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Gestational Trophoblastic Disease

Overview of Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a group of rare tumors that usually develop during the early stages of pregnancy. As the women get pregnant, the fertilized egg or embryo is surrounded by a layer of cells called the trophoblasts. These types of cells support the embryo for implantation in the uterine wall and also make up a large part of the placenta (which provides nutrients to the fetus). In GTD, abnormal growths in trophoblasts are observed that lead to the tumor.

Prevalence of Gestational Trophoblastic Disease(GTD)

Globally, 1 in 1000 cases of GTD is reported worldwide. About 1% of women were affected by this disease. Among all types of GTD, the most common is hydatidiform moles.

Signs and Symptoms of Gestational Trophoblastic Disease

Some common signs and symptoms are below:

  • Preeclampsia (high blood pressure during pregnancy)
  • Frequent headaches
  • Swelling of hands and feet
  • Feeling Pain, pressure, or discomfort in the pelvis
  • Breathing difficulty, tiredness, and dizziness due to vaginal bleeding
  • Larger than normal uterus during pregnancy
  • Stomach upset
  • Vaginal bleeding (not relevant to the menstrual cycle)

It might be possible that GTD causes overactive thyroid due to which common symptoms are below:

  • Fast or irregular heartbeat
  • Shivering
  • Sweating
  • Weight loss

Types of Gestational Trophoblastic Disease

Below are the main types of its disease whether it is a benign or malignant gestational trophoblastic disease:

1. Hydatidiform Moles (HMs)

It is the most common type of GTD of all. It is caused by a group of cysts (fluid-filled sacs). Initially, as the tumor develops, it seems like a normal pregnancy. The baby is not growing. After 6-10 weeks the symptoms start to appear during routine tests.

HMs is categorized further into two subtypes:

  • Complete hydatidiform moles (CHMs) contain no nucleus or DNA when 1 or 2 sperm cells fertilize an egg cell. This DNA comes from the father’s sperm cell. Therefore, there is no fetal tissue.
  • Partial hydatidiform moles (PHMs) form as the 2 sperms fertilize a normal egg. These types of tumors also have some part of fetal tissue, which is often combined with the trophoblastic tissue. But the fetus is alive inside the mother’s womb.

2. Invasive Moles

They usually begin as CHMs, which change into cancer in the muscle of the uterus. In rare cases, they may develop as PHMs.

3. Choriocarcinoma

It is a rarely developed cancer caused by tissues left after an abortion, miscarriage, or delivery of a baby. It is fatal cancer that can spread all over the body including the uterus, lungs, brain, and even the baby.

4. Placental-site trophoblastic tumors (PSTTs) and epithelioid trophoblastic tumors (ETTs) are rare types of cancer. They can expand to the uterus and other parts of the body.

Causes of Gestational Trophoblastic Disease

It is a rare disease and there is no defined cause of it.

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Risk Factors of Gestational Trophoblastic Disease

Some factors may increase the risk of GTD in pregnant women. Few are as follows:

  • Women are being pregnant at the age of less than 20 or older than 35.  These women may have a high risk of gestational trophoblastic disease
  • Had miscarriage history 
  • Women having blood type A and AB are slightly at a higher risk
  • Had a history of hydatidiform moles

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Prevention

There are no known ways to prevent this rare condition.

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Diagnosis

Diagnosis of GTD involves a review of medical history and a general physical exam. Following are the diagnostic tests that may be conducted for this disease.

  • Internal Pelvic Exam: For the determination of lumps or any abnormalities in the shape of the uterus. Pelvic ultrasound may also be done in this case.

  • Pap Test (also called Pap Smear): It is conducted for the microscopic examination of cells collected from the cervix. This is used to detect whether it is cancer or showing any other conditions such as infection or inflammation.

  • Transvaginal Ultrasound (also called Ultrasonography): The TVS ultrasound test consists of a small instrument called a transducer. The device is inserted in the vagina to check the uterus and surrounding tissues.

  • Blood Tests: The blood test is used to check the level of certain hormones related to GTD in blood.

  • Urinalysis: The urinalysis test is used to measure the amount of sugar, protein, bacteria, and certain hormones in a woman’s urine. These components may alter during pregnancy.

If the cancer cells metastasize to other parts of the body, it is known as malignant gestational trophoblastic disease. For this, below are the tests that a doctor may recommend to pregnant women:

 

  • Spinal Tap: This method is used for patients whose GTD has spread to the brain or spinal cord. A doctor injects a needle into the patient’s spinal column for the collection of cerebrospinal fluid. The fluid identifies the high amounts of the hormone Gonadotropin (HCG). 

  • Computed Tomography (CT or CAT): To obtain a detailed cross-section scan of various areas of the abdomen CT Scan or CAT is done.

Treatment of Gestational Trophoblastic Disease | When to Consult a Doctor

On the basis of diagnosis, a doctor will determine the specific treatment for GTD patients. The treatment is based on the following parameters:

  • Patient’s overall health and medical history
  • Extent and type of GTD
  • Tolerance to specific medications
  • Procedures or therapies
  • Women want to become pregnant in future 

Standard methods of treatment include:

  • Surgery:  This is performed to remove tumors or affected organs.
  • Chemotherapy: Using the anticancer drugs responsible to treat cancerous cells. In this way, these drugs kill the cancerous cell and prevent growth.
  • Hysterectomy: In this procedure, the whole uterus is removed surgically. In some cases, it is conducted through salpingo-oophorectomy that removes the fallopian tubes and ovaries. Also, remove the nearby lymph nodes and part of the vagina.
  • Radiation Therapy: The high-energy beams pass through tumors to kill the cancer cells and shrink the tumor.

 

In case you exhibit any concerning signs and symptoms of GTD, consult a medical professional as soon as possible.