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This section outlines treatments that are the standard of care (best proven treatments available) for this specific type of cancer. 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 treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections.
In cancer care, 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.
Descriptions of the most common treatment options for a GTT are listed below. Surgery, chemotherapy, and radiation therapy may all be used to treat a woman with a GTT. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient's preferences and overall health. Learn more about making treatment decisions.
GTTs are typically curable, especially when found early. Women with a GTT may have concerns about how treatment will affect their fertility (ability to become pregnant) and sexual function, and patients are encouraged to talk about these concerns with their health care team before treatment begins.
Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For a GTT, the extent of surgery depends on the stage of the tumor. Two common surgical options are a procedure called dilation and curettage (D&C) and a hysterectomy. D&C is the removal of the contents of the uterus with a small vacuum-like device; then, the walls of the uterus are scraped to remove any material that remains. A D&C is used for a molar pregnancy. A hysterectomy is the removal of the uterus and cervix, and it is used to treat a more advanced tumor.
Following 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 cancer 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 will be recommended. Learn more about cancer surgery and coping with gynecologic surgery.
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells' ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. 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.
Similar to surgery, the type of chemotherapy depends on the stage of the GTT. A low-risk invasive mole or metastatic disease often can be treated successfully with methotrexate (multiple brand names) either alone or in combination with leucovorin (Wellcovorin). Another drug that can be used is dactinomycin (Cosmegen, Lyovac Cosmegen). 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 combination chemotherapy. The most common treatment is a combination called EMA-CO (etoposide [VePesid, Toposar], methotrexate, dactinomycin, cyclophosphamide [Cytoxan, Clafen, Neosar], and vincristine [Oncovin, Vincasar]). Cisplatin (Platinol) with vincristine and methotrexate has been successful to treat women with a tumor that did not go into remission (a temporary or permanent absence of symptoms) with the treatments mentioned above.
Treatment results are measured by beta hCG levels. Usually treatment is continued until beta hCG levels are normal, and then one to two additional cycles of treatment may be given.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer 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.
Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer 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 cancer 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.
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.
A remission is when cancer 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 cancer will come back. While many remissions are permanent, it's important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. 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. 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 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 cancer.
People with recurrent cancer 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 a GTT has spread from the uterus to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. Supportive care will also be important to help relieve symptoms and side effects.
Radiation therapy is not often used to treat GTTs, but it may be used for metastatic cancer that does not respond to chemotherapy. Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Learn more about radiation therapy.
For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
If treatment fails
GTTs are often curable. However, recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.
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.
Palliative care given toward the end of a person's life is called hospice care. 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 cope with the loss. Learn more about grief and bereavement.
Find out more about common terms used during cancer treatment.