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Trophoblastic disease
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OBSTETRICS & GYNAECOLOGY
Trophoblastic disease
I. R. Johnson
teaching would suggest that hydatidiform moles present with bleeding, a uterus large for dates and with exaggerated symptoms of pregnancy including nausea and vomiting and sometimes pregnancy induced hypertension. In practice nowadays, the diagnosis is almost invariably made by ultrasound scan, either coincidentally or for investigation of bleeding in the first trimester of pregnancy. The other symptoms are now quite rare. After clinical diagnosis the mole is usually evacuated using suction. In some cases, second evacuation is required but only when heavy bleeding occurs. In general, repeat evacuation does not improve the prognosis. After diagnosis, referral and registration in a specialist centre is essential. These specialist centres follow enough patients each year to develop appropriate protocols of management and treatment. The prognosis is excellent with survival of 94% up to 15 years. Success in the management of this type of tumour has followed ultrasound diagnosis, the fortuitous presence of a chemical marker (HCG), referral to specialist centres and the development of logical treatment moving from surgery to chemotherapy. Further development depends upon vigilance in the recognition of those cases of gestational trophoblastic disease not following hydatidiform mole and in the proper management of irregular vaginal bleeding.
In this issue, the mini-symposium includes 4 articles concerning trophoblastic disease dealing with the epidemiology, pathology and aspects of clinical care both in Western countries and in the Far East. In the last 35 years, the management of trophoblastic disease has been one of the major success stories of oncology and certainly the major success story of gynaecological oncology. This is the first tumour of life and the first to be effectively cured by chemotherapy. In the UK we see few cases of trophoblastic disease, usually one case of hydatidiform mole for every 1500 or so pregnancies. Only 8% of hydatidiform moles in the U K will require chemotherapy. It is often forgotten that, although much rarer, persistent trophoblastic disease can occur after full term normal deliveries (one in approximately 50 000 pregnancies) and also after stillbirths and spontaneous abortions. Moreover, the malignant trophoblastic condition may manifest itself years after the last recognised pregnancy. Trophoblastic disease involves an inappropriate and excess proliferation of trophoblast. At risk groups include those with increasing maternal age, a previous molar pregnancy (approximately 1% risk) and racial factors, Asians being at most risk. Standard Professor Ian R. Johnson, Department of Obstetrics and Gynaecology, N o t t i n g h a m City Hospital, Hucknall Road, Nottingham N G 5 1PB, U K
Current Obstetrics and Gynaecology (1995) 5,
© 1995PearsonProfessionalLtd
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OBSTETRICS & GYNAECOLOGY
Trophoblastic disease
I. R. Johnson
teaching would suggest that hydatidiform moles present with bleeding, a uterus large for dates and with exaggerated symptoms of pregnancy including nausea and vomiting and sometimes pregnancy induced hypertension. In practice nowadays, the diagnosis is almost invariably made by ultrasound scan, either coincidentally or for investigation of bleeding in the first trimester of pregnancy. The other symptoms are now quite rare. After clinical diagnosis the mole is usually evacuated using suction. In some cases, second evacuation is required but only when heavy bleeding occurs. In general, repeat evacuation does not improve the prognosis. After diagnosis, referral and registration in a specialist centre is essential. These specialist centres follow enough patients each year to develop appropriate protocols of management and treatment. The prognosis is excellent with survival of 94% up to 15 years. Success in the management of this type of tumour has followed ultrasound diagnosis, the fortuitous presence of a chemical marker (HCG), referral to specialist centres and the development of logical treatment moving from surgery to chemotherapy. Further development depends upon vigilance in the recognition of those cases of gestational trophoblastic disease not following hydatidiform mole and in the proper management of irregular vaginal bleeding.
In this issue, the mini-symposium includes 4 articles concerning trophoblastic disease dealing with the epidemiology, pathology and aspects of clinical care both in Western countries and in the Far East. In the last 35 years, the management of trophoblastic disease has been one of the major success stories of oncology and certainly the major success story of gynaecological oncology. This is the first tumour of life and the first to be effectively cured by chemotherapy. In the UK we see few cases of trophoblastic disease, usually one case of hydatidiform mole for every 1500 or so pregnancies. Only 8% of hydatidiform moles in the U K will require chemotherapy. It is often forgotten that, although much rarer, persistent trophoblastic disease can occur after full term normal deliveries (one in approximately 50 000 pregnancies) and also after stillbirths and spontaneous abortions. Moreover, the malignant trophoblastic condition may manifest itself years after the last recognised pregnancy. Trophoblastic disease involves an inappropriate and excess proliferation of trophoblast. At risk groups include those with increasing maternal age, a previous molar pregnancy (approximately 1% risk) and racial factors, Asians being at most risk. Standard Professor Ian R. Johnson, Department of Obstetrics and Gynaecology, N o t t i n g h a m City Hospital, Hucknall Road, Nottingham N G 5 1PB, U K
Current Obstetrics and Gynaecology (1995) 5,
© 1995PearsonProfessionalLtd
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