60:
29:
340:
therapies would be capable of improving the therapeutic perspective among patients with drug resistance. Although chemotherapy and hysterectomy are currently used in a clinical setting, the use of diverse treatments including anti-body and gene therapy also being attempted to cure GTN. In addition, gene delivery tools using genetically engineered neural stem cells are presently being examined for the treatment of GTN and previous studies have indicated a significant inhibitory effect on tumor growth.
262:
331:
Epidemiological studies have reported that hydatidiform mole appears to be caused by abnormal gametogenesis and fertilization more frequent at the extremes of reproductive age of younger than 15 and older than 45 years of age and pregnancies at these ages are a risk factor for hydatidiform mole. The risk increases after age 35 and there is a 5–10 times increased risk after 45 years.
309:
FIGO modified
Prognostic Scoring System. The system evaluates the patients to those with GTN as low-risk and high-risk based on several risk factors such as age, pregnancy or interval of pregnancies, size or metastases of tumor and prior chemotherapy. Each risk factors are rated at levels 0-4 scores.
300:
Several treatment methods are available for GTN that include surgery, chemotherapy or combination of these. Surgery treatment is most common initial method for some types of the disease but it depends on the stage of the tumor. Common surgical options include dilation and curettage, and hysterectomy.
193:
For GTN, the blood is checked for the level of β-hCG, a hormone that is made by the body during pregnancy. β-hCG in the blood of a woman who is not pregnant may be a sign of GTN and also helpful tests to monitor a woman’s recovery during and after treatment. Placental side trophoblastic tumor (PSTT)
98:
and non-gestational and they are differentiated by their different biological feature and prognosis. Signs and symptoms of GTN will appear vary from person to person and depending upon the type of the disease. They may include uterine bleeding not related to menstruation, pain or pressure in pelvis,
321:
Therefore, some studies have shown that the condition is harder to cure if the cancer has spread to the liver or brain or β-hCG level is higher than 40,000 mIU/mL when treatment begins, cancer returns after having chemotherapy or symptoms/ pregnancy occurred for more than 4 months before treatment.
106:
Management of GTN requires pathology review, treatment options and monitoring of hCG. Therefore, it can be treated with curettage, hysterectomy and single agent or multi agent chemotherapy. Although this group of diseases are highly susceptible to chemotherapy, prognosis depends on the type of GTN
330:
According to studies, GTN is found more frequently in Asia compared to North
America or Europe. As of 2020, the reported incidence of choriocarcinoma ranges from 1 in 40 000 pregnancies in North America and Europe, to 9.2 and 3.3 per 40 000 pregnancies in Southeast Asia and Japan, respectively.
283:
All types of gestational trophoblastic neoplasia originate from the placenta. A placenta develops in the uterus during pregnancy and becomes first site of nutrient and gas exchange between mother and fetus. It has two components such as fetal component and mother component. A fetal component is
292:. The exact pathogenesis of choriocarcinoma has not been fully understood, but studies have shown cytotrophoblast cells function as stem cells and transform into malignant form. The neoplastic cytotrophoblast further differentiates into either intermediate trophoblasts or syncytiotrophoblast.
339:
Recently, in order to provide more comprehension tools of GTN pathogenesis, epigenetic modifications and molecular biology techniques could be applied for proper diagnosis, management, and treatment of such neoplasia. The progression of anti-angiogenesis therapy and molecular targeted cancer
123:
and term pregnancies. Although risk factors may impact on the development of the tumor, most do not directly cause of disease. According to some studies, the risk of complete molar pregnancy is highest in women over age 35 and younger than 20. The risk is even higher for women over age 45.
93:
while malignant lesions have four subtypes including invasive mole, gestational choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). The choriocarcinoma has 2 significant subtypes including
569:
181:
Also called a sonogram, an ultrasound creates a picture of the internal organ. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and directed at the uterus to take the pictures.
136:
Most common presenting symptom is vaginal bleeding, which is associated with mild elevation of serum β hCG (< 2,500 IU/L). Vaginal bleeding may also occur after delivery that continues for longer than
317:
Women with a score of 7 or more are at high risk, and their tumors tend to respond less well to chemotherapy, even if they haven't spread much. They may require more intensive chemotherapy.
