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Table of Contents Description
Stage Explanation
Treatment Option Overview
Hydatidiform Mole
Placental-Site Gestational Trophoblastic Tumors
Nonmetastatic Gestational Trophoblastic Tumors
Good Prognosis Metastatic Gestational Trophoblastic Tumors
Poor Prognosis Metastatic Gestational Trophoblastic Tumors
Recurrent Gestational Trophoblastic Tumors
To Learn More About
Gestational Trophoblastic Tumors
Get More Information From NCI
Changes to This Summary (06/26/2008)
About PDQ
Description
What are gestational trophoblastic tumors?
Gestational trophoblastic tumor, a rare cancer in women, is a disease in which
cancer (malignant) cells grow in the tissues that are formed following
conception (the joining of sperm and egg). Gestational trophoblastic tumors
start inside the uterus, the hollow, muscular, pear-shaped organ where a baby
grows. This type of cancer occurs in women during the years when they are able
to have children. There are two types of gestational trophoblastic tumors:
hydatidiform mole and choriocarcinoma.
If a patient has a hydatidiform mole (also called a molar pregnancy), the sperm
and egg cells have joined without the development of a baby in the uterus.
Instead, the tissue that is formed resembles grape-like cysts. Hydatidiform
mole does not spread outside of the uterus to other parts of the body.
If a patient has a choriocarcinoma, the tumor may have started from a
hydatidiform mole or from tissue that remains in the uterus following an
abortion or delivery of a baby. Choriocarcinoma can spread from the uterus to
other parts of the body. A very rare type of gestational trophoblastic tumor
starts in the uterus where the placenta was attached. This type of cancer is
called placental-site trophoblastic disease.
Gestational trophoblastic tumor is not always easy to find. In its early stages, it may look like a normal pregnancy. A doctor should be seen if the
there is vaginal bleeding (not menstrual bleeding) and if a woman is pregnant
and the baby hasn’t moved at the expected time.
If there are symptoms, a doctor may use several tests to see if the patient has
a gestational trophoblastic tumor. An internal (pelvic) examination is usually
the first of these tests. The doctor will feel for any lumps or strange
feeling in the shape or size of the uterus. The doctor may then do an ultrasound, a test that uses sound waves to find tumors. A blood test will
also be done to look for high levels of a hormone called beta-HCG (beta human
chorionic gonadotropin) which is present during normal pregnancy. If a woman
is not pregnant and HCG is in the blood, it can be a sign of gestational
trophoblastic tumor.
The chance of recovery (prognosis) and choice of treatment depend on the type
of gestational trophoblastic tumor, whether it has spread to other places, and
the patient’s general state of health.
Back to Top Stage Explanation
Stages of gestational trophoblastic tumors
Once gestational trophoblastic tumor has been found, more tests will be done to
find out if the cancer has spread from inside the uterus to other parts of the
body (staging). Treatment of gestational trophoblastic tumor depends on the stage of the
disease and the patient’s age and general health. The following stages are used for gestational trophoblastic tumor:
Hydatidiform mole
Cancer is found only in the space inside the uterus. If the cancer is found in
the muscle of the uterus, it is called an invasive mole (choriocarcinoma destruens).
Placental-site gestational trophoblastic tumors
Cancer is found in the place where the placenta was attached and in the muscle
of the uterus.
Nonmetastatic
Cancer cells have grown inside the uterus from tissue remaining following
treatment of a hydatidiform mole or following an abortion or delivery of a
baby. Cancer has not spread outside the uterus.
Metastatic, good prognosis
Cancer cells have grown inside the uterus from tissue remaining following
treatment of a hydatidiform mole or following an abortion or delivery of a
baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered good prognosis or
poor prognosis.
Metastatic gestational trophoblastic tumor is considered good prognosis if all
of the following are true:
- The last pregnancy was less than 4 months ago.
- The level of beta-HCG in the blood is low.
- Cancer has not spread to the liver or brain.
- The patient has not received chemotherapy earlier.
Metastatic, poor prognosis
Cancer cells have grown inside the uterus from tissue remaining following
treatment of a hydatidiform mole or following an abortion or delivery of a
baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered good prognosis or
poor prognosis.
