Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for gestational trophoblastic disease depends on:
- the results of your diagnostic tests
- the type of gestational trophoblastic disease you have
- if it has spread
- your age
- whether you want to become pregnant in the future
- your general health
- your personal preferences.
Treatment options can include surgery, chemotherapy and radiation therapy.
Surgery
Surgery may be used to treat gestational trophoblastic disease. Your doctor will talk to you about the most appropriate type of surgery, depending on the type and stage of gestational trophoblastic disease you have.
Dilation and curettage (D&C)
Dilation and curettage (D&C) with suction evacuation removes tissue from the cervical canal or the inner lining of the uterus. The general steps are:
- The cervix (the opening of the uterus) is dilated (made larger).
- The material inside the uterus is removed with a small vacuum-like device.
- The walls of the uterus are then scraped gently to remove any material that may remain in the uterus.
A D&C would only be used for molar pregnancies.
Following this procedure, your doctor will monitor your condition closely with regular blood tests to make sure your level of human chorionic gonadotrophin (hCG) falls to normal. If the level of hCG increases or does not go down to normal, more tests will be done to see whether the tumour has spread. Treatment will then depend on whether you have nonmetastatic or metastatic gestational trophoblastic neoplasia.
Hysterectomy
A hysterectomy is the surgical removal of the uterus. It is rarely necessary in the treatment of gestational trophoblastic disease. If it is, the ovaries will not usually be removed (an oophorectomy).
Chemotherapy
Chemotherapy for gestational trophoblastic disease may be given before or after surgery, or by itself.
Chemotherapy given prior to surgery is called “neoadjuvant treatment” and can be offered to reduce the size of the tumour to allow less invasive surgery. Chemotherapy given after surgery is called “adjuvant treatment” and can be offered to reduce the risk of the cancer returning. Chemotherapy can be given as an intravenous injection and/or oral tablets.
For further information on chemotherapy, see chemotherapy
Radiation therapy
Radiation therapy is only occasionally used to treat gestational trophoblastic disease that has spread to the brain.
Treatment options for different forms of gestational trophoblastic disease
Hydatidiform mole
Treatment will usually be removal of the mole using D&C and suction evacuation. Rarely, surgery may be needed to remove the uterus (hysterectomy).
Placental-site gestational trophoblastic tumour
Treatment will probably be surgery to remove the uterus (hysterectomy).
If you are wanting to have children, your doctor may just be able to remove the tumour, but the tumour may come back. You will need regular monitoring to make sure any recurrent tumour is detected as soon as possible.[1]
If the tumour has spread, you may have chemotherapy.
Nonmetastatic gestational trophoblastic neoplasia
Treatment may be one of the following:
- chemotherapy
- surgery to remove the uterus (hysterectomy) if you no longer wish to have children.
Good prognosis metastatic gestational trophoblastic neoplasia
Treatment will probably be chemotherapy.[2] Your doctor may recommend a hysterectomy if disease remains after chemotherapy.
Poor prognosis metastatic gestational trophoblastic neoplasia
The treatment for poor prognosis metastatic GTD is usually chemotherapy. Radiation therapy may also be given to places where the cancer has spread, such as the brain.
Treatment given after the main treatment to increase the chances of a cure is called adjuvant therapy. Treatment given before the main treatment is called neoadjuvant treatment.
If you want to try complementary therapies, which are generally used in conjunction with conventional treatment, it is important that you discuss this with your doctors and health professionals.
Recurrent or advanced disease
Recurrent gestational trophoblastic disease is disease that has recurred (come back) after it has been treated.
Recurrence is when the gestational trophoblastic disease comes back in the uterus. Secondary gestational trophoblastic disease is when it spreads to another part of the body.
For women who have had a hydatidiform mole in the past, the chance of it occurring again is about 1%.
Treatment for recurrent gestational trophoblastic disease is usually with chemotherapy.
