Understanding Gestational Trophoblastic Disease (GTD): What You Need to Know

You might not have heard of gestational trophoblastic disease, or GTD, before today. This is a rare health condition that can sometimes happen during pregnancy. In simple terms, it involves unusual cell growth inside your womb where your baby grows. Let us look at how this happens and what it means for you.

These growths start in cells called trophoblasts. Normally, these cells grow into the placenta. You know the placenta as the vital organ that brings oxygen and food to your baby. It also connects your baby safely to your womb.

With GTD, those trophoblast cells do not grow into a normal placenta. Instead, they grow in an abnormal way. Most of the time, this happens very early in pregnancy right after a sperm joins an egg. Doctors often call these molar pregnancies.

Even though people call them pregnancies, these cells do not grow into a real baby. Most of these growths are benign. This they are not cancer. However, some types can become cancerous and spread to nearby tissue. The most important thing to know is that doctors can treat and cure GTD. Many women go on to have healthy pregnancies afterward.

When Does GTD Happen?

GTD usually happens in the early weeks of pregnancy. However, it can also happen at other times. You might experience this condition after a miscarriage or after an abortion procedure. It can also happen after a tubal pregnancy where the egg implants in your fallopian tube instead of the womb. In very rare cases, it can even happen after a normal full-term pregnancy.

What Are the Types of GTD?

There are a few different types of GTD. Your symptoms and treatment will depend on the exact type you have. Let us explore each one in detail.

Hydatidiform Mole or Molar Pregnancy.

This is the most common type of GTD. People commonly call it a molar pregnancy. Instead of a normal placenta or baby, grape-like clusters of tissue grow inside your womb. You might feel pregnant, and your pregnancy test might even show a positive result. However, an ultrasound scan will show no growing baby.

The pregnancy test stays positive because of the pregnancy hormone made inside the tissue. There are two main types of hydatidiform moles: complete moles and partial moles. Most molar pregnancies are not cancer.

The most common sign of a molar pregnancy is unusual bleeding from your vagina during early pregnancy. This blood can look bright red or watery and brown. Sometimes it comes with mild belly pain.

Persistent or Invasive Molar Pregnancy.

This type develops as a result of a molar pregnancy. An invasive mole grows deep into the muscle wall of your womb. Unlike other moles, invasive moles are usually cancerous. If left untreated, these cells usually stay in the womb muscle, but they can sometimes spread to other parts of your body.

Choriocarcinoma.

Choriocarcinoma is a cancerous type of GTD that grows and spreads very quickly. It can start in your womb muscle and spread to your vagina, lungs, kidneys, liver, or brain. This is a very rare condition, but people who had a molar pregnancy before have a higher chance of developing it.

Some people have no symptoms at all. For those who do, the most common sign is unusual bleeding after a pregnancy, miscarriage, or molar pregnancy. Some people also notice belly pain or blood in their urine or stool.

Placental Site Trophoblastic Tumor.

A placental site trophoblastic tumor, or PSTT, is a very rare type of GTD. It forms right where the placenta attached to your womb wall. PSTT grows very slowly. Because of this, symptoms might not show up until years after a pregnancy. PSTT can spread to the womb muscle, blood vessels, lungs, pelvis, and lymph nodes, so it needs active medical care.

Epithelioid Trophoblastic Tumor.

This is another very rare, cancerous type of GTD. Just like PSTT, this tumor can spread to your lungs. An epithelioid trophoblastic tumor can also develop years after a previous pregnancy.

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How Common Is This Condition?

In the United States, GTD happens in about 1 out of every 1,000 pregnancies. Hydatidiform moles are the most common form of GTD. Serious types like choriocarcinoma happen in fewer than 1 out of every 20,000 pregnancies. This means these severe forms are very rare.

Can GTD Be Fatal?

Most cases of GTD, especially when found early, are cured completely with treatment. However, advanced cases of GTD that go untreated can be fatal. This is why early detection and prompt medical care are so important.

What Are the Symptoms of GTD?

Some people with GTD have no symptoms at all. Others have symptoms that mimic a normal pregnancy or other health conditions. If you notice any of these signs, you must see your doctor right away:

• Irregular vaginal bleeding or bleeding that has nothing to do with your normal period.
• Your womb feels much larger than expected for how far along you should be.
• Pain in your lower belly or pelvic area.
• Severe nausea and vomiting that feels worse than normal morning sickness.
• High blood pressure or swelling in your hands and feet very early in pregnancy.
• Vaginal bleeding that continues long after a baby is born or after a miscarriage.

