GESTATIONAL TROPHOBLASTIC TUMOR Definition Hydatidiform mole: A tumor that forms in the uterus as a mass of cysts resembling a bunch

of grapes. Moles occur during the childbearing years. They do not spread outside of the uterus. However, a malignancy called choriocarcinoma may start from a hydatidiform mole. GESTATIONAL TROPHOBLASTIC DISEASE -general term which encompasses both benign and malignant conditions, including hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. GESTATIONAL TROPHOBLASTIC TUMOR(malignant) -is a disease state in which there is clinical evidence of either invasive mole or choriocarcinoma. It is further subdivided into metastatic and nonmetastatic trophoblastic tumor. -Gestational trophoblastic tumor, a rare cancer in women, is a disease in which cancer (malignant) cells grow in the tissues that are formed following conception (the joining of sperm and egg).

complications occurred in 5.3% mostly are choriocarcinoma. ETIOLOGY -abnormal cell gwoth in the trophoblast layer and hydatidiform INVASIVE MOLE(malignant mole) -is a hydatidiform mole that has penetrated or invaded deeply into the uterine wall(especially myometrium and the adjacent structures such as the peritoneum and perimetrium), or has produced metastasis or both. -Majority develops within 6 months post-molar evacuation. Signs and symptoms:

Excessive nausea and vomiting Uterine bleeding Grapelike clusters passing through the vagina Plateuing or increasing Hcg titers. High BP

Pathophysiology Laboratory/diagnostic procedures

Laboratories 1. Serum Beta-hCG (hormone produced during pregnancy called Human chorionic gonadotropin) above 40,000 mIU/mL 2. Urine hCG above 100,000 units/24 hours

INCIDENCE -local incidence of hydatidiform mole is 1 in 145 pregnancies. Malignancy of the trophoblast following hydatidiform mole was 13.5%. Metastatic

Imaging

1. Ultrasound

2. Chest X-Ray to check for lung metastasis Management A & B.MEDICAL AND SURGICAL MAANGEMENT -suction d&c -HYSTERECTOMY(either abdominal or vaginal) C. NURSING MANAGMENT

-to reduce the side effect of methotrexate DACTINOMYCIN -useful in patients w/ liver problems, bec less toxic to liver(IV)

COMPLICATIONS hemorrahage, uterine infection ,vaginal passage of vesicle, and hypovolemia. PROGNOSIS

-Obtain VS. -Observe for complications such as hemorrahage, uterine infection and vaginal passage of vesicle. -prepare patient physically and emotionally for therapies and surgeries -collect samples for lab analysis -instruct the patient not to get pregnant for 1 year(until absence of HCG) D.PHARMACOLOGIC MANAGEMENT -Chemotherapy METHOTREXATE -To dissolve fast-growing tissues(IM,IV or intrathecal) LEUCOVORIN

-survival rate is 80-100% because of chemotherapy.

CHORIOCARCINOMA -is a pure epithelial tumor composed of syncytiotrophoblast and cytotrophoblast cells. It may arise from or accomplany ay type of pregnancy.
-A highly malignant tumor that arises from trophoblastic cells within the uterus. Choriocarcinoma tends to be invasive and to metastasize early and widely through both the venous and lymphatic systems. ETIOLOGY -no etiology known but in most cases always preceded by:

hydatidiform mole (50% of cases) Spontaneous abortion (20%of cases) ectopic pregnancy (2% of cases)

normal term pregnancy (20-30% of cases)

Signs and symptoms:

Irregular vaginal bleeding Ovarian cysts Uneven swelling of the uterus Pain increased quantitative -hCG levels vaginal bleeding shortness of breath hemoptysis (coughing up blood) chest pain chest X-ray shows multiple infiltrates of various shapes in both lungs

-Hysterectomy (surgical removal of the uterus) can also be offered[8] to patients > 40 years of age or those for whom sterilisation is not an obstacle. It may be required for those with severe infection and uncontrolled bleeding. - suction d&c C. NURSING MANAGEMENT -Obtain VS. -Observe for complications such as hemorrahage, uterine infection and vaginal passage of vesicle. -prepare patient physically and emotionally for therapies and surgeries -collect samples for lab analysis

Laboratory/diagnostic procedures

Laboratories 3. Serum Beta-hCG (hormone produced during pregnancy called Human chorionic gonadotropin) above 40,000 mIU/mL 4. Urine hCG above 100,000 units/24 hours

-instruct the patient not to get pregnant for 1 year(until absence of HCG) D. PHARMACOLOGICAL MANAGEMENT.
-Choriocarcinoma is one of the tumors that is most sensitive to chemotherapy. The cure rate, even for metastatic choriocarcinoma, is around 90-95%. Virtually everyone without metastases can be cured; however, metastatic disease to the liver and/or brain is usually fatal. At present, treatment with single-agent methotrexate or actinomycin D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and vincristine (Oncovin)) are recommended for intermediate or high-risk disease.[6][7]

Imaging
3. Ultrasound

4. Chest X-Ray to check for lung metastasis MANAGEMENT A. MEDICAL & SURGICAL

COMPLICATIONS
-Complications associated with choriocarcinoma are related to the possibility of the cancer spreading (metastasis). In individuals in whom the cancer has spread to the lungs, pneumonia is a common complication. -sepsis - Uterine bleeding

- Irregular vaginal bleeding

PROGNOSIS
-The prognosis for individuals with choriocarcinoma depends on the stage at which the condition is diagnosed. The prognosis is considered good if the associated pregnancy was recent, the blood level of the hormone beta hCG is low, and the disease has not spread to the liver or brain. Since the condition is usually diagnosed early, the prognosis is generally favorable. Individuals whose disease has not spread (metastasized) and even those whose cancer has spread can typically expect a 90% to 95% cure rate; the chance of relapse is low because it responds well to chemotherapy ("Gestational Trophoblastic Disease").

PLACENTAL SITE TROPHOBLASTIC TUMOR -is a rare trophoblastic neoplasm with the potential for metastases and death. It may follow an abortion, a molar pregnancy or normal pregnancy.