View All Pages

Gestational Trophoblastic Disease - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find some basic information about this group of diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Gestational Trophoblastic Disease. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

The uterus is a part of a woman’s reproductive system. It is pear-shaped, hollow, and located in a woman's pelvis between her bladder and rectum. The uterus is also known as the womb, where a fetus (unborn baby) grows when a woman is pregnant. It has three sections: the cervix, which is the narrow, lower section; the corpus, which is the broad, middle section; and the fundus, which is the dome-shaped top section. The uterine wall has two layers of tissue. The inner layer is called the endometrium, and the outer layer is muscle tissue called the myometrium.

About gestational trophoblastic disease

Gestational trophoblastic disease (GTD) is the general name for a group of rare tumors that occur during pregnancy in the fetal chorion, which is the outer part of the sac that surrounds the fetus as it grows. GTD can occur in any kind of pregnancy.  GTD is almost always curable, especially if found early.

This type of tumor begins when normal cells of the placenta, called trophoblast cells, change and form a mass. GTD is usually benign, which means noncancerous. But some GTD tumors can be cancerous, meaning they can spread to other parts of the body.

Usually, GTD occurs when there is a problem during the combination of a man’s sperm and a woman’s egg. Trophoblast cells normally grow and surround a fertilized egg in the uterus, helping to connect the fertilized egg to the uterine wall and to form the placenta. The placenta is the organ that develops during pregnancy to provide nutrients to the fetus from the mother. When this type of problem occurs, a healthy fetus will not develop and a tumor forms instead. In rare cases, GTD is a cancerous growth that begins from a normal placenta and may be found after a normal pregnancy and delivery of a baby.

Types of GTD

There are two main groupings of GTD. The first group is called hydatidiform moles, and the second group is called gestational trophoblastic neoplasia. There are subtypes under each grouping, explained below.

Hydatidiform Moles (HM). HMs account for about 80% of all GTD. A hydatidiform mole is also called a molar pregnancy. There are two types of HM: complete or partial. HMs are usually slow-growing and benign, although there is a chance a mole can become cancerous. A complete HM is much more likely to become cancerous than a partial HM.

A complete HM begins when sperm fertilizes an abnormal egg that doesn’t contain the mother’s DNA or a nucleus. Instead of forming a fetus, the tissue grows into a mound of cells that look like grape-like cysts.

A partial HM begins with fertilization of a normal egg by two sperm, so there are two sets of DNA from the father. The result has some of the features of a complete HM but part of the fetus may form, although there is no chance for fetal survival.

Gestational Trophoblastic Neoplasia (GTN). The second grouping is called GTN. While they can be related to HMs, GTNs are typically cancerous. The main types of GTNs include:

Invasive mole. Although it is also a type of HM, an invasive mole is considered a GTN because of its potential to grow and spread. An invasive mole may grow into the muscle layer of the woman’s uterus. Fewer than 15% of HMs spread outside of the uterus.

Choriocarcinoma. This is a cancerous tumor formed from trophoblast cells, and it can grow and spread more quickly than other GTNs. Choriocarcinoma can spread to the uterine muscle layer, nearby blood vessels, and outside of the uterus, including to nearby organs, brain, lung, liver, or kidneys. About 5% of all GTD are choriocarcinomas. It is most often found in women who’ve had an HM; a normal pregnancy and delivery of a baby; a tubal pregnancy where the fetus grows in the fallopian tube instead of the uterus; an induced ending of a pregnancy called an abortion; or an uninduced ending of a pregnancy called a miscarriage.

Placental-site trophoblastic tumor (PSTT). This rare type of GTN is also formed from trophoblast cells. It starts where the placenta joins with the uterus. This type of tumor grows slowly, but it can eventually spread to the uterine muscle, nearby blood vessels, or to the lymph nodes, pelvis, or lungs. Signs and symptoms may not occur until well after a normal pregnancy, an abortion, or treatment for an HM.

