Cause Of Gestational Trophoblastic Disease

There are countries in the world where this disease is more common than in others.

The U.S. is on of the countries where it is less common (about 1 in 1200 pregnancies). In South America and Asia the rate is about 1 in 120 pregnancies, in other words 10-fold more common. It was found in a study in the Philippines that those people who are meat eating and who are wealthier have a much lower rate of this disease than those who are rice eating.

Risk increases with the age (woman above 40 or 45), as much as 10- to 12-fold compared to younger women (age group of mid 20-ies). About 50% of trophoblastic tumors follow a pregnancy. They can develop after a pregnancy, a tubal pregnany or a miscarriage. The other 50% develop out of a molar pregnancy.

This looks initially like a regular pregnancy in that the woman does not have a period and develops an enlarged uterus. However, the uterine enlargement within the first 10 to 16 weeks after conception is very rapid and ultrasonography fails to show any fetal parts.

The uterus contains only the abnormally formed placenta-like tissue called "hydatiform mole", which is still a benign tumor formation (see above). This will rapidly deteriorate and, if left alone will become a choriocarcinoma. It is clear that there is only a short window of opportunity to quickly evacuate this tissue. About 15% of patients after a molar pregancy develop a locally invasive mole and if this is left alone, choriocarcinoma develops with metastases through the blood stream as this is a tumor with a large amount of blood vessels that metastasizes early. Any such case needs urgent attention by a gynecologist.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Vol. 1. Chapter on gynecological tumors.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on gynecological tumors.

3. EI Kohorn Int J Gynecol Cancer 2001 Jan;11(1):73-77.

4. MS Cha et al. Biochem Biophys Res Commun 2001 Apr 13;282(4):1061-1066.

5. IK El-Lamie et al. Int J Gynecol Cancer 2000 Nov;10(6):488-496.

6. AM Case et al. Hum Reprod 2001 Feb;16(2):360-364.

Last Modified:April 1, 2012