Treatment
Types of treatment
Your doctor will advise you on the best treatment for you. This will depend on the results of your tests, the type of gestational trophoblastic disease, if it has spread, your age, your general health, and what you want.
Treatment choice may also depend on whether you want to become pregnant in the future.
Two kinds of standard treatment are used: surgery and chemotherapy.
Surgery
Your doctor will talk to you about the most appropriate type of surgery, depending on the type and stage of gestational trophoblastic disease.
Dilation and curettage (D&C)
Dilation and curettage (D&C) with suction evacuation is a procedure to remove tissue from the cervical canal or the inner lining of the uterus. The cervix (the opening of the uterus) is dilated (made larger), and the material inside the uterus is removed with a small vacuum-like device. The walls of the uterus are then scraped gently to remove any material that may remain in the uterus.
This procedure is used only for molar pregnancies.
Following this procedure, your doctor will follow you closely with regular blood tests to make sure your level of human chorionic gonadotrophin (hCG) falls to normal. If the level of hCG increases or does not go down to normal, more tests will be done to see whether the tumour has spread. Treatment will then depend on whether you have nonmetastatic or metastatic gestational trophoblastic neoplasia.
Hysterectomy
A hysterectomy is the surgical removal of the uterus. It is rarely necessary in the treatment of gestational trophoblastic disease. If it is, the ovaries will not usually be removed.
Side effects of surgery
After a hysterectomy, some women experience the following side effects:
- Pain. As with all major operations, you will have some pain or discomfort. It is best to let your doctor or nurse know when you are feeling uncomfortable – don’t wait until the pain becomes severe. You will be administered pain relief medication through an intravenous drip. You may be able to use a patient-controlled analgesia (PCA) system, which allows you to choose when you receive a dose of medication. Some people receive an epidural to relieve pain. An epidural is a form of regional anaesthesia involving injection of drugs into the spine.
- Tiredness. Women usually feel extremely tired after a hysterectomy.
- Nausea, vomiting, and bladder and bowel problems. Some women may have problems with nausea and vomiting after surgery, and some may have bladder and bowel problems. The doctor may restrict your diet to liquids at first, with a gradual return to solid food.
- Adhesions. Adhesions, or internal scar tissue that glues together tissues in the body, may form. Sometimes this can be painful. Adhesions to the bowel or bladder may need to be treated with further surgery.
- Lymph fluid build-up. If you have had lymph nodes removed (lymphadenectomy), parts of your body may swell because your lymphatic system is not working properly. This is called lymphoedema. Lymphoedema symptoms may not appear for more than 2 years after surgery. Swelling in your limbs may be reduced with gentle massage towards your heart, special compression garments and gentle exercise.
- Not being able to become pregnant. After a hysterectomy, you will not be able to become pregnant.
- Menopause. If you have had a bilateral salpingo-oophorectomy and were not menopausal before the surgery, the removal of your ovaries will cause menopause. Hot flushes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Hormone replacement therapy (HRT) can help reduce your symptoms. You will need to talk to your gynaecologic oncologist about the benefits and risks of HRT. Because cancer of the uterus can be hormone sensitive, HRT may not be suitable for some women.
- Effects on your sex life. The physical and emotional changes you experience may also affect how you feel about sex and how you respond sexually.
Recovery from surgery
A hysterectomy is a major surgical procedure, and you may be in hospital for up to 7 days. Your recovery time will depend on different factors, such as how much tissue was removed and the stage of your gestational trophoblastic disease.
Ask your doctor what to expect when you wake up from the operation and for advice on rest, lifting, driving and sex during your recovery.
Chemotherapy
Chemotherapy for gestational trophoblastic disease may be given before or after surgery or alone.
Radiotherapy
Radiotherapy is only occasionally used to treat gestational trophoblastic disease that has spread to the brain.
Treatment options for different forms of gestational trophoblastic disease
Hydatidiform mole
Treatment may be one of the following:
- removal of the mole using D&C and suction evacuation
- rarely, surgery to remove the uterus (hysterectomy).
Placental-site gestational trophoblastic tumour
Treatment will probably be surgery to remove the uterus (hysterectomy).
Nonmetastatic gestational trophoblastic neoplasia
Treatment may be one of the following:
- chemotherapy
- surgery to remove the uterus (hysterectomy) if you no longer wish to have children.
Metastatic gestational trophoblastic neoplasia with good prognosis
Treatment may be one of the following:
- chemotherapy
- surgery to remove the uterus (hysterectomy) followed by chemotherapy
- chemotherapy followed by hysterectomy if disease remains following chemotherapy.
Metastatic gestational trophoblastic neoplasia with poor prognosis
Treatment will probably be chemotherapy. Radiotherapy may also be given to places where the cancer has spread, such as the brain.
Treatment given after the main treatment to increase the chances of a cure is called adjuvant therapy. Treatment given before the main treatment is called neoadjuvant treatment.
If you want to try complementary therapies, which are generally used in conjunction with conventional treatment, it is important that you discuss this with your doctors and health professionals.
Recurrent gestational trophoblastic disease
Recurrent gestational trophoblastic disease is disease that has recurred (come back) after it has been treated.
Recurrence is when the gestational trophoblastic disease comes back in the same part of the body. Secondary gestational trophoblastic disease is when it spreads to another part of the body.
Gestational trophoblastic disease may come back in the uterus or in other parts of the body.
For women who have had a hydatidiform mole in the past, the chance of it occurring again is about 1%.
Treatment for recurrent gestational trophoblastic disease will probably be chemotherapy.
A clinical trial may also be possible.