99:
large uterus and high blood pressure during pregnancy. The cause of this disease is unknown but the identification of the tumor based on total beta-human chorionic gonadotropin (
992:"A promising therapeutic strategy for metastatic gestational trophoblastic disease: Engineered anticancer gene-expressing stem cells to selectively target choriocarcinoma"
314:
Women with a score of 6 or less are at low risk and tend to have a good prognosis regardless of how far the cancer has spread which usually respond well to chemotherapy.
1108:
230:
840:
1225:
1258:
1208:
70:
668:
1101:
159:
If metastases are present, signs and symptoms associated with the metastatic disease and more severe symptoms may be present.
233:(International Federation of Gynecology and Obstetrics) 2000 Anatomical staging is commonly used to evaluate stage of GTN.
1263:
244:
187:
It can be done to check the levels of certain hormones and other substances that may be impacted by the presence of GTN.
132:
The symptoms of GTN will vary from person to person. People with the same disease may not have all the symptoms listed.
100:
594:
200:
A test to check the color of urine and its contents, such as sugar, protein, blood, bacteria, and the level of β-hCG.
727:
493:
357:
194:
is differentiated by low β-hCG levels because it is a neoplastic proliferation of intermediate trophoblastic cells.
643:
433:
1094:
1058:
82:
1168:
434:"Gestational trophoblastic tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program"
28:
69:
Gestational trophoblastic neoplasia (GTN) is group of rare diseases related to pregnancy and included in
59:
1163:
289:
206:
209:
is tested for high amounts of the hormone β-hCG if the GTN has spread to the brain or spinal cord.
728:"Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute"
494:"Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute"
358:"Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version - National Cancer Institute"
115:
The exact cause of gestational trophoblastic neoplasia (GTN) is unknown. GTN often arises after
261:
1197:
1021:
972:
921:
888:
Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. (October 2018).
816:
786:
709:
551:
469:
415:
86:
48:
1011:
1003:
962:
952:
911:
901:
776:
766:
701:
541:
531:
405:
395:
240:
95:
1220:
1213:
1155:
1125:
1117:
755:"Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia"
520:"Current chemotherapeutic management of patients with gestational trophoblastic neoplasia"
285:
271:
116:
90:
619:
239:
Stage II - GTN extends outside of the uterus, but is limited to the genital structures (
149:
High blood pressure with headache and swelling of feet and hands early in the pregnancy.
1237:
1016:
991:
967:
940:
781:
754:
546:
519:
410:
383:
705:
620:"Gestational Trophoblastic Neoplasia Clinical Presentation: History, Physical, Causes"
310:
The numbers are then added up, and the overall score determines a woman's risk level.
250:
Stage III - GTN extends to the lungs, with or without known genital tract involvement
1252:
1192:
1179:
152:
Fatigue, shortness of breath, dizziness, and a fast or irregular heartbeat caused by
1232:
1187:
1143:
78:
864:
276:
40:
1063:
120:
74:
957:
808:
461:
266:
36:
890:"Update on the diagnosis and management of gestational trophoblastic disease"
384:"Epithelioid trophoblastic tumor: a case report and review of the literature"
1133:
1069:
1025:
976:
925:
820:
790:
713:
555:
473:
419:
771:
536:
400:
1175:
1138:
1007:
53:
1050:
916:
906:
889:
39:
of intermediate trophoblast and a hydatidiform mole (bottom of image).
153:
1086:
694:
Best
Practice & Research. Clinical Obstetrics & Gynaecology
1074:
260:
1090:
941:"A review on management of gestational trophoblastic neoplasia"
692:
Kim SJ (December 2003). "Placental site trophoblastic tumour".
753:
May, Taymaa; Goldstein, Donald P.; Berkowitz, Ross S. (2011).
221:
It may be done if the tumor has spread outside of the uterus.
107:
and whether the tumor has spread to other areas of the body.
382:
Scott EM, Smith AL, Desouki MM, Olawaiye AB (2012-12-02).
140:
A uterus that is larger than expected during pregnancy
1040:
1154:
1124:
1044:
894:
International
Journal of Gynaecology and Obstetrics
865:"Choriocarcinoma: MedlinePlus Medical Encyclopedia"
47:
21:
595:"Gestational Trophoblastic Disease - Risk Factors"
215:A CT scan can be used to measure the tumor's size.
