Gestational trophoblastic disease

Gestational trophoblastic disease is a disease of the proliferative trophoblastic allograft and includes partial mole (PM), complete hydatidiform mole (CM), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). Suction evacuation is recommended to terminate CM or PM. PM or CM should be monitored with serum human chorionic gonadotrophin, and effective contraception should be advised for at least 6 months. About 10–20% of patients with molar pregnancy may progress to gestational trophoblastic neoplasia (GTN) which requires chemotherapy. At the 2000 International Federation of Obstetrics and Gynecology (FIGO) meeting, recommendations were made on the criteria for diagnosing GTN and on methods of investigation. Staging was revised to include a modified World Health Organization risk score. The first-line chemotherapy for low-risk GTN is methotrexate and, for high-risk GTN, EMA-CO is recommended. In PSTT and ETT, surgery plays a more important role than chemotherapy. Referral of patients to a centre with experience in treating GTN is important to ensure a good outcome.