Supportive care for gestational trophoblastic disease

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of gestational trophoblastic disease (GTD). It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from GTD and adjusting to life after treatment is different for each woman, depending on the stage of the GTD, the type of treatment and many other factors. The end of treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for GTD may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. GTD and its treatments can affect a woman’s self-esteem and body image. Often this is because GTD or GTD treatments may result in body changes, such as:

• scars
• hair loss
• skin changes
• loss of a body part, such as the uterus

Some of these changes can be temporary. Others will last for a long time or be permanent.

Find out more about how to cope with problems of self-esteem and body image.

You may have concerns about future pregnancies after having treatment for GTD. There is an increased chance that you could have another GTD, but most women have normal pregnancies after being previously treated for GTD. All future pregnancies in women with a history of GTD must be followed carefully.

You should wait a period of time after treatment before getting pregnant. An effective contraceptive method, such as oral contraceptives (birth control pills), is recommended during this time. It is usually advised to wait at least 6 months or longer before getting pregnant after a hydatidiform mole and at least 1 year before getting pregnant after gestational trophoblastic neoplasia.

If you do become pregnant an ultrasound is done within the first trimester, often at 6 and 10 weeks, to check for GTD. Human chorionic gonadotropin (HCG or b-HCG) levels should be checked after about 6 weeks following all future normal births, miscarriages or abortions. After birth, the placenta should be examined under a microscope to look for signs of GTD.

Some women may become pregnant sooner than is recommended after treatment. Most women will have a normal and healthy pregnancy. However, researchers have found that a pregnancy in the first 6 months after treatment for malignant GTD may have a higher risk of:

• miscarriage
• stillbirth (death of a fetus that is over 20 weeks gestational age)
• birth defects

Many women continue to have strong, supportive relationships and a satisfying sex life after GTD. If sexual problems occur because of GTD treatments, there are ways to manage them.

Some women may lose interest in having sex. It is common to have a decreased interest in sex around the time of diagnosis and treatment.

Find out more about sexuality and cancer.

Women who have been treated for GTD may also have concerns about the following:

• loss of pregnancy associated with a hydatidiform mole
• inability to have future pregnancies following a hysterectomy (removal of the uterus)
• fatigue
• emotions, such as anxiety, anger and confusion

Some women may find it helpful to speak to a counsellor to help them deal with any concerns.

To make decisions that are right for you, ask your healthcare team questions about supportive care.