119:but can also occur after any gestation including
802:
800:
518:May T, Goldstein DP, Berkowitz RS (2011-05-11).
815:. Treasure Island (FL): StatPearls Publishing.
644:"Gestational Trophoblastic Disease - Diagnosis"
570:"References: Gestational Trophoblastic Disease"
468:. Treasure Island (FL): StatPearls Publishing.
175:to check for lumps or anything unusual changes.
85:lesions. Benign lesions include placental site
77:grow in the uterus. GTN can be classified into
1102:
455:
453:
8:
146:Severe nausea and vomiting during pregnancy.
945:Journal of Family Medicine and Primary Care
1109:
1095:
1087:
1041:
841:"Gestational Trophoblastic Disease Stages"
58:
27:
18:
1015:
966:
956:
915:
905:
780:
770:
545:
535:
409:
399:
388:Case Reports in Obstetrics and Gynecology
236:Stage I - Disease confined to the uterus
168:Initial screening tests for GTN include:
990:Kim GS, Hwang KA, Choi KC (March 2019).
349:
939:Sharami SR, Saffarieh E (March 2020).
253:Stage IV - All other metastatic sites
1169:Endodermal sinus tumor/Yolk sac tumor
809:"Gestational Trophoblastic Neoplasia"
7:
669:"Gestational Trophoblastic Disease"
1226:Placental site trophoblastic tumor
759:Chemotherapy Research and Practice
524:Chemotherapy Research and Practice
14:
1209:Gestational trophoblastic disease
71:gestational trophoblastic disease
460:Bishop BN, Edemekong PF (2020).
143:Pain or pressure in the pelvis.
179:Ultrasound exam of the pelvis:
1:
807:AlJulaih GH, Muzio M (2020).
706:10.1016/s1521-6934(03)00095-6
1280:
958:10.4103/jfmpc.jfmpc_876_19
438:rarediseases.info.nih.gov
213:Computed tomography (CT):
35:
26:
1259:Gynaecological neoplasia
191:Serum tumor marker test:
185:Blood chemistry studies:
73:(GTD) in which abnormal
673:www.hopkinsmedicine.org
1205:Trophoblastic neoplasm
624:emedicine.medscape.com
280:
111:Cause and Risk factors
22:Trophoblastic neoplasm
264:
173:Internal pelvic exam:
1008:10.3892/ol.2019.9911
1264:Germ cell neoplasia
1164:Embryonal carcinoma
772:10.1155/2011/806256
537:10.1155/2011/806256
401:10.1155/2012/862472
290:syncytiotrophoblast
265:High magnification
207:Cerebrospinal fluid
907:10.1002/ijgo.12615
900:(Suppl 2): 79–85.
281:
128:Signs and Symptoms
91:hydatidiform moles
1246:
1245:
1214:Hydatidiform mole
1198:Strumal carcinoid
1084:
1083:
462:"Choriocarcinoma"
117:molar pregnancies
103:) in the serum.
75:trophoblast cells
67:
66:
16:Medical condition
1271:
1156:Nongerminomatous
1118:Germ cell tumors
1111:
1104:
1097:
1088:
1042:
1030:
1029:
1019:
1002:(3): 2576–2582.
996:Oncology Letters
987:
981:
980:
970:
960:
951:(3): 1287–1295.