Gestational trophoblastic disease can sometimes make your thyroid gland overactive. If this happens, you might notice these signs:

• A fast heartbeat.
• Shaking in your hands.
• Sudden weight loss.
• Heavy sweating.

What Causes Molar Pregnancies?

In a normal pregnancy, a sperm fertilizes an egg and provides all the instructions needed to build an embryo and a placenta. This early cluster of cells is called a blastocyst. This embryo later grows into a fetus. Trophoblast cells help the blastocyst attach to your womb wall.

In a molar pregnancy, fertilization does not happen correctly, so the embryo does not grow right. Instead, trophoblast cells grow into tumor clusters instead of a healthy placenta. This is the root cause of the condition.

How Do Doctors Diagnose GTD?

Your doctor will check for GTD by reviewing your medical history, doing a physical exam, and running special tests. Doctors use these methods to diagnose GTD:

• Pelvic exam: Your doctor puts gloved fingers into your vagina to feel your womb and check its size or check for any unusual lumps.
• Ultrasound scan: This test uses sound waves to create pictures of your inside organs. If your doctor suspects GTD, they may use a transvaginal ultrasound to get clear pictures of your pelvis and womb.
• Blood tests: Blood tests measure specific substances in your body. For example, pregnant women with GTD have much higher levels of human chorionic gonadotropin, or hCG, than women with normal pregnancies.

Staging the Disease.

Once doctors confirm you have GTD, they may order more tests to see if cancer cells have spread to other parts of your body. Finding out how far the disease has spread is called staging. These results help your doctor figure out which stage of the disease you have.

Doctors write cancer stages using Roman numerals like I, II, III, and IV. Higher numbers mean the disease has spread further.

Doctors use these tests to determine the stage of GTD:

• CT scan: This test uses a series of X-rays and a computer to create 3D images of your tissues and bones.
• MRI scan: This test uses a strong magnet and radio waves to take detailed pictures of your body. Your doctor might inject a dye called gadolinium into your veins to make tumor cells show up clearly.
• Chest X-ray: This test uses a focused radiation beam to check your lungs, chest organs, and bones.

How Do Doctors Treat GTD?

Treatments for gestational trophoblastic disease vary depending on several factors. These factors include:

• The type of GTD, tumor size, and exact location.
• Whether the tumor has spread and its current stage.
• Whether the condition started during pregnancy, after a miscarriage, or after childbirth.
• Your overall health status.
• Your medical history and any past treatments for GTD.
• Whether you plan to have children in the future.

Your doctor will choose the treatment plan that fits your situation best. Common treatments for GTD include:

• Surgery: Procedures to remove abnormal tissue and cells from your womb. The most common surgery for GTD is a dilation and curettage, or D&C. During this procedure, your doctor opens your cervix and cleans out the womb.
• Chemotherapy: Chemotherapy uses special medicines to kill cancer cells throughout your body.
• Radiation therapy: Radiation therapy uses strong energy beams to kill cancer cells and shrink tumors.
• Hysterectomy: A hysterectomy is a surgery to remove your womb completely. Sometimes surgeons also remove your fallopian tubes and ovaries.

You and your doctor should talk together about your treatment options, risks, and side effects so you can make an informed choice.

Can GTD Come Back?

Yes, gestational trophoblastic disease can come back. Depending on your initial type of GTD and how well you responded to treatment, there is a small risk it might return. This is why doctors continue to monitor your health closely even after treatment ends.

Can You Have a Baby After GTD?

Yes, absolutely! Most people who have a history of GTD go on to have normal, healthy pregnancies later. Depending on your medical history, your doctor may suggest extra tests during your next pregnancy to make sure everything is fine.

Can You Prevent GTD?

Doctors have not found a way to prevent gestational trophoblastic disease. This condition is something outside of your control.

What Are the Risk Factors for GTD?

Even though GTD is rare, certain risk factors can increase your chances of developing it. These factors include:

• Your age: People older than 35 or younger than 20 have a slightly higher risk of GTD.
• Past history: Having had a molar pregnancy in the past.
• Family history: Having a family history of molar pregnancies.

What Should We Remember From All This?

Learning that you have gestational trophoblastic disease can feel scary, confusing, and overwhelming. Coping with a pregnancy loss combined with a complex diagnosis is very difficult.

Remember that your doctor will run tests, understand your condition fully, and choose the right treatment for you. Most importantly, doctors can treat and cure GTD in most cases. Your chances of having children in the future, if you wish, remain very good.

During this hard time, lean on your family, friends, and doctors for support. Never hesitate to ask questions and speak your mind. You are not alone, and many people are here to help you.