Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Abstract

Gestational trophoblastic disease (GTD) comprises a spectrum of disorders from the pre-malignant conditions of complete (CHM) and partial (PHM) hydatidiform moles through to the malignant invasive mole, choriocarcinoma (CC) and very rare placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). The malignant forms of the disease are also collectively known as gestational trophoblastic tumours or neoplasia (GTN). In the UK, all GTD cases are nationally registered, with central pathology review. The incidence is estimated at 1-3: 1000 pregnancies for CHM and 3: 1000 pregnancies for PHM, respectively, with other western countries reporting similar data [1]. GTD appears to be more frequent in Asia than in North America or Europe. This may be because of discrepancies between hospital- and population-based data, availability of central pathological review or may reflect dietary and genetic influences. An increased risk of molar pregnancy is seen in the very young (45 years) [1]. Following a molar pregnancy, the risk of a further CHM or PHM increases to ∼1%. After two molar gestations, the risk of a third mole is 15%–20% and is not decreased by changing partners.