Gestational Trophoblastic Neoplasia

A gestational trophoblastic neoplasia (GTN) is a malignant tumor originating from specialized placental tissue during pregnancy.

About Gestational Trophoblastic Neoplasia

After conception, some of the first cells to form from the fertilized egg are trophoblast cells, which secure the embryo to your uterine wall and penetrate the endometrium (uterine lining) to form much of the placenta, the organ that allows nutrients to pass from your body to the fetus.

The robust spread of trophoblast cells required to penetrate the endometrium is typically regulated by cellular mechanisms. However, in gestational trophoblastic disease (GTD), this regulation fails and the trophoblastic tissue grows into a tumor. While most GTD tumors are benign (noncancerous), some forms of the condition, collectively known as gestational trophoblastic neoplasia (GTN), are cancerous. Although rare, these conditions are serious and require immediate medical intervention.

Types of Gestational Trophoblastic Neoplasia

GTN refers to a range of multiple malignant tumors that form from trophoblastic tissue.

Types of gestational trophoblastic neoplasia include:

• Choriocarcinoma: A tumor that affects the muscular wall of the uterus and surrounding blood vessels. This form of GTN can also spread to other pelvic organs, including the intestines and vagina, the liver, kidney, spleen, and even the lungs and brain.
• Epithelioid trophoblastic tumor: A rare form of GTN that may spread to the lungs.
• Invasive moles: Trophoblast cells that spread into the muscular wall of the uterus.
• Placental-site trophoblastic tumor (PSTT): A form of GTN that develops between the placenta and the uterus and may spread to the muscular wall of the uterus, surrounding blood vessels, other pelvic organs, the lungs, and lymph nodes.

Symptoms of Gestational Trophoblastic Neoplasia

As trophoblastic tissue forms after conception, symptoms of GTN may resemble other pregnancy-related concerns.

Symptoms of gestational trophoblastic neoplasia may include:

• Abnormal vaginal bleeding unrelated to menstruation, including extended bleeding after delivery
• Anemia
• Anxiety or irritability
• Dizziness or shakiness
• Excessive sweating
• Fast or irregular pulse
• Frequent bowel movements
• High blood pressure in early pregnancy accompanied by headache and swelling of hands and feet
• Nausea or vomiting
• Pelvic pain or pressure
• Sleep difficulties
• Shortness of breath
• Uterine swelling beyond what is expected during pregnancy
• Weight loss

Risk Factors for Gestational Trophoblastic Neoplasia

Both cancerous and benign GTD are associated with a prior history of the condition and pregnancies occurring before the age of 20 or after 35. Individuals with certain types of GTD are at higher risk for developing a cancerous form of the condition.

Risk factors for gestational trophoblastic neoplasia may include:

• Comorbid conditions: An overactive thyroid gland, a large uterine tumor, or a large ovarian cyst may increase a person’s risk of GTD becoming cancerous. Certain events during pregnancy, including high blood pressure, nausea or vomiting, and overproduction of a pregnancy hormone known as beta human chorionic gonadotropin (beta-hCG), are also associated with cancerous forms of GTD.
• Health history: Choriocarcinomas are more common in people with a history of tubal pregnancy or miscarriage.

Treating Gestational Trophoblastic Neoplasia at UT Health Austin

GTN treatment may involve chemotherapy, radiation treatment, surgery (either to remove the cancer or the uterus), or a combination of methods. Your care team will work with you to determine the best course of treatment.

Care Team Approach

Patients are cared for by a dedicated multidisciplinary care team, meaning you will benefit from the expertise of multiple specialists across a variety of disciplines. Our gynecologic oncologists work alongside a team of women’s health experts, including radiation oncologists, pathologists, radiologists, oncofertility specialists, onco-psychiatrists, genetic counselors, physical therapists, dietitians, social workers, and more, to provide unparalleled care for patients every step of the way.

We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with referring physicians and other partners in the community to ensure that we are providing you with comprehensive, whole-person care.

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