Epithelioid trophoblastic tumor (ETT). This is an extremely rare type of GTD. If it does spread, the most common area is the lungs. It is most often found after a normal pregnancy. ETT can also take a long time to show signs and symptoms.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Gestational Trophoblastic Disease - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find information about how many women learn they have GTD each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Overall, GTD is rare and often curable. In the United States, GTD accounts for less than 1% of all cancers that start in a woman's reproductive system, which is a grouping called gynecologic cancers. GTD occurs in about one pregnancy out of every 1,000 U.S. pregnancies. GTD are more common in other parts of the world, including Asia and Africa. Specifically, choriocarcinoma is very rare, occurring in about two to seven pregnancies out of every 100,000 in the United States.

Nearly all women with an HM or low-risk GTN can be cured, often with fertility-sparing surgery alone. PSTT can often be cured, particularly if it is found before it spreads outside the uterus. Even with faster-growing GTN, a cure may be possible with more intensive treatment with estimates at 80% to 90%.

Survival statistics should be interpreted with caution. Estimates are based on data from thousands of women with this type of tumor in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live after a diagnosis of GTD. Learn more about understanding statistics.

Statistics source: American Cancer Society.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Gestational Trophoblastic Disease - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of tumor. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing disease. Although risk factors often influence the development of a tumor, most do not directly cause it. Some people with several risk factors never develop a tumor, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman’s risk of developing GTD:

Age. Being younger than 20 or older than 35 when becoming pregnant brings a higher risk of GTD. The risk increases when the woman is over age 45 at the time of pregnancy.

Previous HM. A previous molar pregnancy may increase the risk of developing another GTD.

Nutrition/diet. Some studies have linked low levels of carotene and vitamin A in a person’s diet with a higher risk of molar pregnancy.

Blood type. Specific blood types – blood type A or AB – may slightly increase the risk of GTD.

Birth control pills. Women who take birth control pills may have a higher risk of GTD once they do become pregnant, particularly for those who took the pill for a long time.

Family history of HM. There have been rare cases of women in the same family having one or more molar pregnancies.

The only known way to avoid GTD is to avoid pregnancy. However, in making such family planning decisions, women should remember that GTD overall is rare. Women who’ve had an HM in the past, or are worried about GTD for any reason, are encouraged to talk with their doctors about the future risk of GTD.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Gestational Trophoblastic Disease - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Women with GTD may experience the following symptoms or signs. Sometimes, women with GTD do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not GTD.

GTD may not cause any symptoms in its early stage because it may resemble a normal pregnancy. However, the following symptoms could signal a potential problem:

  • Vaginal bleeding, during or after pregnancy
  • A uterus that is larger than expected at a given point in the pregnancy
  • Severe nausea or vomiting during pregnancy
  • High blood pressure at an early point in the pregnancy. This may also include headaches and/or swelling of the feet and hands at the same time.
  • A pregnancy where the baby has not moved at the expected time
  • Pain or pressure in the pelvic area
  • Abdominal swelling
  • Anemia, which is a low red blood cell count that can cause fatigue, dizziness, shortness of breath, or an irregular heartbeat.
  • Anxiety or irritability, including feeling shaky or severe sweating
  • Sleep problems
  • Unexplained weight loss

Occasionally, symptoms may appear weeks, months, or even years after a normal pregnancy and birth.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If GTD is diagnosed, relieving symptoms remains an important part of your care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

In rare situations, the cancer has already spread beyond the uterus at the time of diagnosis, and other symptoms may occur depending on the location. In this case, GTD may be misdiagnosed as another health problem. For example, spread of choriocarcinoma to the brain may result in bleeding, which can be mistaken for a brain aneurysm. A beta human chorionic gonadotropin (beta hCG) blood test (see Diagnosis) should help the health care team better understand the problem.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose GTD, determine whether it is cancerous, and if so, find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. Imaging tests may also be used to find out whether a cancerous GTD has spread. This list describes options for diagnosing GTD, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Type of disease suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose GTD:

Pelvic examination. The doctor may feel the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for lumps or any unusual changes. This is similar to the physical exam done when women have an annual gynecologic check-up.

Beta human chorionic gonadotropin (hCG) test. Tumor markers are substances found at higher than normal levels in the blood, urine, or body tissues of some people with a tumor. Women who are pregnant normally produce high levels of the hormone beta hCG in their blood and urine. High levels of beta hCG in a woman who is not pregnant could mean that GTD is present. hCG tests are also helpful tests during and after treatment for GTD, to monitor a woman’s recovery.

