Persistent Gestational Trophoblastic Disease

Persistent Gestational Trophoblastic Disease is a malignancy of the placental (trophoblast) cells. It occurs when the Bhcg fails to fall appropriately or starts to rise. It occurs in approximately 15% of patients with GTD. The placental cells may remain localised to the uterus, however they can spread (metastasize) to other organs.

What Treatment is required?

You will be notified by the QTC registry if your Bhcg levels are rising or not falling appropriately. You will then require further blood and imaging tests.

Blood tests include Full Blood Count and Electrolytes. Imaging studies include a CT scan of the chest, abdomen and pelvis. An MRI of the head may be required.

You will be invited to attend the Queensland Trophoblast Centre at the Royal Brisbane and Women’s Hospital to evaluate your condition. A Prognostic Score will be calculated. This informs us whether you have Low Risk or High Risk disease.

Low Risk Disease

If you are classified as having Low Risk disease you will be administered single agent chemotherpy (Methotrexate or Actinomycin D). This chemotherapy agent will target the trophoblast cells. It will be given intravenously every two weeks. Possible side effects of this medication include a sore mouth or taste changes, altered kidney and liver function, skin changes (rash), eye changes (blurred vision, gritty eyes), sun sensitivity, hair thinning, nausea or vomiting, headaches, fatigue and lung toxicity. All of these side effects are temporary and medication is available to improve the symptoms should they occur.

High Risk Disease

If you are classified as having High Risk disease you will be administered a combination of 5 chemotherapy agents (Etoposide, Methotrexate, Actinomycin, Cyclophosphamide and Vincristine - EMACO). Possible side effects of this medication include a sore mouth or taste changes, altered kidney and liver function, skin changes (rash), eye changes (blurred vision, gritty eyes), sun sensitivity, hair loss, nausea or vomiting, headaches, fatigue and haematologic changes. All of these side effects are temporary and medication is available to improve the symptoms should they occur.

Precautions

For 7 days after treatment with chemotherapy the following precautions should be followed:

  • Full flush the toilet to dilute any drugs that pass via the urine
  • Wash any surfaces or skin that comes into contact with bodily fluids with water and soap (skin) or detergent (surfaces)
  • Soiled clothing or linen (urine, vomit, faeces) needs to be washed separately twice, then dried as normal on the line or in the dryer (wear household gloves to handle)

Follow Up

Once your chemotherapy has been completed and your Bhcg has returned to normal you will be required to have monthly blood tests for 12 months. During this time we recommend any form of contraception that you and your partner are comfortable with. You will be notified when you are able to pursue further pregnancies.

Recurrence

The chance of this condition occurring again is approximately 1%. When you do fall pregnant again we advise that you have an early Ultrasound to establish the presence of a viable pregnancy. No special precautions need to be taken during your pregnancy. Six weeks after your baby is delivered a Bhcg level will be performed to ensure it has returned to normal.

The Queensland Trophoblast Centre (QTC)

Queensland has been running a trophoblast registry since 1976. We have recently updated and expanded this service. QTC provides a registration and monitoring service for patients diagnosed with Gestational Trophoblastic Disease. We also provide a consultative service for patients and clinicians. We undertake research to a high ethical standard in order to improve our knowledge about the condition and improve patient outcomes and to provide expert care to our patients.