would be unable to distinguish initially between a normal pregnancy and a recurrence of gestational trophoblastic neoplasia, as βhCG levels rise in both cases.
Sometimes menstruation doesn't stop. Otherwise, periods usually return within 4-6 weeks of finishing chemotherapy, and will then be regular if you are taking the pill. Any abnormal bleeding between periods requires that you speak to your doctor.
This monitoring will be done by 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 trying for another pregnancy as soon as your βhCG levels are monitored, either 12 or 24 months after they become negative. The risk of a molar pregnancy recurrence at this time is very low, estimated at around 0.5 to 1%. It is important to have an ultrasound scan early in your pregnancy to ensure everything is progressing well and a βhCG test 6 weeks postpartum to check for any recurrence.
Gestational trophoblastic neoplasms are malignant diseases, meaning they can spread and disseminate throughout the body if left untreated. The risk of recurrence is 2-4% (low-risk neoplasm) and 10% (high-risk neoplasm) within an average of 6 months. While they meet the definition of cancer, fortunately the cure rate for the most common forms is nearly 100% if treated promptly and according to current guidelines.
Your family and friends may sometimes unintentionally provide you with inaccurate or partially accurate information. The rarity of this disease means it is often poorly understood. It is important to obtain information from your doctor, specialists in this field, or websites run by teams experienced in treating these patients. You can contact us if you would like advice or information about your monitoring. We also invite you to visit our links .
Modified on 12/24/2023