Other lab tests. Additional blood and urine tests may also done, including tests to check the woman’s thyroid, liver, kidney, and bone marrow function.

Ultrasound. Also called a sonogram, an ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus, to obtain the pictures.

X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. A chest x-ray may be done to see if the doctor believes there may be spread outside of the uterus.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is injected into a patient’s vein and given as a drink to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. In GTD, MRIs are most often used to see a patient’s brain.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is GTD, these results also help the doctor describe the disease in more detail; this is called staging.

The next section helps explain the different stages for this type of tumor. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Stages and Groups

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will learn about how doctors describe the disease’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the tumor is located, if it is cancerous, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the tumor’s stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of tumors. For GTD, here is the staging system developed by the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO.

FIGO Anatomic Staging

  • Stage I: Disease confined to the uterus
  • Stage II: GTD extends outside the uterus, but is limited to the genital structures
  • Stage III: GTD extends to the lungs, with or without known genital tract involvement
  • Stage IV: All other metastatic sites

World Health Organization (WHO) Risk Score as Adapted by FIGO

The table below shows how the risk score staging factor is determined. Low risk is a score of 6 or less, and high risk is a score of 7 or more. Women with a low-risk tumor means the prognosis is good, even if cancer has spread, because treatment is usually very effective. Women with a high-risk tumor may require more intense treatment even if the tumor has not spread.

Risk Score

Prognostic Factor

0

1

2

4

Age

Younger than 40

40 and/or older

-

-

Previous pregnancy

Hydatidiform mole

Abortion

Full-term pregnancy

-

Months since last pregnancy

Less than 4

4 to 6

7 to 12

More than 12

Pretreatment hCG (IU/ml)

Less than 10³

Greater than or equal to 10³ to 104

>104 to 105

Greater than or equal to 105

Largest tumor size, including uterus

Less than 3 cm

3 to <5 cm

Greater than or equal to 5 cm

-

Site of spread

Lung

Spleen or kidney

Gastrointestinal tract

Brain, liver

Number of tumors that have spread*

Zero

1 to 4

5 to 8

More than 8

The number of drugs used to treat the tumor that have not worked

None

None

Single drug

Two or more drugs

*For lung metastases, chest x-ray (not CT scan) is used to count the number of metastases

To stage and determine a risk factor score, a patient’s diagnosis is assigned to a stage as represented by a Roman numeral I, II, III and IV. This is then separated by a colon from the sum of all the actual risk factor scores expressed in Arabic numerals, such as Stage II:4 or Stage IV:9. This stage and score will be given for each patient. 

For people with PSTT/ETT only the stage will be given (risk factor score is not applicable).

Recurrent: Recurrent GTD is a tumor that has come back after treatment. If there is a recurrence, the tumor may need to be staged again (called re-staging) using the system above.

Information about the GTD’s stage and risk group will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of tumor. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat women with GTD. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (best proven treatments available) for this specific type of tumor. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

For GTD, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For GTD, this often includes the woman’s gynecologist, who is a doctor that treats problems of a woman’s reproductive system, as well as a gynecologic oncologist, who specializes in specifically treating cancer of the female reproductive system. Other specialists may include a medical oncologist, surgeon, and radiation oncologist, described below.

GTD is typically curable, especially when found early. Descriptions of the most common treatment options for GTD are listed below. Surgery and/or chemotherapy may be used to treat a woman with GTD. Treatment options and recommendations depend on several factors, including the type, stage, and risk grouping of GTD, and the patient’s preferences and overall health.

Your care plan may also include treatment for symptoms and side effects, an important part of medical care. Women diagnosed with GTD may have concerns about how treatment will affect their fertility (ability to become pregnant in the future) and sexual health, and patients are encouraged to talk about these concerns with their health care team before treatment begins. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is often the first treatment used for an HM and may be the only treatment necessary. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

For GTD, the extent of surgery depends on the stage of the tumor. Two common surgical options are described below:

Suction dilation and curettage (D&C). A D&C is when the doctor removes a tumor within the uterus using a small vacuum-like device. After that, the walls of the uterus are scraped to remove any molar tissue that remains. The patient may receive a drug called oxytocin that helps remove the uterine tissue. A D&C is used for an HM and allows for preservation of a woman’s fertility. Side effects may include some vaginal bleeding, infection, scarring, cramping, and blood clots. Talk with your health care team about what to expect before a D&C.

