ON THIS PAGE: You will learn about the different ways doctors use to treat women with this disease. Use the menu to see other pages.
This section tells you the treatments that are the standard of care for this type of tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.
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 in a woman’s reproductive system, and a gynecologic oncologist, who specializes in treating cancer of the female reproductive system. Other specialists may include a medical oncologist, surgeon, and radiation oncologist, described below. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
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 include treatment for symptoms and side effects, an important part of medical care. Women diagnosed with GTD may have concerns about whether treatment will affect their ability to become pregnant in the future, called fertility, and their sexual health. 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. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often the first treatment used for a molar pregnancy and may be the only treatment necessary. A surgical oncologist is a doctor who specializes in removing a tumor using surgery.
For GTD, the extent of surgery depends on the stage of the tumor. Common surgical options are:
Suction dilation and curettage (D&C). During D&C, the doctor dilates the cervix and removes the tissues inside the uterus using a small vacuum-like device. After that, the walls of the uterus are scraped to remove any remaining molar tissue. The patient may receive a drug called oxytocin that helps the uterus contract to normal size. A D&C is used when there is a molar pregnancy and allows for preservation of a woman’s fertility. Side effects may include some vaginal bleeding, infection, scarring inside the uterus, cramping, and blood clots. Talk with your health care team about what to expect from this procedure.
Hysterectomy. A hysterectomy is the removal of the woman’s uterus and uterine cervix. In most cases of GTD, a hysterectomy is not necessary because the women are cured with D&C, followed by chemotherapy when needed. A hysterectomy is usually recommended to reduce the risk of recurrence or to treat a tumor type of PSTT or ETT. Types of hysterectomy include:
Simple hysterectomy: the removal of the uterus and its cervix
Radical hysterectomy: the removal of the uterus, its cervix, the upper vagina, and the tissue around the cervix
Supracervical hysterectomy: the removal of the body of the uterus, while preserving the uterine cervix
There are different techniques used to perform a hysterectomy, including a traditional incision in the stomach or a technique that uses several, smaller incisions, called a laparoscopic hysterectomy. Side effects may include pain, bleeding, and infection. Talk with your health care team about possible side effects and how they can be relieved. Women who have a hysterectomy cannot become pregnant in the future
Following GTD surgery, the woman’s beta hCG level (see Diagnosis) will be monitored with blood tests to make sure that it returns to 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 GTD 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 (see below) is started immediately. Choriocarcinoma is cancerous and always needs chemotherapy.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.
Chemotherapy is the use of drugs to destroy tumor cells, usually by ending 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 a molar pregnancy 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 gets into the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intramuscular (IM) injection (or shot), an intravenous (IV) tube placed into a vein using a needle, or in a pill or capsule that is swallowed (orally).
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time. Common drugs used in chemotherapy for GTD include:
Methotrexate (multiple brand names)
Dactinomycin (Actinomycin-D, Cosmegen)
Etoposide (VePesid, Toposar, Etopophos)
Cyclophosphamide (Cytoxan, Neosar)
Vincristine (Oncovin, Vincasar)
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 a cancerous GTD that has spread can often 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. About 15% of women with low-risk disease will need additional treatment with a second drug.
Women with high-risk, metastatic disease generally receive more than 1 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. Additional cycles of chemotherapy are given after beta hCG levels are normal to reduce the risk of recurrence. In most instances, patients require 3 to 4 cycles of chemotherapy.
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 after 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 the basics of 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 treatments intended 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 is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of disease, may receive palliative care. It works best when palliative care is started as early as needed in the treatment process. People often receive treatment for the tumor at the same time that they receive treatment to ease side effects. Patients who receive both at the same time 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, emotional support, and other therapies. You may receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy or 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 palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be 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 having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions of GTD are permanent, it is 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 10% to 15% for women with a high-risk tumor. Understanding your 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 new cycle of testing will begin to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatment 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 suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Treatment is often effective for a recurrent GTD. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
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 doesn’t work
GTD is most often curable. However, recovery is not always possible. If a cancerous GTD cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people advanced cancer is difficult to discuss. 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 6 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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 in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for women with GTD. You may use the menu to choose a different section to read in this guide.