Gestational Trophoblastic Neoplasia: Treatment, Procedure, Cost and Side Effects

Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. Gestational trophoblastic neoplasia(GTN) is a type of GTD that is most of the time malignant. This condition includes:

1) Invasive moles, which are made up of trophoblast cells, spreads to the muscle layer of the uterus. In rare occasions, an invasive mole can disappear without treatment. They are more likely to grow and spread than hyatidiform moles.

2) Choriocarcinomas are also made up of trophoblast cells and spreads to the blood vessels and the muscle layer of the uterus. A choriocarcinoma is more likely to affect a woman who has had molar pregnancy, normal pregnancy, miscarriage or tubal pregnancy.

3) A rare type of GTN is placental-site trophoblastic tumor that forms where the placenta attaches to the uterus.

4) Another rare type of GTN is epithelioid trophoblastic tumors that may be benign or malignant.

There are different types of treatment for people suffering from gestational trophoblastic diseases including gestational trophoblastic neoplasia. Three types of standard treatments are used: surgery, chemotherapy and radiation therapy. New types of treatments are being tested in clinical trials and people should weigh the pros and cons before taking part in a clinical trial. Two types of surgical procedures are used: dilatation and curettage with suction evacuation and hysterectomy. Other types of treatment include chemotherapy and radiation therapy.

The dilatation and curettage with suction evacuation is a surgical procedure to remove abnormal tissue and parts of the inner lining of the uterus. The material uterus is removed with a small vacuum-like device after the cervix is dilated. A curette is used to gently scrape the walls of the uterus so as to remove any material. This procedure can be used in molar pregnancies.

Hysterectomy is the surgery to remove the uterus and, in some cases, the cervix. The operation is called vaginal hysterectomy if the uterus and the cervix are taken out through the vagina. Total abdominal hysterectomy is the name of the surgery wherein the uterus and the cervix are taken out through a large incision in the abdomen. If the cervix and the uterus are taken out through a small incision of the abdomen using a laparoscope, it is called laparoscopic hysterectomy.

Another potent form of treatment is chemotherapy that uses drugs to stop the growth of cancer cells, either by killing the cells or by preventing them from spreading. Chemotherapy can be systemic or regional. How chemotherapy is to be administered depends on type and stage of the cancer and also whether the tumor is low-risk or high-risk.

Radiation therapy uses high energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There can be external radiation therapy or internal radiation therapy.

A person belongs eligible for treatment of gestational trophoblastic neoplasia if she suffers from some or all of these symptoms: vaginal bleeding which is not related to menstruation, if uterus is larger than expected during pregnancy, pain or pressure in the pelvis, severe nausea and vomiting during pregnancy, high blood pressure with headache and swelling of feet during pregnancy, abnormally long periods of vaginal bleeding and fatigue, shortness of breath, dizziness or irregular heartbeat caused by anemia.

There are a number of tests to detect gestational trophoblastic diseases. They include a physical exam and checking the medical history of the concerned person, a pelvic exam, an ultrasound exam of the pelvis, blood chemistry studies, urinalysis and serum tumor marker test. These tests help to understand whether a person is indeed suffering from gestational trophoblastic neoplasia or not. A person without the symptoms and who, in spite of the various tests, have not tested positive are not eligible.

The side effects of this treatment can include anemia, appetite loss, bleeding, constipation, delirium, fertility issues, diarrhea, fatigue, nerve problems, sexual health issues, memory or concentration problems, infection and neutropenia, hair loss and others. In addition, chemotherapy and radiation therapy can cause problems for your heart. Sometimes, a person may also start to suffer from hypertension due to fluctuations in blood sugar levels. There is a significant risk of lung damage as well.

It is advisable for a person to go for her regular follow-up appointments after completing her treatment for gestational trophoblastic neoplasia. The follow up program depends on the type of GTD a person had and what type of treatment she has received. However, in almost all cases, the levels of human chorionic gonadotrophin( HCG) are measured. This is because a rising HCG level may indicate that the disease is again growing in the uterus. Doctors also will recommend physical examination at an interval of 3-6 months for the first few years after treatment. It is also important to go for a balanced diet and also to lead an active life so as to improve your physical and psychological health.

There are a number of methods by which gestational trophoblastic diseases can be cured. Abdominal hysterectomy requires a hospital stay for 2-3 days is common. However, it takes 4-6 weeks to recover completely. A patient is required to stay for 1-2 days in the hospital for vaginal hysterectomy and the recovery time for this type of surgery is 2-3 weeks. Chemotherapy involves alternative treatment and rest periods which are known as cycles. So the recovery period would depend on how many cycles of treatment you require. The rest period could be anything from a few days to several weeks to allow your body to recuperate. If radiation therapy is used to control symptoms, the treatment will go on 2-3 weeks. However it is not always possible to figure out the recovery period as this treatment has side-effects and requires a person to follow-up with a doctor at regular intervals.

The price range for treating cancer can vary between Rs 2.5 lakhs for 6 months of treatment to Rs 20 lakhs for novel drugs and expensive medicines. This is a rough estimation and can vary from person to person. A person who requires more cycles of chemotherapy will obviously have to spend more money. Again, if cancer is recurrent, more money has to be spent.

There is a risk of gestational trophoblastic neoplasia occurring more than once in an individual. This is not a widespread affair, but nevertheless, is possible. There is another situation where this condition does not respond to treatment and it is called recurrent gestational trophoblastic neoplasia. Thus it is not always a permanent treatment for this disease.

There are alternative clinical treatments for gestational trophoblastic diseases. Patients may take part in a clinical trial if they think that it will be beneficial for them. Clinical trials help to improve the procedures by which cancer will be treated in the future. Clinical trials may also help to reduce the side effects of cancer treatment and may also stop cancer from recurring.