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Q&A: Gestational Trophoblastic Cancer

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Gestational trophoblastic cancer (GTC) is a rare, yet highly treatable, disease. Although it is sometimes referred to as gestational cancer, it usually does not coincide with a successful, long-term pregnancy.

Karen Lu, M.D., professor in the Department of Gynecologic Oncology at M. D. Anderson, answers some questions about this unusual cancer.

What is GTC?

GTC is a rare cancer in which malignant cells grow in the tissues that are formed in a woman's uterus following conception (the joining of sperm and egg). The uterus is the hollow, pear-shaped organ where a fetus grows.

Most frequently, GTC develops after a woman experiences a miscarriage or molar pregnancy.

A molar pregnancy, which occurs in one of 1,000 pregnancies in the United States, is an abnormality of the placenta that leads to a growth of abnormal tissue when an egg is fertilized. A developing embryo is rarely present, but the tissue grows rapidly and appears in grape-like cell clusters.

Rarely, GTC can occur after a live birth. This is called choriocarcinoma.

GTC generally affects women younger than 20 and older than 40.

What are the symptoms of GTC?

The main symptom is abnormal vaginal bleeding, especially after a miscarriage, but also after a molar pregnancy or live birth. Abnormal bleeding would be defined as bleeding between normal menstrual periods or bleeding almost every day instead of having menstrual periods.

If a woman has a molar pregnancy, she usually will be monitored afterward to make sure she doesn't develop GTC.

How is GTC diagnosed?

Most often, a woman notices irregular bleeding and visits her doctor, thinking maybe she's pregnant. The physician may test the patient's level of human chorionic gonadotropin (hCG), which is elevated in pregnancy and in GTC.

If the hCG level is high, the doctor probably will perform an ultrasound to determine if the pregnancy is normal or molar, or if tumors are present.

What is the treatment for GTC?

Once a woman is diagnosed with GTC, CT (computed tomography) scans are performed to determine if the tumor has spread beyond the uterus.

If the tumor has not moved outside the uterus, the patient typically has chemotherapy until hCG levels return to normal. Levels are monitored for about a year to make sure they remain normal.

If GTC has spread beyond the uterus, treatment may include chemotherapy and/or surgery.

What is the prognosis for women diagnosed with GTC?

GTC has a cure rate greater than 90%, depending on the tumor's sensitivity to chemotherapy.

The ability to measure hCG levels has helped increase survival in recent years.

Women with GTC have higher rates of survival when they are referred to specialized centers with experience in treating this rare disease.

Does GTC or its treatment affect a woman's ability to have children?

To treat this cancer, doctors typically don't need to remove the uterus. Many women go on to have children after treatment.

What are some risks associated with the disease?

Because GTC can occur in women over 40, some patients may think they're going through menopause when they experience irregular bleeding and not visit their physicians.

Also, because GTC isn't very common, it's often misdiagnosed. Women of reproductive age can request their physician measure their hCG levels if they're concerned.

What should a woman do if she is diagnosed with GTC?

Once a woman is diagnosed, it's in her best interest to go to a specialized center that frequently sees cases of GTC. Overall, GTC is easier to treat and monitor than other cancers, but certain subtypes can be aggressive and more difficult to treat.



Related article:
New Mom Finds Strength in Cancer Ordeal

M. D. Anderson resources:


Karen Lu, M.D,

Gynecologic Oncology Center

Sources:
What is Gestational Trophoblastic Disease? (American Cancer Society)


Read more Feature Stories from Cancerwise

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