Diagnostic
Tests And Staging Gestational Trophoblastic DiseaseWhen the physician
sees the clinical signs of a possible gestational trophoblastic disease,
beta HCG levels are ordered. If they are high, the patient should be referred
to a gynecologist with experience in this field. Other tests such as an ultrasound
of the pelvis, the uterus and the ovaries will be done. In the past amniography
was done, which showed a "moth-eaten" pattern typical for the disease. However,
with other test methods (CT and MRI scan) and the more sophisticated high resolution
ultrasonography these other tests are more likely used. The specialist in the
field will order the appropriate tests. Depending on the clinical situation there
may be other tests required to look for distant metastases.
Staging Like with other cancers it is important to
establish the exact nature of the gestational trophoblastic disease. Questions
like these have to be answered: Is ist benign or malignant disease, in other words
is it a hydatiform mole, which is benign, is it the less serious locally invasive
mole, or is it the choriocarcinoma, which is aggressive? Is it still contained
in the uterus, has it spread locally or possibly into the blood stream and into
the rest of the body? All these questions are answered so that different treatment
decisions can be made. A mistake in the beginning, like an overlooked distant
metastasis, can cost the woman her life! Here is the an overview of the
staging for trophoblastic disease:
| Staging
of gestational trophoblastic disease * |
| Stage: | Type
of disease: | Description of extent:
| | 0 A
| low risk molar pregnancy | no
infiltration of uterus | | 0 B | high
risk molar pregnancy | may
start to invade uterus | | I | locally
invasive mole | confined to uterus |
| II | choriocarcinoma
| local metastases to vagina and pelvis |
| III | choriocarcinoma
| lung metastases |
| IV | choriocarcinoma
| distant metastases
| * New England
Trophoblastic Disease Center staging classification As can
be seen from the table, the staging depends on the spread of the gestational trophoblastic
disease. This can be determined using the tests mentioned above in combination
with a thorough history and gynecological examination. As
the total tumor load depends on how much of the trophoblastic tissue is present
within the body, the concentration of the beta-HCG in the blood stream (high versus
low levels) accurately reflects whether there is a lot or very little total tumor
tissue present in the body. This has improved the cancer survival rates dramatically
in the past few decades, particularly in the earlier stages, as the physician
has now a means of defining the end point of treatment. As long as the very specific
beta-HCG blood test is positive, the treatment must go on and may have to be stepped
up until a cancer cure has been achieved. |
