Management of gestational trophoblastic disease

Gestational trophoblastic diseases (GTD) are rare and heterogeneous diseases characterized by an abnormal differentiation and/or pathological proliferation of trophoblastic epithelium. The incidence of GTD is considered to be 1-2/1000 births/year. The most frequent benign GTDs are complete and partial hydatidiform moles, which are associated with an altered chromosome set (disomy and triploidy) due to a malignant fertilized ovum. Patients with GTDs often present with vaginal bleeding and a significantly elevated serum human chorionic gonadotropin (hCG). In addition to the histological diagnosis confirmation through vacuum aspiration, the determination of hCG is the most important parameter in treatment planning. According to the FIGO score, GTDs can be divided into low risk and high risk GTDs to determine a curative chemotherapy with high rates of healing. Hydatidiform and partial moles are normally treated by curettage, whereas the aggressive and early metastatic choriocarcinoma typically requires chemotherapy mostly with methotrexate, actinomycin D or the EMA-CO regimen. Hysterectomy is only performed in exceptional cases of life-threatening uterine bleeding.