Gestational Trophoblastic Disease Treatment

Gestational trophoblastic disease (GTD) treatment may include surgery, chemotherapy and, in rare cases, radiation therapy. You may also need support for symptoms and follow-up care after treatment.

Gestational trophoblastic disease treatment plans

Your treatment plan depends on several factors:

• The type of GTD (molar pregnancy, invasive mole, choriocarcinoma, etc.)
• How far the disease has spread
• Your levels of human chorionic gonadotropin (hCG), a hormone made by placental tissue during pregnancy
• Whether you want to have children in the future

Low-risk GTD usually refers to cases where the disease is limited in spread, hCG levels are lower, and there is no significant organ involvement. These cases are generally easier to treat and have a very good prognosis. Treatment often involves dilation and curettage (D&C), and sometimes single-drug chemotherapy if needed.

High-risk GTD refers to cases where the disease has spread to other organs, hCG levels are very high, or there are signs that the disease may behave more aggressively. These cases require more intensive treatment, usually multi-drug chemotherapy, and may sometimes involve surgery or radiation.

Gestational trophoblastic disease surgery

Surgery is usually the first treatment, especially for molar pregnancies (a type of non-cancerous GTD). Surgery helps remove abnormal tissue from the uterus.

Dilation and curettage (D&C) with suction

This is the most common surgery for complete or partial molar pregnancies. The doctor gently opens the cervix and removes the tissue with a suction tool. Then, the inside of the uterus is lightly scraped with a spoon-shaped instrument to make sure no tissue is left behind. Regular blood tests are done afterward to make sure hCG levels return to normal.

Additional patient-care details:

• Most D&C procedures are performed on an outpatient basis, which means patients can go home the same day.
• The surgery is usually done under general anesthesia, although some patients may receive deep sedation instead.
• Most people can resume light activities, such as preparing simple meals or taking short trips around the house, within one to two days.
• Many patients can return to desk work or other light duties within three to five days, depending on how they feel.
• Full recovery (including the uterus returning to its normal state and most discomfort resolving) typically takes one to two weeks.

Hysterectomy

This surgery removes the uterus and sometimes nearby areas like the cervix or part of the vagina. It may be recommended if:

• You don’t want more children.
• The tumor is large or bleeding heavily.
• The GTD is a type that does not respond well to chemotherapy.

Additional patient-care details:

• A hysterectomy is usually an inpatient surgery, and most patients stay in the hospital for one to two days, although some minimally invasive procedures may allow same-day discharge.
• The surgery is performed under general anesthesia.
• Most people can resume basic tasks such as light meal preparation or gentle walking after one to two weeks, but heavier chores (such as vacuuming, lifting or pushing carts) usually need to wait four to six weeks.
• The time it takes to return to work varies. People with desk or non-physical jobs can often return within two to four weeks, while those with physically demanding jobs may need six to eight weeks.
• Complete recovery, including internal healing, generally takes six to eight weeks, and sometimes longer depending on the surgical method and the patient’s overall health.

Surgery side effects:

• Cramping and bleeding after D&C
• Infertility if you have a hysterectomy
• Risk of infection (rare)

Most side effects go away after treatment ends, but some may last longer. Your care team can help you manage these.

Learn more about surgery.

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer, its stage, and how fast it is growing.

Chemotherapy is most often used for gestational trophoblastic neoplasia (GTN), which refers to the cancerous types of gestational trophoblastic disease, not the non-cancerous molar pregnancies.

Patients can receive chemotherapy as pills, injections, or through an intravenous (IV) line. If chemotherapy is given intravenously, each session usually lasts about 30 minutes to a few hours, depending on the drug combination and dosage. Most chemotherapy treatments for GTN are given in cycles—often once a week or once every two weeks for several weeks or months. The exact schedule depends on whether the patient is receiving single- or multi-drug chemotherapy and how well the body responds to treatment.

• Single-drug chemotherapy is for low-risk GTN, and one drug is often enough. It may be given as a shot or a pill.
• Multi-drug chemotherapy is used to treat high-risk GTN.  More than one drug is used in a cycle. These are stronger treatments but can cause more side effects.

Chemotherapy side effects:

• Fatigue (feeling very tired)
• Nausea or vomiting
• Hair loss (especially with multi-drug chemotherapy)
• Mouth sores
• Increased risk of infections
• Irregular or stopped periods (may be temporary)
• Fertility issues (usually temporary, but can be long-term with certain drugs)

Learn more about chemotherapy.

Radiation therapy

Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue. While rarely used in GTN, radiation therapy may be used in specific circumstances:

• If GTD spreads to the brain, radiation may be used to shrink the tumor and reduce bleeding in the brain.
• To ease symptoms, radiation may help relieve pain or pressure when tumors have spread and can’t be fully treated with surgery or chemotherapy.

If radiation therapy is recommended, treatment is usually given once a day, five days a week for about two weeks. Each visit typically takes 15 to 30 minutes, although the actual radiation exposure lasts only a few minutes.

Side effects of radiation therapy for GTN are usually mild and depend on where the tumor is located. When radiation is directed at the brain, side effects may include:

• Fatigue
• Headaches
• Hair loss in the treated area
• Mild skin irritation
• Temporary nausea  

 Learn more about radiation therapy.

Gestational trophoblastic disease survivorship care

Most people with GTD recover fully and can go on to have healthy pregnancies. Regular follow-up is very important to catch any signs of the disease returning.

Follow-up care may include:

• Blood tests (usually hCG levels every 1–2 weeks, then monthly)
• Physical exams
• Birth control during recovery (usually 6–12 months) to avoid confusing hCG results
• Emotional and mental health support
• Fertility counseling if you want to get pregnant in the future

Learn more about gestational trophoblastic disease:

• Gestational trophoblastic disease overview
• Gestational trophoblastic disease symptoms
• Gestational trophoblastic disease diagnosis
• Gestational trophoblastic disease stages