Trophoblastic disease is a group of benign and malignant tumors that arise from placental trophoblasts. The term includes pathologies such as hydatidiform mole (partial and complete), invasive hydatidiform mole, placental site trophoblastic tumor, choriocarcinoma, and trophoblastic epithelioid tumor. Pathology is diagnosed mainly with the help of ultrasound and CT scans, examinations that are designed to detect the concentration of hCG in the blood. Therapy is prescribed in the form of hysterotomy, chemotherapy, removal of the mole.
Description of the disease
Trophoblastic disease in gynecological practice is rare - in 1-3% of cases out of a hundred - and is considered a very rare disease. The development of this pathology is impossible without the presence of pregnancy, since in most cases the uterus is the main site of localization. It should be noted that it has more than one form. Considering the variety of forms,partial cystic drift accounts for 5% of cases, chorioncarcinoma - 17%, complete drift - 72.2%, and other types - 5.3%.
During trophoblastic disease, proliferative pathologies of the outer layers of embryonic cells develop, which, in turn, are directly involved in the creation of the epithelial cover of the chorionic villi. Such a pathology can occur after the end of pregnancy and at the stage of gestation. It can occur in a malignant form and benign. But one way or another, pathology is a very dangerous condition that can lead to quite negative results.
Factors that increase the risk of pathology
When the causes and risk factors of this disease were studied, it was found that trophoblastic tumor is diagnosed more often in women at a certain age, the anamnesis and obstetric history are characteristic, and the geographical factor can play an important role in this. Thus, risk circumstances are:
- woman's age is 20-50 years old, the most dangerous period is 40 years and older;
- second and subsequent pregnancies;
- History of miscarriage.
Among women who live in eastern countries, this pathology is common. If a patient has already been diagnosed with a mole, there is a risk of invasive mole and choriocarcinoma. Metastasis becomes more likely in those who observe symptoms of pathology and a latent period for a long time.
Classification of trophoblastic disease
Based oninternational classification distinguish between benign forms and malignant neoplasms of the disease.
Thus, malignant neoplasm is subdivided into:
- for invasive mole;
- trophoblastic tumor of the placental bed;
- choriocarcinoma;
- emitters of a unicellular trophoblastic tumor.
Malignant neoplasm has metastatic and non-metastatic clinical presentation, low or high risk.
In turn, the benign form of trophoblastic disease in gynecology is divided into:
- for partial hydatidiform drift (mild form);
- full skid.
Different character
Specification of trophoblastic disease shows that it can have a different character. One way or another, it will be equally important to consider more stages of the development of the disease, which allow us to understand the level of danger of the disease.
As shown by the FIGO clinical classification, there are stages:
- The first stage. Only the uterus is affected, there are no metastases at this stage.
- Second stage. Metastases have spread to the vagina, pelvis and appendages.
- Third stage. Metastases have penetrated the lungs, not to mention the affected genitals.
- The fourth stage. Various distant metastases occur (kidneys, liver, spleen, gastrointestinal tract, brain).
Forecast
If the disease of the uterus is cured in time and correctly, then everything will pass without complications. Chemotherapy has a 70% success rate with the metastatic form and 100% success rate with the non-metastatic form.
In many cases, young women can fully retain their generative functions. In order for the next pregnancy to be successful, you must follow all the recommendations and prescriptions of the doctor. It is necessary to undergo an examination twice a year and be constantly under the supervision of a doctor, use contraception.
Relapse occurs only in 4-8% of cases.
Any kind of disease is considered in oncology as an integral etiopathogenetic process. Possible causes of trophoblastic disease may be influenza viruses, special properties of the egg, chromosomal aberrations, immunological factors, high hyaluronidase activity, protein deficiency.
Who gets it more often?
Pathology most often occurs in women over forty years old (probably 5 times), women under 35 suffer from this disease much less often. Other sources of risk can also be identified, among which are abortions, self-terminated pregnancy or childbirth. There is one pattern that this disease is most often observed in women from the East, but women from the West are less prone to the appearance of this disease.
After the hydatidiform mole has been transferred, the development of choriocarcinoma may begin. With a complete form of cystic drift, an invasive drift develops. Partial skid has much less impact on this process.
After the end of gestation,abortion, miscarriage, childbirth, or during pregnancy (normal or ectopic), changes in the structure of the trophoblast may occur.