936:
930:
929:
919:
909:
885:
879:
878:
876:
875:
861:
855:
854:
852:
851:
837:
831:
830:
828:
827:
804:
795:
794:
784:
774:
749:
743:
742:
740:
739:
724:
718:
717:
689:
683:
682:
680:
679:
665:
659:
658:
656:
655:
640:
634:
633:
631:
630:
616:
610:
609:
607:
606:
591:
585:
584:
582:
581:
566:
560:
559:
549:
539:
515:
509:
508:
506:
505:
490:
484:
483:
481:
480:
457:
448:
447:
445:
444:
430:
424:
423:
413:
403:
379:
373:
372:
370:
369:
354:
63:
62:
31:
19:
1279:
1278:
1274:
1273:
1272:
1270:
1269:
1268:
1249:
1248:
1247:
1242:
1221:Choriocarcinoma
1150:
1120:
1115:
1085:
1080:
1079:
1053:
1039:
1034:
1033:
989:
988:
984:
938:
937:
933:
887:
886:
882:
873:
871:
869:medlineplus.gov
863:
862:
858:
849:
847:
839:
838:
834:
825:
823:
806:
805:
798:
752:
750:
746:
737:
735:
726:
725:
721:
691:
690:
686:
677:
675:
667:
666:
662:
653:
651:
642:
641:
637:
628:
626:
618:
617:
613:
604:
602:
593:
592:
588:
579:
577:
568:
567:
563:
517:
516:
512:
503:
501:
492:
491:
487:
478:
476:
459:
458:
451:
442:
440:
432:
431:
427:
381:
380:
376:
367:
365:
356:
355:
351:
346:
337:
328:
307:
298:
286:cytotrophoblast
272:choriocarcinoma
259:
257:Pathophysiology
228:
166:
130:
113:
57:
17:
12:
11:
5:
1277:
1275:
1267:
1266:
1261:
1251:
1250:
1244:
1243:
1241:
1240:
1238:Gonadoblastoma
1235:
1229:
1228:
1223:
1218:
1217:
1216:
1201:
1200:
1195:
1190:
1185:
1172:
1171:
1166:
1160:
1158:
1152:
1151:
1149:
1148:
1147:
1146:
1141:
1130:
1128:
1122:
1121:
1116:
1114:
1113:
1106:
1099:
1091:
1082:
1081:
1078:
1077:
1066:
1054:
1049:
1048:
1046:
1045:Classification
1038:
1037:External links
1035:
1032:
1031:
982:
931:
880:
856:
845:www.cancer.org
832:
796:
744:
732:www.cancer.gov
719:
700:(6): 969–984.
684:
660:
635:
611:
586:
576:. 25 June 2012
574:www.cancer.org
561:
510:
498:www.cancer.gov
485:
449:
425:
374:
362:www.cancer.gov
348:
347:
345:
342:
336:
333:
327:
324:
319:
318:
315:
306:
303:
297:
294:
258:
255:
245:broad ligament
227:
224:
223:
222:
216:
210:
201:
195:
188:
182:
176:
165:
162:
161:
160:
157:
150:
147:
144:
141:
138:
129:
126:
112:
109:
65:
64:
51:
45:
44:
33:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
1276:
1265:
1262:
1260:
1257:
1256:
1254:
1239:
1236:
1234:
1231:
1230:
1227:
1224:
1222:
1219:
1215:
1212:
1211:
1210:
1206:
1203:
1202:
1199:
1196:
1194:
1193:Struma ovarii
1191:
1189:
1186:
1184:
1183:
1177:
1174:
1173:
1170:
1167:
1165:
1162:
1161:
1159:
1157:
1153:
1145:
1142:
1140:
1137:
1136:
1135:
1132:
1131:
1129:
1127:
1126:Germinomatous
1123:
1119:
1112:
1107:
1105:
1100:
1098:
1093:
1092:
1089:
1076:
1072:
1071:
1067:
1065:
1061:
1060:
1056:
1055:
1052:
1047:
1043:
1036:
1027:
1023:
1018:
1013:
1009:
1005:
1001:
997:
993:
986:
983:
978:
974:
969:
964:
959:
954:
950:
946:
942:
935:
932:
927:
923:
918:
913:
908:
903:
899:
895:
891:
884:
881:
870:
866:
860:
857:
846:
842:
836:
833:
822:
818:
814:
810:
803:
801:
797:
792:
788:
783:
778:
773:
768:
764:
760:
756:
748:
745:
733:
729:
723:
720:
715:
711:
707:
703:
699:
695:
688:
685:
674:
670:
664:
661:
649:
645:
639:
636:
625:
621:
615:
612:
600:
596:
590:
587:
575:
571:
565:
562:
557:
553:
548:
543:
538:
533:
529:
525:
521:
514:
511:
499:
495:
489:
486:
475:
471:
467:
463:
