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Gestational Trophoblastic Tumors

Last updated May 28, 2018

Approved by: Maulik P. Purohit MD, MPH

Gestational Trophoblastic Tumors are a group of rare, pregnancy-related tumors.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Gestational Trophoblastic Disease (GTD)
  • Gestational Trophoblastic Neoplasia (GTN)
  • GTN (Gestational Trophoblastic Neoplasia)

What are Gestational Trophoblastic Tumors? (Definition/Background Information)

  • Gestational Trophoblastic Tumors are a group of rare, pregnancy-related tumors
  • The cells that form these tumors are called trophoblasts and these cells normally form the placenta during pregnancy (placenta is an organ that provides nutrition to the fetus during pregnancy). The abnormal growth of these trophoblastic cells result in Gestational Trophoblastic Tumors
  • Some such tumor type are benign, while others are malignant with potential to spread and metastasize to other distant organs in the body
  • The main types of Gestational Trophoblastic Tumors include:
    • Hydatidiform mole
    • Invasive mole        
    • Choriocarcinoma
    • Placental-site trophoblastic tumor
    • Epithelioid trophoblastic tumor
  • The condition generally affects women in their childbearing age. Also, women under the age of 20 and over 35 are at a higher risk for Gestational Trophoblastic Tumors
  • Women with a history of one or more molar pregnancies should consult their healthcare provider to understand about the risk of future molar pregnancies
  • Common signs and symptoms associated with Gestational Trophoblastic Tumors include vaginal bleeding, excessively enlarged uterus, severe nausea and vomiting. The condition may be diagnosed through a complete physical examination, checking beta-hCG levels, and by an abdominal ultrasound scan
  • In most cases, a surgical removal of the tumor is the most effective treatment. All forms of Gestational Trophoblastic Tumors can be treated and generally an effective treatment results in a complete cure
  • The prognosis for Gestational Trophoblastic Tumors is excellent with appropriate treatment

Who gets Gestational Trophoblastic Tumors? (Age and Sex Distribution)

  • Gestational Trophoblastic Tumors generally affect women who are in their childbearing age. It occurs very rarely in postmenopausal women
  • The incidence of the condition increase with age and it is 5-15 times higher in women who are 40 years and older, than in younger women

What are the Risk Factors for Gestational Trophoblastic Tumors? (Predisposing Factors)

The risk factors related to Gestational Trophoblastic Tumors include:

  • Age: Women under the age of 20 and over the age of 35 years
  • Previous history of Gestational Trophoblastic Disease
  • Being from Asia (Asian ethnicity)
  • Women with blood group type A
  • Women who have had earlier miscarriages and difficulties getting pregnant. Also, the risk is higher for women who uses birth-control pills
  • Women belonging to lower income groups or with lower education levels seem to also have a higher risk
  • Low levels of beta-carotene in the diet is a risk factor for Gestational Trophoblastic Diseases 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Gestational Trophoblastic Tumors? (Etiology)

The causative factor for each of the Gestational Trophoblastic Tumor type is as follows:

  • Complete hydatidiform moles are caused when a sperm cell fertilizes an abnormal egg cell that has no nucleus or chromosomes. After fertilization, the chromosomes duplicate themselves and hence, there are 2 copies of identical chromosomes that both come from the sperm. When this occurs, no fetus is formed, but complete hydatidiform moles develop
  • Partial hydatidiform moles are caused when 2 sperm cells fertilize a normal egg at the same time.  The fertilized egg contains 3 sets of chromosomes instead of the usual 2 sets. This leads to the formation of an abnormal fetus
  • Invasive moles are caused when hydatidiform moles begin to grow into the muscle layer of the uterus
  • Choriocarcinomas develop from persistent hydatidiform moles. They can also occur from remnants of tissues that are left behind in the uterus after a miscarriage or an intended termination of pregnancy

The cause for placental-site trophoblastic and epithelioid trophoblastic tumor types remains unknown. 

What are the Signs and Symptoms of Gestational Trophoblastic Tumors?

The common signs and symptoms of Gestational Trophoblastic Tumors include:

  • Vaginal bleeding
  • Enlarged uterus
  • Pelvic pain and discomfort
  • Severe nausea and vomiting

How is Gestational Trophoblastic Tumors Diagnosed?

The diagnosis of Gestational Trophoblastic Tumors may involve:

  • Complete evaluation of medical history along with a thorough physical exam with emphasis on pelvis and genital examination
  • Blood test for checking beta-hCG (human chorionic gonadotropin) levels
  • Abdominal ultrasound: An imaging process that uses sound waves to detect the presence of tumors
  • X-rays, CT scans, and MRI tests of the brain, chest, abdomen, and pelvis may be undertaken to find the extent to which the condition has spread

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Gestational Trophoblastic Tumors?

The complications associated with Gestational Trophoblastic Tumors include:

  • Vaginal bleeding that may lead to anemia
  • Spread of choriocarcinoma to other body parts

How is Gestational Trophoblastic Tumors Treated?

The treatment of Gestational Trophoblastic Tumors depends upon the following factors:

  • Location of the tumor
  • Extent of the condition
  • Type of Gestational Trophoblastic Tumor
  • Level of human chorionic gonadotropin (hCG) hormone
  • Duration of the condition
  • Extent and sites of metastases

The treatment methods may include:

  • Surgery: Hydatidiform moles are generally removed by dilatation and suction curettage (D & C). Sometimes, the surgery may involve the complete removal of the uterus (hysterectomy)
  • Chemotherapy and radiation therapy: If the tumors have spread beyond the uterus
  • Drugs, such as methotrexate or actinomycin-D, are recommended for women who have had the hydatidiform moles removed, though they still persist
  • Methotrexate, cyclophosphamide, etoposide, vincristine, and actinomycin-D are drugs used in the treatment of choriocarcinomas
  • Sometimes a combination of the above medications, chemotherapy, and surgery may be employed to obtain effective results

How can Gestational Trophoblastic Tumors be Prevented?

  • Presently, no effective preventive measures are available for Gestational Trophoblastic Tumors
  • Women with a history of one or more molar pregnancies should consult their healthcare provider to understand the risk of future molar pregnancies

What is the Prognosis of Gestational Trophoblastic Tumors? (Outcomes/Resolutions)

  • All forms of Gestational Trophoblastic Tumors can be effectively treated
  • In most cases, such a treatment can result in a complete cure

Additional and Relevant Useful Information for Gestational Trophoblastic Tumors:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/pregnancy-related-disorders/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 14, 2015
Last updated: May 28, 2018