Let's consider the main symptoms of trophoblastic disease.
Symptoms
The main signs of the disease are:
- an increase in the size of the uterus that does not match the norms of gestational age (50%);
- bilateral thecalutein cysts (in 40% of cases);
- Vaginal bleeding (about 90%).
In most cases, the course of hydatidiform mole can be complicated by preeclampsia, toxicosis of the pregnant woman (persistent vomiting), arterial hypertension, rupture of ovarian cysts, symptoms of hyperthyroidism (hyperthermia, tachycardia). This process is also negatively affected by profuse bleeding. In some cases, this form causes PE and DIC.
If we consider clinical anomalies of hydatidiform mole in trophoblastic disease, then it is necessary to highlight:
- metastasis to the vagina, lungs, vulva;
- infiltrative growth;
- increased risk of transformation into choriocarcinoma.
Chorioncarcinoma can be dangerous because under its influence the wall of the uterus can collapse. Consequently, this form of the disease often causes severe bleeding. From choriocarcinoma, metastases quickly spread to the pelvic organs, then to the liver, kidneys, spleen, lungs, stomach, and brain.
In turn, the trophoblastic tumor destroysserous lining of the uterus, which will then cause bleeding. This tumor contributes to the penetration of metastases into the abdominal cavity, vagina and brain.
An epithelioid cell tumor is located in the cervical canal or at the bottom of the uterus. This tumor in its symptoms may resemble cervical cancer. This type of trophoblastic disease makes itself felt only after several years of pregnancy.
What triggers metastases?
The occurrence of metastases provokes headache, chest pain, cough with bloody sputum, gastric bleeding, anemia, intestinal obstruction, cachexia, intoxication and so on.
There are such forms of pathology that they can cause pain in the abdomen, rupture and torsion of the legs of cysts, compression of the nerve trunks, perforation of the uterus.
You need to know that the symptoms of the disease can be different. But when the first signs appear, you should immediately consult a doctor.
Diagnosis of trophoblastic disease
Women diagnosed with this disease have had pregnancies that ended in abortion (induced or spontaneous), tubectomy for ectopic pregnancy, or childbirth.
Most women complain of acyclic uterine bleeding, headaches, amenorrhea, oligomenorrhea, menorrhagia, cough, chest and abdominal pain, hemoptysis.
During a gynecological examination, the real dimensions of the uterus are determined, which sometimes do not correspondpostpartum or gestational age. Often a gynecologist can detect tumor nodes in the vagina, uterus, and small pelvis by palpation.
To detect tumors with a small size up to 5 mm, transvaginal ultrasound is ideal. A sign of the disease will be large thecalutein ovarian cysts.
Helper methods
Detection of metastases in the pelvis and other organs is determined using auxiliary methods:
- CT;
- MRI of the brain;
- Ultrasound of the abdominal cavity, kidneys, liver;
- PET;
- CT lungs;
- chest x-ray.
In case of detection of metastases, you should seek advice from an abdominal surgeon, neurosurgeon, urologist, pulmonologist.
How is trophoblastic disease treated?
Therapy
The scheme of therapeutic measures is determined for a given disease by its stage and form.
Treatment of hydatidiform drift is carried out using vacuum extraction with the forthcoming control curettage of the uterine cavity. Once the mole has been removed, contraception should be used for one year. Chemotherapy with a dynamic decrease in the level of hCG to a normal value is not prescribed.
Clinical guidelines for trophoblastic disease must be strictly observed.
Chemotherapy
If there is a pathology with malignant signs, then chemotherapy is prescribed. The scheme of such treatment may be as follows:
- Cisplatin and Etoposide;
- "Dactinomycin" and "Methotrexate";
- Methotrexate, Cisplatin, Dactinomycin, Vincristine.
In cases of perforation of the walls of the uterus, bleeding from the initial tumor and resistance to chemotherapy, a surgical method is advisable. Organ-sparing hysterotomy is recommended for patients of reproductive age. In the case when a woman no longer plans to give birth to children, a radical hysterectomy or supravaginal removal is performed.
After the end of the therapeutic course of gestational trophoblastic disease, it is recommended to undergo hCG monitoring, echographic control, and dynamic lung radiography several times a year.
After undergoing pathology, women will be able to plan pregnancy no earlier than in 11-17 months.
We reviewed the main recommendations for trophoblastic disease.