456:
454:
450:
439:
435:
429:
426:
421:
417:
412:
407:
402:
397:
393:
389:
385:
378:
375:
363:
359:
353:
350:
343:
341:
334:
332:
325:
323:
316:
313:
312:
311:
304:
302:
295:
293:
291:
287:
278:
277:H&E stain
274:
273:
268:
263:
256:
254:
251:
248:
246:
242:
237:
234:
232:
226:Tumor staging
225:
220:
217:
214:
211:
208:
205:
202:
199:
196:
192:
189:
186:
183:
180:
177:
174:
171:
170:
169:
163:
158:
155:
151:
148:
145:
142:
139:
135:
134:
133:
127:
125:
122:
118:
110:
108:
104:
102:
97:
92:
88:
84:
80:
76:
72:
61:
55:
52:
50:
46:
42:
41:H&E stain
38:
34:
30:
25:
20:
1233:Polyembryoma
1204:
1188:Dermoid cyst
1181:
1144:Dysgerminoma
1068:
1057:
999:
995:
985:
948:
944:
934:
897:
893:
883:
872:. Retrieved
868:
859:
848:. Retrieved
844:
835:
824:. Retrieved
812:
762:
758:
747:
736:. Retrieved
734:. 2020-05-11
731:
722:
697:
693:
687:
676:. Retrieved
672:
663:
652:. Retrieved
650:. 2012-06-25
647:
638:
627:. Retrieved
623:
614:
603:. Retrieved
601:. 2012-06-25
598:
589:
578:. Retrieved
573:
564:
527:
523:
513:
502:. Retrieved
500:. 2020-05-11
497:
488:
477:. Retrieved
465:
441:. Retrieved
437:
428:
391:
387:
377:
366:. Retrieved
364:. 2020-05-11
361:
352:
338:
329:
326:Epidemiology
320:
308:
299:
284:composed of
282:
270:
252:
249:
238:
235:
229:
219:Chest x-ray:
218:
212:
203:
197:
190:
184:
178:
172:
167:
131:
121:miscarriages
114:
105:
68:
917:2066/196937
751:Table 1 in
204:Spinal tap:
198:Urinalysis:
96:gestational
1253:Categories
874:2020-12-17
850:2020-12-17
826:2020-12-16
813:StatPearls
738:2020-11-02
678:2020-12-16
654:2020-12-16
648:Cancer.Net
629:2020-12-16
605:2020-12-16
599:Cancer.Net
580:2020-12-16
530:: 806256.
504:2020-12-16
479:2020-12-16
466:StatPearls
443:2020-12-16
394:: 862472.
368:2020-12-16
344:References
267:micrograph
243:, vagina,
37:Micrograph
1180:Fetus in
1134:Germinoma
1075:115234004
1070:SNOMED CT
305:Prognosis
296:Treatment
164:Diagnosis
83:malignant
49:Specialty
1176:Teratoma
1139:Seminoma
1026:30867726
977:32509606
926:30306586
821:32965896
791:22312558
765:: 1–12.
714:14614893
556:22312558
474:30571055
420:23243530
335:Research
54:Oncology
1064:D014328
1017:6396211
968:7266251
782:3265241
547:3265241
411:3518084
137:normal.
1024:
1014:
975:
965:
924:
819:
789:
779:
712:
554:
544:
472:
418:
408:
241:adnexa
154:anemia
87:nodule
79:benign
56:
101:β-hCG
1182:fetu
1059:MeSH
1022:PMID
973:PMID
922:PMID
817:PMID
787:PMID
763:2011
710:PMID
552:PMID
528:2011
470:PMID
416:PMID
392:2012
288:and
231:FIGO
89:and
81:and
1012:PMC
1004:doi
963:PMC
953:doi
912:hdl
902:doi
898:143
777:PMC
767:doi
702:doi
542:PMC
532:doi
406:PMC
396:doi
269:of
1255::
1207::
1178::
1073::
1062::
1020:.
1010:.
1000:17
998:.
994:.
971:.
961:.
947:.
943:.
920:.
910:.
896:.
892:.
867:.
843:.
811:.
799:^
785:.
775:.
761:.
757:.
730:.
708:.
698:17
696:.
671:.
646:.
622:.
597:.
572:.
550:.
540:.
526:.
522:.
496:.
464:.
452:^
436:.
414:.
404:.
390:.
386:.
360:.
275:.
247:)
1110:e
1103:t
1096:v
1051:D
1028:.
1006::
979:.
955::
949:9
928:.
914::
904::
877:.
853:.
829:.
793:.
769::
741:.
716:.
704::
681:.
657:.
632:.
608:.
583:.
558:.
534::
507:.
482:.
446:.
422:.
398::
371:.
279:.
156:.
43:.
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
