GTN Cancer
Home / Treatment / Gynecologic Cancer / GTN Cancer
GTN Cancer Doctor in Kolkata
GTN cancer or Gestational Trophoblastic Neoplasia is a group of cancers that arise from the abnormal growth of placental cells. It can occur following a pregnancy, miscarriage, or molar pregnancy, where the placenta forms a tumour composed of small cysts instead of developing normally. Consulting the GTN cancer doctor in Kolkata will help you get the most suitable treatment for your condition.
Symptoms of GTN Cancer
Common signs of GTN Cancer are as follows.
- Continuous bleeding after a miscarriage, abortion, or childbirth
- Ongoing absence of menstruation after miscarriage, abortion, or childbirth
- Abdominal pain or cramping
- Enlarged uterus and/or presence of ovarian cysts
- Persistently positive pregnancy test results
- Pelvic pain or a sensation of pressure
- Coughing or difficulty breathing
- Headaches or seizures
If you experience any of these symptoms, connect connect with the GTN oncologist in Kolkata.
Causes of GTN Cancer
GTN Cancer is a rare form of cancer that occurs in the cells of the placenta during pregnancy. The main causes or risk factors for GTN include:
Molar Pregnancy
The most common cause of GTN is a molar pregnancy, which can be either complete or partial. In a complete mole, no normal foetal tissue develops, while in a partial mole, some abnormal tissue and a foetus may develop, but the foetus cannot survive.
Previous GTN or Molar Pregnancy
Women who have had a previous molar pregnancy or GTN are at a higher risk of developing the condition again in future pregnancies.
Miscarriage
GTN can develop after a miscarriage (spontaneous abortion) if some abnormal placental cells remain in the uterus and continue to grow.
Abortion
Like miscarriage, GTN may arise if abnormal trophoblastic tissue persists after an abortion.
Ectopic Pregnancy
In rare cases, GTN can develop from abnormal placental cells after an ectopic pregnancy (when the embryo implants outside the uterus).
Full-Term Pregnancy
Although rare, GTN can occur following a normal full-term pregnancy.
Age
Women who are either under the age of 20 or over the age of 40 at the time of pregnancy have a higher risk of developing GTN.
Genetic Factors
Certain genetic abnormalities in the sperm or egg involved in conception can contribute to the development of molar pregnancy, leading to GTN.
GTN can often be treated successfully, especially when detected early, with high cure rates using chemotherapy and other treatments.
Types of GTN Cancer
Gestational trophoblastic neoplasia (GTN) includes several types:
Invasive Mole
This occurs when a complete or partial molar pregnancy invades the muscular or vascular layers of the uterus.
Choriocarcinoma
A rapidly growing form of GTN that arises from trophoblastic cells (cytotrophoblasts and syncytiotrophoblasts) which would normally form part of the placenta.
Placental Site Trophoblastic Tumour (PSTT)
A rare tumour that originates from the intermediate trophoblast layer. Approximately 70% of cases are benign, while 30% are malignant.
Epithelioid Trophoblastic Tumour (ETT)
Even rarer than PSTT, this tumour has similar behaviour and prognosis. It is usually diagnosed 15-20 years after a previous pregnancy.
Stages of GTN Cancer
The stages of Gestational Trophoblastic Neoplasia (GTN) are determined by the extent of the cancer’s spread within the body. GTN is classified using the FIGO (International Federation of Gynecology and Obstetrics) staging system, which categorises it into four stages:
Stage I
The cancer is confined to the uterus, where it originally developed.
Stage II
GTN has spread beyond the uterus to nearby structures, such as the ovaries, fallopian tubes, or vagina, but remains limited to the reproductive organs.
Stage III
The cancer has spread to the lungs, with or without the involvement of nearby reproductive organs. This is known as “pulmonary metastasis.”
Stage IV
GTN has spread to distant organs outside of the reproductive system and lungs, such as the liver, brain, or kidneys. This is the most advanced stage.
Diagnosis of GTN Cancer
The diagnosis of gestational trophoblastic disease (GTD) is initiated by a general obstetrician-gynecologist following a miscarriage, termination, or dilation and curettage (D&C) procedure for a molar pregnancy. After these events, the physician closely monitors the patient’s levels of the pregnancy hormone β-HCG (human chorionic gonadotropin). A gradual decline in β-HCG is expected, but if the hormone levels fail to decrease and normalise, it could indicate abnormal growth of trophoblastic tissue. In such cases, patients are usually referred to a gynecologic oncologist for further evaluation.
