Gestational Trophoblastic Neoplasia Overview

A form of gestational trophoblastic disease, gestational trophoblastic neoplasia (GTN) is a rare type of tumor that can develop during the early stages of pregnancy. Immediately after a woman conceives, a layer of cells (trophoblast) surrounds the newly fertilized egg. In addition to helping the embryo implant itself into the uterine wall, the trophoblast forms a large part of the placenta, which supplies nutrients to the developing fetus. GTN arises in the trophoblast cells.

Gestational trophoblastic neoplasia causes and risk factors

Gestational trophoblastic neoplasia results from harmful DNA changes in the trophoblast cells. The mutations allow for uncontrolled cell growth, which fosters tumor development. The causes of the cellular changes that lead to GTN are unknown.

Although gestational trophoblastic neoplasia is uncommon, scientists have identified several risk factors, including:

• Pregnancy before age 20
• Pregnancy after age 35
• Previous molar pregnancy
• History of miscarriage

Gestational trophoblastic neoplasia signs and symptoms

GTN can cause:

• Unusual vaginal discharge or bleeding unrelated to menstruation
• Pain or a mass in the pelvic area
• Extreme bouts of nausea and vomiting
• Excessive uterine enlargement during pregnancy

Because the symptoms of gestational trophoblastic neoplasia are associated with many other gynecologic and pregnancy-related conditions, it is important to promptly discuss them with a physician.

Gestational trophoblastic neoplasia diagnosis

In addition to a thorough medical history review and general physical examination, the diagnostic process for GTN may include:

• A pelvic exam - A physician manually checks for lumps and changes in the size or shape of the uterus.
• A Pap test - A physician collects a small sample of cells from the cervix for microscopic evaluation by a pathologist.
• A transvaginal ultrasound - After placing a small instrument (transducer) into the vagina, a sonographer captures detailed images of the uterus and nearby tissues.
• Blood work - A lab technician tests a blood sample for levels of hormones and other substances that can be affected by GTN.
• A urinalysis - A lab technician tests a urine sample for levels of sugar, protein, bacteria and certain hormones that can be affected by GTN.

If cancer is detected, other tests may be performed to determine whether the tumor has spread beyond the uterus to other parts of the body. In addition to a chest X-ray and computed tomography (CT) scan of the abdomen, a physician may order a spinal tap to test the cerebrospinal fluid (CSF) for a high level of human chorionic gonadotrophin (hCG), a hormone produced by the placenta during pregnancy. The presence of hCG in the CSF may suggest a tumor.

Gestational trophoblastic neoplasia treatment

GTN treatment can vary based on several factors, including the extent of the tumor and the patient’s overall health, medical history and preferences, including whether she would like to try to become pregnant in the future.

Treatment options for gestational trophoblastic neoplasia can include:

• Surgery to remove the tumor
• Radiation therapy to shrink the tumor and make it easier to surgically remove
• Hysterectomy to remove the uterus
• Bilateral salpingo-oophorectomy to remove the fallopian tubes, ovaries, nearby lymph nodes and possibly part of the vagina (may be performed along with a hysterectomy)
• Chemotherapy to target and destroy widespread cancer cells

Benefit from world-class care at Moffitt Cancer Center

With a commitment to rapidly translating the scientific knowledge we gain in the laboratory into groundbreaking treatments for our patients, Moffitt is proud to be the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida. Because we are a high-volume cancer center, our physicians have opportunities to diagnose and treat many patients who have highly uncommon and complex tumors, including rare gynecological cancers that develop during pregnancy.

Women who are concerned about GTN will find a complete range of diagnostic and treatment options in Moffitt’s gynecological clinic. Guided by evidence-based clinical pathways, our multispecialty team takes an individualized approach to patient care and support.

You can request an appointment with an expert at Moffitt with or without a referral. Reach out by calling 1-888-663-3488 or submitting a new patient registration form online.