Diseases Treated

Gestational Trophoblastic Disease/Molar Pregnancy

What are the treatment options?

What is the treatment for non-metastatic (Stage I) and metastatic trophoblastic disease (Stage II and III)?

Initial evaluation

Pre-treatment evaluation is carried out to determine the location of the abnormal trophoblastic tissue. These tests may include x-rays of the lungs and gastrointestinal tract, ultrasound of the uterus and ovaries, testing of spinal fluid for hCG, and scans of the brain and liver.

Chemotherapy

Drug treatment for non-metastatic and most patients with metastatic disease is mainly with a drug called Methotrexate and its antidote Citrovorum Factor. Methotrexate has been used for over 40 years as an anti-tumor agent. When given alone it can cause toxic side effects such as hair loss, sore mouth, fever and skin rash. However, we administer this drug with an antidote (Citrovorum Factor) so that side effects do not occur. Furthermore, there does not appear to be any effect on the ovaries or future childbearing.

You may be given Methotrexate therapy one of two ways:

• Intramuscularly. Methotrexate is given by an intramuscular injection every other day for four days. Twenty-four hours after the Methotrexate is given, you will get an injection of the antidote, Citrovorum Factor. The use of the antidote allows us to give you more anti-tumor drug without toxicity.
• Intravenously. Methotrexate is given intravenously over 12 hours at a dose calculated for your particular height and weight. You will receive injections or oral dose of the antidote, Citrovorum Factor, every 12 hours for four doses.

In some patients, Methotrexate cannot be used because of temporary abnormalities in liver function due to transfusions or recent pregnancy. When this situation is present a drug called actinomycin-D is used. This drug is usually given intravenously for five days.

It is impossible to accurately predict the total number of courses of chemotherapy that will be required to completely eradicate your tumor. This is determined in each patient on the basis of a number of factors that will be discussed with you individually. In some patients with high risk or resistant disease, combination chemotherapy consisting of several drugs may be required to achieve cure.

A D&C (dilatation and curettage) is usually performed during the first course of drug therapy to remove tumor tissue from the uterine cavity. A laparoscopy may also be carried out to allow the doctor to look into your abdomen to check for the presence of tumor and ovarian cysts. Hysterectomy may be recommended if you have completed your family and if the tumor is present only in the uterus.

What is the treatment for Stage IV disease?

Initial evaluation

Pre-treatment testing is carried out to determine the location of the abnormal trophoblastic tissue. This may include x-rays of the lungs and gastrointestinal tract, ultrasound of the uterus and ovaries, testing of spinal fluid hCG, and scans of the brain and liver.

Chemotherapy

There is no set protocol for treating patients with Stage IV disease. Each woman's treatment must be based on an individualized plan designed to fit her particular needs. The best treatment may include a combination of chemotherapy, surgery and radiation. There is constant research going on to determine the best treatment for women with Stage IV trophoblastic disease, so anything written today may be outmoded tomorrow. We prefer to discuss with you your treatment in detail following admission and after the results of your initial evaluation are completed. You may expect a few days of tests to determine the extent of disease before actual treatment begins.