Stages of gestational trophoblastic disease (GTD)

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. The healthcare team uses information from tests to find out the size of the tumour, if the cancer has spread from where it first started, and where the cancer has spread. Doctors use the stage to plan treatment and estimate the outcome (prognosis).

Cancerous gestational trophoblastic disease (GTD) is also called gestational trophoblastic neoplasia (GTN). Only cancerous GTD – invasive moles, gestational choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelial trophoblastic tumour (ETT) – are staged. Hydatidiform moles, atypical placental site nodules and exaggerated placental site reactions are not cancer, so they are not given a stage.

The most common staging system for cancerous GTD is the International Federation of Gynecology and Obstetrics (FIGO) system. It has 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread.

When describing the stage, doctors may use the words local, regional or distant.

Local means that the cancer is only in the uterus and has not spread to other parts of the body.

Regional means close to the uterus or around it.

Distant means in a part of the body farther from the uterus.

Find out more about staging cancer.

Cancer is only in the uterus.

Cancer has spread (metastasized) outside the uterus. It is only in reproductive organs, such as an ovary, a fallopian tube or the vagina. Or it has grown into nearby areas, such as ligaments.

Cancer has spread to the lungs. It may also have spread to the reproductive organs.

Cancer has spread to other parts of the body, such as the brain, liver, kidneys or gastrointestinal (GI) tract. This is also called distant metastasis or metastatic GTD.

Recurrent GTN means that cancerous GTD has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

Usually any abnormal trophoblast cells left behind after a hydatidiform mole is removed will die off. In some cases, these trophoblast cells will keep growing and can become an invasive mole. An invasive mole that develops after a hydatidiform mole is removed may also be called a persistent mole or persistent trophoblastic disease.