Once referred, the gynecologic oncologist conducts a thorough assessment, including tissue sampling, blood tests, and imaging studies, to make a definitive diagnosis of gestational trophoblastic neoplasia (GTN). The following steps are essential parts of the diagnostic process:
Pelvic Examination
A detailed pelvic exam is performed to assess the uterus, cervix, and surrounding structures. The doctor will check for any abnormal masses, uterine enlargement, or signs of excessive bleeding, which may suggest the presence of GTN.
Blood Tests
-
β-HCG Testing:
Regular monitoring of β-HCG levels is crucial. Persistently high or rising levels can indicate that GTN is present, as the hormone is produced by trophoblastic tissue.
-
Complete Blood Count (CBC):
To check for anaemia or other blood-related issues.
-
Liver and Kidney Function Tests:
These tests help evaluate how well the organs are working and whether cancer has spread to distant sites like the liver.
Pelvic Ultrasound
A transvaginal or abdominal ultrasound is conducted to visualise the uterus and ovaries. Ultrasound imaging can help identify:
- The presence of a molar pregnancy or retained products of conception.
- Uterine abnormalities such as an enlarged uterus or cysts.
- Any masses or signs that suggest the cancer has spread locally.
Chest X-ray
A chest X-ray is performed to check whether GTN has spread to the lungs. This is important since the lungs are a common site of metastasis for GTN, even when there are no respiratory symptoms.
Treatment of GTN Cancer
The primary treatments for GTN Cancer include:
Radiation Therapy
Although not commonly used in the treatment of GTN, radiation therapy may be considered for cases where cancer has spread to the brain or other locations that are not responding well to chemotherapy. It is reserved for advanced cases with metastasis.
Chemotherapy
Chemotherapy is the most common and effective treatment for GTN. It is especially effective in cases where the cancer has spread beyond the uterus (metastatic GTN). The choice of chemotherapy depends on the risk score (low-risk or high-risk GTN).
-
Low-Risk GTN:
These drugs are given in cycles, and treatment continues until β-HCG levels return to normal and stay normal for a few additional cycles.
-
High-Risk GTN:
These regimens are more intensive and aim to treat more advanced or aggressive forms of GTN.
Monitoring of β-HCG Levels
After successful treatment, close monitoring of β-HCG levels is essential to ensure that the cancer has been fully eradicated and to detect any recurrence early. Blood tests for β-HCG are done regularly until the levels return to normal and remain stable for a period of time.
Treatment for Recurrent GTN
In cases where GTN recurs after initial treatment, additional chemotherapy or a change in the drug regimen may be needed. For recurrent high-risk GTN, more aggressive multi-agent chemotherapy or targeted therapy may be recommended.
Fertility Considerations
For women wishing to preserve fertility, conservative treatments like chemotherapy are usually prioritised. Many women can have successful pregnancies after treatment for GTN, but careful follow-up is required.
Consult the doctor for the most suitable treatment for your condition.
Frequently Asked Questions
What are the most effective chemotherapy regimens for treating low-risk versus high-risk Gestational Trophoblastic Neoplasia?
The choice of chemotherapy for GTN depends on whether the patient is classified as low-risk or high-risk. For low-risk GTN, single-agent chemotherapy is often sufficient. These drugs are given in cycles until β-HCG levels normalise. For high-risk GTN, more aggressive treatment is required.
How is the FIGO risk scoring system used to determine treatment options?
The FIGO risk scoring system is used to classify GTN into low-risk and high-risk categories, based on factors such as the patient’s age, the time since the pregnancy event, the levels of β-HCG, the site of metastasis, and the number of metastases. GTN risk scores range from 0 to 12 or more, with scores of 6 or less classified as low-risk, and scores of 7 or higher classified as high-risk.
What are the most common sites for GTN metastasis?
The most common sites for GTN metastasis are the lungs, followed by the liver and brain. Metastasis to the lungs can occur even in cases classified as low-risk GTN. When metastasis is present, the disease is considered more advanced, and treatment becomes more aggressive.
What are the fertility preservation options for women diagnosed with GTN?
Most women with GTN can retain their fertility after treatment. Chemotherapy, particularly for low-risk GTN, usually does not affect fertility, and many women go on to have successful pregnancies afterward.
What are the risk factors for the recurrence of GTN Cancer?
Recurrence of GTN Cancer is more common in high-risk cases, patients with incomplete remission, or those who have delayed diagnosis. The recurrence is detected through rising β-HCG levels after treatment.
How long should patients be monitored to ensure remission?
Patients are usually monitored with weekly blood tests until β-HCG levels remain normal for several weeks. After this, monthly monitoring continues for 6 months to a year, depending on the type and risk level of GTN. Persistent or rising β-HCG levels may indicate a recurrence, requiring further evaluation and treatment.