Hysterectomy. A hysterectomy is the removal of the woman’s uterus and cervix. It is usually recommended to reduce risk of recurrence, treat a later-stage tumor, or a tumor type of PSTT and ETT. Hysterectomy can be either a simple hysterectomy, which is the removal of the uterus and cervix, or a radical hysterectomy which is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix. There are different techniques to perform a hysterectomy, including a traditional incision in the stomach or a technique that use several, smaller incisions called a laparoscopic hysterectomy. Side effects of a hysterectomy include infertility. Other side effects include pain, bleeding, and infection. Talk with your doctor and other members of your health care team about possible side effects and how they can be relieved.

Following GTD surgery, the woman’s beta hCG level (see Diagnosis) will be monitored with blood tests to make sure it falls into normal levels. If the beta hCG level remains high or increases after an initial drop, it may mean that tumor cells are still present, either in a portion of the original tumor -- called a persistent or invasive mole -- and/or the cancer has spread to another area. If this occurs, additional treatment such as chemotherapy will be recommended. If the GTD surgery shows the presence of choriocarcinoma, chemotherapy (described below) is started immediately.  Choriocarcinoma is malignant and always needs chemotherapy.  Learn more about cancer surgery and coping with gynecologic surgery that can affect sexual health.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by stopping those cells’ ability to grow and divide. Chemotherapy is given by a gynecologic oncologist or medical oncologist, a doctor who specializes in treating a tumor with medication. Chemotherapy is usually very effective in treating an HM and some types of GTN, but it is not as effective with PSTT and ETT. Sometimes, chemotherapy is used as a single treatment, and in other cases, it may be combined with surgery.

Systemic chemotherapy is delivered through the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intramuscular (IM) injection (or shot), intravenous (IV) tube placed into a vein using a needle, or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Common drugs used in chemotherapy for GTD include:

  • methotrexate (multiple brand names)
  • dactinomycin (Actinomycin-D, Cosmegen)
  • etoposide (VePesid, VP-16, Toposar)
  • cyclophosphamide (Cytoxan, Neosar)
  • vincristine (Oncovin, Vincasar)
  • cisplatin (Platinol, CDDP)

Similar to surgery, the type of chemotherapy depends on the stage grouping of GTD, including whether the tumor is low risk or high risk. A low-risk invasive mole or metastatic disease often can be treated successfully with methotrexate either alone or in combination with leucovorin (folinic acid, Wellcovorin). Another drug that can be used is dactinomycin, especially if the patient’s liver is not fully healthy. Approximately 15% of women with low-risk disease will need treatment with a second drug for treatment.

Women with high-risk, metastatic disease generally receive more than one drug, called combination chemotherapy. Common combinations include:

  • EMA-CO: etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine
  • EMA-EP: etoposide, methotrexate, dactinomycin, etoposide, and cisplatin

Treatment results are measured by testing the woman’s beta hCG levels. Usually chemotherapy is continued until beta hCG levels are normal, and for additional cycles of treatment.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, mouth sores, hair loss, loss of appetite, neuropathy (numbness and tingling in the fingers and toes) and oto-toxicity, which is loss of high-frequency hearing and/or ringing in the ears. These side effects usually go away once treatment is finished. Talk with your doctor beforehand about the possible side effects from the specific drug(s) given and how side effects may be relieved or reduced.

Learn more about chemotherapy and preparing for treatment. The medications used to treat GTD are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

GTD and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the tumor, an important part of medical care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy and surgery. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.  

Remission and the chance of recurrence

A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the tumor will come back. While many remissions of GTD are permanent, it’s important to talk with your doctor about the possibility of the tumor returning. The risk of recurrence for GTD overall is low, but it may be as high as 10% to 15% for women with a high-risk tumor. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence

If GTD does return after the original treatment, it is called recurrent. It may come back in the uterus (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the GTD stage and risk group has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery or chemotherapy but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Treatment is often effective for a recurrent GTD.

