Hydatidiform mole: 1 in 1000–2000 pregnancies (United States and Europe)
Choriocarcinoma: 1 in 20,000–40,000 pregnancies (United States and Europe)
Gestational trophoblastic neoplasia (GTN) lesions are nearly always disorders of the reproductive years. The incidence is higher in women <20 years and >40 years
Gestational Trophoblastic Neoplasia
Potential for local invasion and metastases
Most commonly develops after a molar pregnancy, but can arise de novo after any gestational experience: spontaneous or induced abortion, ectopic pregnancy, or preterm or term pregnancy
The most common sites of metastases are lungs (80%), brain (10%) liver (10%), and vagina (~5%)
Hancock BW et al. Gestational Trophoblastic Disease, 3rd ed, 2009
FIGO Anatomic Staging System for GTN
|Stage ||Extent of GTN |
|I: ||Confined to the uterus |
|II: ||Extends outside the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament) |
|III: ||Extends to the lungs, with or without known genital tract involvement |
|IV: ||All other metastatic sites | Favorite Table
FIGO Scoring System✫ (Modified WHO Scoring System)
[Note: This scoring system does not apply to patients with placental-site trophoblastic tumors]
|Prognostic Factor ||0 ||1 ||2 ||4 |
|Age (years) ||≤39 ||>39 ||— ||— |
|Antecedent pregnancy ||Hydatidiform mole ||Abortion ||Term pregnancy ||— |
|Interval from index pregnancy ||<4 months ||4–6 months ||7–12 months ||>12 months |
|Pretreatment hCG level (IU/L) ||<1000 ||1000–10,000 ||>10,000–100,000 ||>100,000 |
|Largest tumor size including uterus ||— ||3–4 cm ||≥5 cm ||— |
|Sites of metastases ||Lung† ||Spleen, kidney ||GI tract ||Brain, liver |
|Number of metastases identified† ||0 ||1–4 ||5–8 ||>8 |
|Previous ineffective chemotherapy ||— ||— ||Single drug ||≥2 drugs |
✫FIGO staging system includes a modification of the WHO prognostic index score for risk assessment
†Chest x-ray is used to count the number of metastases for risk score assessment
Note: Total score for a patient is obtained by adding individual scores for each prognostic factor
|Total Score ||Risk |
|0–6 ||Low risk |
|≥7 ||High risk |
Both FIGO Anatomic Staging System and the Modified WHO score should be used. By convention, the FIGO stage is depicted by a Roman numeral and is followed by the Modified WHO Score depicted by an Arabic numeral. The 2 values are separated by a colon (eg, III:9)
Kohorn EI:. Int J Gynecol Cancer 2001;11:73–77
Ngan HYS et al. Int J Gynaecol Obstet 2003;83:175–177
Once a diagnosis of GTN has been made, it is necessary to determine the extent of disease
Once the initial work-up is completed, patients are categorized (see Staging below)
Note: For staging purposes, the hCG level that is important is that obtained immediately before instituting treatment and not the hCG obtained at the time of the previous molar evacuation
CBC, LFT, serum electrolytes, BUN, creatinine, PTT, and PT
CT of chest, abdomen, and pelvis
MRI brain ...
Log In to View More
If your institution is currently a subscriber
of the HemOnc Collection please sign in below.
If your institution is not a subscriber
please click here
to learn more.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.