Metastatic gestational trophoblastic tumor is considered poor prognosis if any
the following are true:
- The last pregnancy was more than 4 months ago.
- The level of beta-HCG in the blood is high.
- Cancer has spread to the liver or brain.
- The patient received chemotherapy earlier and the cancer did not go away.
- The tumor began after the completion of a normal pregnancy.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the uterus or in another part of the body.
Back to Top Treatment Option Overview
How gestational trophoblastic tumor is treated
Different types of treatment are available for patients with gestational trophoblastic tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Two kinds of standard treatment are used: surgery (taking out the cancer) and chemotherapy (using drugs to kill cancer cells). Radiation therapy (using
high-energy x-rays to kill cancer cells) may be used in certain cases to treat
cancer that has spread to other parts of the body.
The doctor may take out the cancer using one of the following operations:
- Dilation and curettage (D & C) with suction evacuation is stretching the
opening of the uterus (the cervix) and removing the material inside the
uterus with a small vacuum-like device. The walls of the uterus are then
scraped gently to remove any material that may remain in the uterus. This is
used only for molar pregnancies.
- Hysterectomy is an operation to take out the uterus. The ovaries usually
are not removed in the treatment of this disease.
Chemotherapy uses drugs to kill cancer cells. It may be taken by pill or put
into the body by a needle in a vein or muscle. It is called a systemic
treatment because the drugs enter the bloodstream, travel through the body, and
can kill cancer cells outside the uterus. Chemotherapy may be given before or
after surgery or alone.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam
radiation therapy) or from putting materials that produce radiation
(radioisotopes) through thin plastic tubes into the area where the cancer cells
are found (internal radiation).
Treatment in a clinical trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. In the following lists of treatments for the different stages, a link to search results for current clinical trials is included for each section. These have been retrieved from NCI’s clinical trials database. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Back to Top Hydatidiform Mole
Treatment may be one of the following:
- Removal of the mole using dilation and curettage (D & C) and suction
evacuation.
- Surgery to remove the uterus (hysterectomy).
Following surgery, the doctor will follow the patient closely with regular blood tests to make sure the level of beta-HCG in the blood falls to normal
levels. If the blood level of beta-HCG increases or does not go down to
normal, more tests will be done to see whether the tumor has spread. Treatment
will then depend on whether the patient has nonmetastatic disease or metastatic
disease (see the treatment sections on metastatic or nonmetastatic disease).
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with hydatidiform mole. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Placental-Site Gestational Trophoblastic Tumors
Treatment will probably be surgery to remove the uterus (hysterectomy).
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with placental-site gestational trophoblastic tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Nonmetastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
- Chemotherapy.
- Surgery to remove the uterus (hysterectomy) if the patient no longer
wishes to have children.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with nonmetastatic gestational trophoblastic tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Good Prognosis Metastatic Gestational Trophoblastic Tumors
Treatment may be one of the following:
- Chemotherapy.
- Surgery to remove the uterus (hysterectomy) followed by chemotherapy.
- Chemotherapy followed by hysterectomy if cancer remains following chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with good prognosis metastatic gestational trophoblastic tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Poor Prognosis Metastatic Gestational Trophoblastic Tumors
Treatment will probably be chemotherapy. Radiation therapy may also be given
to places where the cancer has spread, such as the brain.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with poor prognosis metastatic gestational trophoblastic tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Recurrent Gestational Trophoblastic Tumors
Treatment will probably be chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent gestational trophoblastic tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top To Learn More About
Gestational Trophoblastic Tumors
For more information from the National Cancer Institute about gestational trophoblastic tumors, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
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For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
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- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (06/26/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials. The following changes were made:
- Information about patients taking part in clinical trials was added to the Treatment Option Overview section.
- Links to ongoing clinical trials listed in NCI’s PDQ Cancer Clinical Trials Registry were added to the treatment sections.
- A new section called “ To Learn More ” was added. It includes links to more information about this type of cancer and about cancer in general.
- The “Get More Information from NCI” section (originally called “To Learn More”) was revised.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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