Treatments for gestational trophoblastic disease

Surgery is the main treatment for non-cancerous types of gestational trophoblastic disease (GTD). A combination of treatments may be used for cancerous GTD (also called gestational trophoblastic neoplasia, or GTN). These treatments can include surgery, chemotherapy and radiation therapy.

Your healthcare team will suggest treatments based on the type of GTD you have and work with you to develop a treatment plan.

Surgery is usually used to treat non-cancerous GTD. It is also used to treat some types of cancerous GTD. Doctors will also consider if cancerous GTD has spread when planning surgery. Surgery may be the only treatment you need, or it may be used along with other cancer treatments. You may have surgery to:

• remove abnormal tissue from the uterus

• completely remove the uterus to reduce the chance that cancer will develop

• remove metastatic cancer that has spread outside of the uterus

Side effects of surgery will depend mainly on the type and site of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

The following types of surgery are used to treat GTD. The type of surgery offered depends mainly on the type of GTD.

Dilation and curettage (D&C) is the main treatment for non-cancerous GTD. During a D&C, the doctor will gently widen (dilate) the cervix using small instruments and sometimes medicine. Then they use a suction device and a small, spoon-shaped instrument (called a curette) to remove abnormal tissue from the lining of the uterus.

The procedure usually takes 15 to 30 minutes, and you will likely go home the same day. It is normal to have some mild cramping in your abdomen and bleeding from the vagina that is not related to your period for a few days after the procedure.

Sometimes a second D&C is needed if some abnormal trophoblast cells are left behind. Doctors may also offer a second D&C to treat low-risk cancerous GTD that hasn’t spread outside of the uterus as an alternative to chemotherapy.

A D&C doesn’t remove the uterus, so it is possible to become pregnant after this procedure.

A hysterectomy is done to completely remove cancer that is in the uterus or to reduce the chance that cancer will develop. A hysterectomy is often used to treat placental site trophoblastic tumours (PSTTs) and epithelioid trophoblastic tumours (ETTs) because they don’t usually respond well to chemotherapy.

The type of hysterectomy used for GTD is called a total, or simple, hysterectomy. It removes the uterus and the cervix.

If you have a hysterectomy, you’ll no longer be able to get pregnant. Hysterectomy may also cause these side effects:

• bleeding from the vagina that is not related to your period

• soreness at site of the incisions

• fatigue (feeling very tired)

• problems urinating (peeing) or having a bowel movement (pooping)

Find out more about a hysterectomy.

Surgery is rarely done to remove cancerous GTD that has spread (metastasized) to other parts of the body. Usually, metastatic GTD can be successfully treated with chemotherapy alone.

In rare cases, metastatic GTD doesn’t respond (is resistant) to chemotherapy or comes back (recurs) after chemotherapy. Resistant or recurrent GTD can be treated with surgery.

The type of surgery you have will depend on where the cancer is in the body.

Find out more about surgery for cancer and side effects of surgery.

Chemotherapy uses drugs to destroy cancer cells. It can be used to treat some types of cancerous GTD.

Chemotherapy is usually given to treat invasive moles and gestational choriocarcinoma. In some cases, it may be used to treat placental site trophoblastic tumours (PSTTs) and epithelioid trophoblastic tumours (ETTs).

If cancerous GTD doesn’t respond (is resistant) to chemotherapy or comes back (recurs) after it is treated, you may be offered a different chemotherapy regimen.

The most common chemotherapy drugs used for low-risk cancerous GTD that hasn’t spread include methotrexate or dactinomycin.

A combination of drugs may be used for high-risk cancerous GTD. The most common combination is EMA-CO (etoposide, methotrexate/folinic acid and dactinomycin alternated each week with vincristine and cyclophosphamide).

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about chemotherapy.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Some people with cancerous GTD may be offered radiation therapy.

You may be offered radiation therapy to treat cancerous GTD that:

• has spread (metastasized) to the liver or brain

• doesn’t respond to chemotherapy

Your healthcare team will use what they know about the cancer and about your health to plan the type and amount of radiation, and when and how it is given.

External radiation therapy is the type of radiation therapy most often used to treat cancerous GTD. A machine will direct radiation through the skin to the tumour and some of the tissue around it. External radiation therapy is also called external beam radiation therapy.

During radiation therapy, your healthcare team protects healthy cells in the treatment area as much as possible. Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation and the treatment schedule. Tell your healthcare team if you have side effects that you think are from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about radiation therapy.

Talk to your doctor about clinical trials open to people with GTD in Canada. Clinical trials look at new ways to prevent, find and treat cancer.

Find out more about clinical trials.