Gestational trophoblastic disease, or GTD, is a rare condition that occurs only in women and most often during pregnancy. It is typically associated with tumors of the female reproductive system, but is not always cancerous.
The abnormal cells characteristic of GTD start growing in the tissues formed during conception. Common causes for GTD development include an abnormal number of chromosomes present when sperm and egg meet and any abnormal changes in the placenta.
GTD is very rare. The American Cancer Society (ACS) estimates that this cancer accounts for less than one percent of cancers of the female reproductive system (ACS). According to the Memorial Sloan-Kettering Cancer Center (MSKCC), GTD can be successfully treated, and in 80 percent of cases, the GTD is not cancerous.(MSKCC) Even if you have had GTD previously, it is possible to go on to have healthy pregnancies.
There are three main types of this disease:
This is also commonly referred to as a “molar pregnancy.” This kind of GTD occurs when the sperm and egg connect but fail to make a fetus. This results in cyst-like tissue. It is typically contained to the uterus and is not cancerous.
Chorioadenoma and Choriocarcinoma
These forms of GTD are cancerous. They can develop from a hydatidaform mole or from leftover tissue after a miscarriage or birth. Chorioadenoma develops only in the uterine wall, whereas choriocarcinoma can spread to other organs.
This type of GTD develops at the site of placental attachment inside the uterus. Typically, it’s contained within the uterus, but it is possible for the disease to spread.
There are some factors that may increase your risk of developing GTD. Remember, though, that having one or more does not mean you will definitely develop GTD. If you are concerned about your risk, talk with your doctor.
Risk factors include:
- age (pregnancy between the ages of 20 and 40)
- history of molar pregnancy
- infertility problems
Swelling of the abdomen may be present, along with a variety of symptoms:
- nausea and vomiting that seem to be more severe than typical pregnancy nausea
- vaginal bleeding, passing blood clots, or a watery brown vaginal discharge
- absence of fetal heart sounds or movement
GTD is typically found during routine pregnancy checkups, or because of abnormal symptoms during pregnancy or suspected pregnancy. If your doctor suspects GTD, blood and urine tests can help with the diagnosis. These fluids contain the hormone hCG (human chorionic gonadotropin). HCG is a hormone found only in pregnant women. In many of those with GTD, it is markedly higher than it should be, although not every woman with GTD will have a higher hCG count.
Imaging tests such as sonograms, MRI, and CT scans can help your doctor diagnose GTD by allowing him or her to see the tissues of the uterus.
Once it has been diagnosed, your doctor may stage your GTD. The stage assigned to your condition describes the extent of disease in your body. However, unlike other cancers, treatment for GTD is typically successful regardless of stage. According to the ACS, other factors such as age and HCG level are more pertinent to prognosis of GTD than staging (ACS).
GTD is usually treated with surgery and/or chemotherapy, depending on the situation.
Hydatidiform moles and other abnormal growths may be removed by a dilation and curettage (D&C). A D&C procedure involves surgery where tissues within the uterus are removed but the uterus itself remains intact. Another surgical option is a hysterectomy, which removes the uterus.
For GTD that has spread, chemotherapy might be necessary.
Treatment for GTD is extremely successful. Many women with a history of GTD go on to have normal, healthy pregnancies. Your doctor will be able to provide insight into the long-term effects of GTD given your specific set of circumstances.