TYPES of GTD

There are various types of gestational trophoblastic disease. The most common is molar pregnancies. Other types include malignant forms-choriocarcinoma (placental cancer), placental site trophoblastic tumor, non-gestational choriocarcinoma, ephiliod trophoblastic tumor and quiescent GTD.

Molar Pregnancies

Molar pregnancies include both complete and partial hydatidiform moles, some are invasive. Some of these are persistent GTD, all of which hold chance to turn malignant.

1. Partial moles are when a regular egg is fertilized by two sperm, doubling the father's chromosomes, causing fetal abnormalities. Termination is needed.
2. Complete moles are a regular fertilized egg but the egg is missing dna/chromosomes so a fetus cannot be supported, stopping at the formation of the placenta. Complete moles hold higher percentage to turn into malignant choriocarcinoma.
3. Twin molar pregnancies are more rare and can be either partial twin or complete twin. Some cases have viable twin some have surviving twin. Of these cases, not all are caught during prenatal care, thus complicating the situation for both mother and fetus'.

Choriocarcinoma

Choriocarcinoma is a highly aggressive and fast growing malignant form of GTD usually from molar pregnancies, particularly complete, but can result form any pregnancy, miscarriage, termination, ectopic or left over fragments. 


Chemotherapy is needed, single or multiple regimen, depending on metastasis, FIGO Score and Stage Level. Choriocarcinoma usually results from complete molar pregnancies but partial molars and left over placental fragments can also result into this malignant form of GTD, though more rare.

An even more rare form is Non-Gestational Choriocarcinoma which doesn't result from any gestational period and is usually on the ovary or teste (testicular choriocarcinoma). Pure form of ovarian choriocarcinoma is very rare. Male choriocarcinoma does not respond well to chemotherapy.

Placental Site Trophoblastic Tumor (PSTT)

PSTT is another rare form of GTD. This malignant type does not respond well to chemo unlike other GTD forms and a hysterectomy is usually needed. B-hcg levels are also low, opposite of other GTD forms. When chemotherapy fails, new treatments of stem cell transplant and immunotherapy are being used for cure in different countries, though extending more throughout. Cases of PSTT can come years after a pregnancy/childbirth and occurs after pregnancy and are slow growing.

Epithelioid Trophoblastic Tumor (ETT) and Quiescent GTD
Both very rare forms of GTD. ETT is malignant and speculated as either it's own form of GTD or "differentiating effects of treatment". 
Quiescent GTD is "completely inactive, benign or quiescent"

Chemotherapy Used for Treatment

The most common* chemo used is methotrexate, act-D (dactinomycin), etoposide, vincristine, cyclophosphamide, platinum, and cisplatin. Leucovorin follows methotrexate. These are  given single or in a combo regimen like ema-co (etoposide, methotrexate, act-D, cyclophophasamide, vincristine), ema-ep (etoposide, methotrexate, act-D, etoposide, cisplatin), pe (platinim, etoposide), or ape (act-D, platinum, etoposide). These chemos are given either daily, weekly or bi-weekly, depending on treatment plan based on FIGO Score, Staging level and any metastasis. The first initial chemo will be given either inpatient or long outpatient stay, depending on chemo and case, to monitor any adverse reactions. Some chemo regimens require continued inpatient for infusion, others are split with inpatient and outpatient alternating or only outpatient. Chemo is infused in varieties from a shot, IV, catheter, or port.

New chemo and treatments are being studied with continued research. Immunotherapy and stem cell transplant are also being used for those that fail chemotherapy and becoming more widely used.

Pre-chemo meds can include corticosteroids,  anti- nausea, anti-anxiety. White cell booster shots may also be needed such as Neulasta or Neupogen. 


*Availability depends on geographical area and hospital/doctors.



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Blood Transfusions

As part of treatment, some women may or potentially need a blood transfusion or more than one. This can be due to blood loss or hemorrhage and/or from anemia from the chemotherapy treatment.

​*Medical Disclaimer. The information on this site is not intended or implied to be a substitute for professional or medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.

Last Updated on February 7, 2023