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Contact Andrew Walbank. Gestational trophoblastic disease GTDalso known as molar pregnancyis a range of pregnancy related tumours. Molar pregnancies occur when the placenta or afterbirth of a defective pregnancy transforms into a tumour.
It can occur following normal or abnormal fertilisation. The tumours are unique because they arise from placental tissues and therefore contain maternal and paternal genes whereas most tumours arise only from the tissues of the individual in which they are found. They can Straight chub wanting to Sheffield (AU 19 either benign i.
Benign forms of GTD are known as hydatidiform moles, whereas cancerous moles are known as gestational trophoblastic tumours, or gestational trophoblastic neoplasia. Benign GTD tumours are either complete or partial hydatidiform moles. They represent incomplete pregnancies in which the placenta grows but the embryo i. In a normal pregnancy, a single chromosome from each of the mother egg and Straight chub wanting to Sheffield (AU 19 sperm to form an embryo which is surrounded by the placenta.
It develops into a foetus and is then born as a baby. In molar pregnancies this process of fertilisation is defective. A complete hydatidiform mole is an androgenetic pregnancy i. Partial hydatidiform moles are known as triploid gestations i. They occur when two sperm fertilise a single egg. Partial moles sometimes coexist with a foetus. In such instances the foetus will usually have congenital abnormalities and be unviable i.
In rare instances a normal foetus will co-occur with a molar pregnancy, in which case there is the possibility of preterm birth. Malignant GTD tumours are either:. These malignant forms of GTD most commonly occur after a benign molar pregnancy, however they can also occur after an apparently normal pregnancy either carried to term or terminated through spontaneous or induced abortion or an ectopic pregnancy.
The extent and sites of metastasis vary depending on the type of tumor:. An estimated in pregnancies are affected by benign hydatidiform moles, however incidence varies internationally and is highest in the Asian region. All women of reproductive age who have ly been, or are currently pregnant, are at risk of GTD, however women younger than 16 or older than 40 who become pregnant are more likely than women agedto develop a molar pregnancy. There is a one in three chance of GTD in women aged over 50 who become pregnant.
Other factors which predispose women to GTD relate to genetics and reproductive history. These include:. Benign hydatidiform moles occurs following any type of pregnancy, however they most commonly occurs following other molar pregnancies.
Scientists are still investigating exactly how placental tissues go on to form moles, however the most likely cause is defective fertilisation, which le to an abnormal pregnancy, in which the placenta grows, but the embryo does not. GTD characterised by malignant trophoblastic tumours is often a result of the transformation of hydatidiform moles, however when it occurs concurrently with a normal pregnancy, there is no clear explanation regarding the cause of the disease.
Scientists are still investigating the mechanisms by which benign tumours transform Straight chub wanting to Sheffield (AU 19 become malignant. The most common symptom of molar pregnancy is vaginal bleeding and many women go to the doctor thinking they are having a miscarriage.
Other symptoms include abdominal pain and excessive nausea and vomiting more than normal during early pregnancy. However many women with a molar pregnancy do not display any symptoms. If a doctor suspects GTD, a physical examination of the pelvic area will usually be performed. An enlarged uterus i. As this involves surgery, it is normal for a doctor to perform a of other tests prior to performing surgery. Taking measurements of the hormone human Chorionic Gonadotrophin hCG levels of which are elevated during pregnancy, and behave abnormally during a molar pregnancy can give a doctor a good indication of whether or not GTD is possible.
Transvaginal and transabdominal ultrasound are also commonly used diagnostic tools, which enable doctors to see s of molar pregnancy e.
The doctor will take an ultrasound of the areas likely to be affected if a molar pregnancy is in fact occurring, and examine the ultrasonic images for evidence of GTD. In the past GTD was often Straight chub wanting to Sheffield (AU 19. However, medical advances in the past 50 years mean that the disease is now invariably curable. Following a definitive diagnosis of GTD, a doctor will normally classify the tumours as low or high risk, in order to determine the best treatment for each patient. Treatments for GTD include surgery and chemotherapy, however because chemotherapy has a toxic effect on the body, it is normal for surgical options to be attempted in the first instance.
Where surgery is unsuccessful, low-dose single-agent chemotherapy is instituted, followed by high-dose multi-agent chemotherapy in the event of failure. There are two types of surgical techniques which can be used to treat non-metastatic GTD, dilatation and cutterage and hysterectomy. Dilatation and cutterage is a process of evacuating abnormal tissues from the uterus. It involves a doctor opening the vagina using an instrument known as a speculum, so that the cervix is visible.
The cervix is then dilated so that the uterus can be accessed. An instrument called a curette is then used to scrape the walls of the uterus. Following this procedure a doctor will normally measure a patients hormone levels for 8 weeks to a year to ensure that the treatment has been fully successful. If hormone levels rise, further treatment, often with chemotherapy may be needed. Hysterectomy is sometimes used to remove benign moles when the woman being treated does not wish to have anymore children. Hysterectomy may also be used to treat placental site trophoblast tumours which are often resistant to chemotherapy.
A doctor will usually commence chemotherapy as a last resort, due to the toxic effects of chemotherapy medications. This is when surgery is unsuccessful and the moles return following the surgical treatment.
In patients with a low risk score, single agent chemotherapy is usually prescribed. A drug known as Methotrexate is the most commonly prescribed in these circumstances. However there is a risk that patients will become resistant to single agent chemotherapy i.
When patients have a high risk score usually when the tumour has already spread or when patients become resistant to single-agent chemotherapy, multi-agent chemotherapy is required. This involves taking a combination of different chemotherapy drugs on alternating days.
Women should not become pregnant again for at least six months after their treatment has been declared successful. The use of oral contraceptives is safe following successful treatment of GTD. Health Engine Patient Blog. Tools Med Glossary Tools. Looking for a practitioner? HealthEngine helps you find the practitioner you need. Find your practitioner. Find a provider. What are you looking for? Search for articles. Popular searches How can I relieve my back pain? Pregnancy and Lifestyle. Women's Health. Related Articles.
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