People with recurrent GTD often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

GTD is often curable. However, recovery is not always possible. If treatment is not successful, the disease may be called advanced or terminal.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced disease and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with GTD. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating GTD. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with GTD.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for GTD, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are closely monitored by experts who watch for any problems with the study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of tumor.

The next section helps explain the areas of research going on today about this type of tumor. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about GTD and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about gynecologic tumors (tumors in the female reproductive system), ways to prevent them, how to best treat them, and how to provide the best care to women diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Because GTD is uncommon, GTD-only clinical trials may be hard to find. However, there are several clinical trials that are open to people with different types of cancer, particularly other gynecologic tumors, that include GTD. Always talk with your doctor about the diagnostic and treatment options best for you.

New drug therapies. Researchers are studying new drugs for the treatment of GTD and gynecologic cancers, including targeted therapies. Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to its growth and survival. New drugs that impair various processes in the tumor cell, including topoisomerase-I inhibitors (drugs that interfere with the replication of DNA, which affects tumor cell growth), angiogenesis inhibitors (drugs that stop the formation of blood vessels that deliver nutrients needed for the tumor to grow and spread), and microtubule agents (drugs that disrupt the structure of tumor cells), are being tested to treat GTD. In addition, researchers are also studying the use of growth factors added to chemotherapy.

New treatment combinations. Doctors continue to evaluate different combinations of current treatment options and different drugs, as well as integrating new approaches that are being studied in clinical trials.

Stem cell transplantation. A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Early studies are underway to determine if transplantation is effective for advanced GTD. Learn more about stem cell transplantation.

Causes of GTD. Researchers are working to learn more about what causes GTD, including possible chromosome changes or problems.

Earlier diagnosis. There is research being done to produce more sensitive blood tests to find hCG levels at smaller amounts, which could lead to some women being diagnosed with GTD at an earlier stage.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current treatments for GTD in order to improve patients’ comfort and quality of life.

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of GTD, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for GTD are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the tumor’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a woman with GTD. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your medical care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will read about your medical care after treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for GTD ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers treatment summary forms to help keep track of the treatment you received and develop a survivorship care plan once treatment is completed.

Follow-up treatment always includes the doctor measuring the blood’s beta hCG levels, typically every one to two weeks until the hormone level is normal for three consecutive tests. After that, beta hCG levels should be monitored monthly for the first year, every four months for the second year, then yearly for the third and fourth years.

Women are encouraged to talk with their doctors about the recommended amount of time to wait before becoming pregnant after reaching normal levels of beta hCG. If the woman had either a complete or partial HM and no chemotherapy was given, pregnancy may be safe after three to six months. Also, patients with a history of GTD should have a beta hCG check after each pregnancy, even if the pregnancy was completely normal.

If chemotherapy was given, talk with your doctor about possible long-term side effects based on the specific drug(s) used. Different drugs and doses can cause different side effects.

Women recovering from GTD are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your medical care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of GTD do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage of the tumor? What does this mean?
  • Is it low risk or high risk? What does this mean?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the tumor, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • If I need surgery, what type of surgery do you recommend? Will I need to stay in the hospital? What will recovery be like?
  • If I need chemotherapy, which drug(s) will be given?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • Will I be able to have children after treatment? Should I talk with a fertility specialist before GTD treatment begins?
  • Do you recommend I wait following treatment to try to become pregnant? If so, how long? Is it OK to use birth control pills or other methods during this time?
  • Could this treatment affect my sex life? If so, how and for how long?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • If I’m worried about managing the costs related to my medical care, who can help me with these concerns?
  • What are the chances that the GTD will recur?
  • What follow-up tests will I need, and how often will I need them?
  • If I become pregnant in the future, are there specific tests or exams that I need? How often?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Gestational Trophoblastic Disease - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Gestational Trophoblastic Disease. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of being diagnosed with a tumor, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with a tumor.

- Find out more about clinical trials as a treatment option.

Learn more about coping with the emotions that a tumor diagnosis can bring, including those within a family or a relationship.

Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of disease.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Gestational Trophoblastic Disease. Use the menu on the side of your screen to select another section to continue reading this guide.