Things you need to know about Gestational Trophoblastic Disease (GTD)!

You may not have heard of the term Gestational Trophoblastic Disease (GTD). But it is a condition that can sometimes occur during pregnancy. Simply put, it is a type of tumor that develops in your uterus, the place where your baby is developing, and is related to pregnancy. Shall we talk about this in a little more detail?

These tumors start to develop from cells called trophoblasts . These cells are usually the ones that develop into the placenta during pregnancy. You know, the placenta is the most important part that connects the baby to your uterus, providing oxygen and nutrients to the baby inside your uterus.

However, in this `GTD` condition, instead of developing into a healthy placenta, those trophoblast cells (i.e., placenta-like cells) grow abnormally.

Most often, GTD occurs early in pregnancy, after a sperm fertilizes an egg. We also call these molar pregnancies . But even though these are called pregnancies, these cells do not develop into an embryo that develops into a baby. Most of the time, these are non-cancerous (benign) conditions. However, some of them can become cancerous and spread to nearby tissues and organs. The important thing is that GTD is a treatable condition. Most people can go on to have healthy pregnancies after this condition.

What are the possible situations where GTD can occur?

We often say that `GTD` occurs in early pregnancy. However, this condition can also occur at other times:

• Either after a miscarriage or after an abortion.
• After a tubal pregnancy. That is, when the fertilized egg implants in the fallopian tube instead of in the uterus.
• Even after a normal pregnancy, it can occur very rarely.

What are the types of GTD? So let's see?

There are different types of `GTD`. The symptoms also vary depending on the type.

Hydatidiform mole or molar pregnancy

This is the most common type of GTD. It is also commonly called a molar pregnancy . This is when, instead of a placenta or embryo, a grape-like cyst develops in your uterus. You may feel pregnant, and a pregnancy test may be positive. However, an ultrasound scan will not show a developing baby. The pregnancy test is positive because of the pregnancy hormone produced by the placenta. There are two types of hydatidiform moles: complete and partial hydatidiform moles. Most molar pregnancies are not cancerous.

The most common symptom of a molar pregnancy is unusual vaginal bleeding early in the pregnancy. This bleeding can be red or watery brown. It can sometimes be accompanied by abdominal pain.

Persistent/invasive molar pregnancy

This is considered a molar pregnancy. This type of invasive mole can grow into the uterine muscle. Unlike other types of molar pregnancies, these invasive moles are usually cancerous. If left untreated, these cancer cells often remain in the uterine muscle, but they can sometimes spread to other parts of the body or tissues.

Choriocarcinoma

Choriocarcinoma is a cancerous, fast-growing type of GTD. It starts in the lining of your uterus and can spread to other organs, such as your vagina, lungs, kidneys, liver, and brain. This is also a very rare condition, but it is more likely to develop in people who have had a previous molar pregnancy.

Some people may not have any symptoms at all. But for those who do have symptoms, the most common symptom is abnormal vaginal bleeding after a miscarriage, abortion, or molar pregnancy. Some people may also experience abdominal pain, blood in the urine, or blood in the stool.

Placental site trophoblastic tumor (PSTT)

Placental site trophoblastic tumor (PSTT) is a very rare type of GTD. It develops where the placenta attaches to the uterus. A PSTT grows very slowly. Therefore, it can take years after pregnancy for symptoms to appear. PSTT can spread to the uterine muscles, blood vessels, lungs, pelvis, and lymph nodes, so active treatment is needed.

Epithelioid trophoblastic tumor (ETT)

This is also a very rare, cancerous type of `GTD`. Like `PSTT`, it can also spread to the lungs. `ETT` can also develop years after pregnancy.

How common is this condition?

In the United States, it is said that GTD occurs in about 1 in 1,000 pregnancies. The most common type of GTD is hydatidiform moles, which we discussed earlier. More serious GTD conditions, such as choriocarcinoma, occur in less than 1 in 20,000 pregnancies. This means that they are very rare.

Can GTD be fatal?

Many cases of GTD, especially if detected early, can be treated and completely cured. However, in advanced cases, GTD can be fatal. That's why early detection and treatment are important.

What are the symptoms of GTD?

Some people with GTD may not experience any symptoms at all. Others may experience symptoms similar to those of pregnancy or other illnesses/conditions. If you have any of these symptoms, be sure to see your doctor:

• If you have irregular vaginal bleeding, or bleeding that is not related to your monthly period.
• If your uterus feels larger than expected for your pregnancy.
• If you have pain in the abdomen or pelvic area.
• If nausea and vomiting occur earlier than expected during pregnancy.
• If you have high blood pressure early in pregnancy, or if your limbs are swollen.
• If you continue to bleed from your vagina, whether after having a baby or after a miscarriage.

Gestational Trophoblastic Disease can sometimes cause an overactive thyroid . If this happens, you may experience symptoms such as:

• Heart rate increases.
• Trembling.
• Weight loss.
• Sweating.

What are the causes of molar pregnancies?

Simply put, in a normal pregnancy, when an egg is fertilized by a sperm, it contains all the information needed to form an embryo and a placenta. We call this early collection of cells a blastocyst . This embryo is what later develops into a fetus. The trophoblast cell layer becomes part of the placenta and helps the blastocyst attach to the uterine wall.

However, in a molar pregnancy, the embryo does not develop properly because fertilization did not occur. Instead, the trophoblast cells develop into tumors instead of a healthy placenta. This is the main cause.

How to identify GTD?

Your doctor will diagnose GTD by taking your complete medical history, performing a physical exam, and performing other tests to look inside your uterus. GTD can be diagnosed by:

• Pelvic exam: The doctor inserts gloved fingers into the vagina and checks for signs of disease, such as lumps or masses, or the size of the uterus.
• Ultrasound scan: This uses sound waves to take pictures of your internal organs. If your doctor suspects GTD, a transvaginal ultrasound will take pictures of your pelvis and uterus.
• Blood tests: To help diagnose GTD, blood tests are done to measure the levels of certain substances in your body. For example, a pregnant woman with GTD may have much higher levels of a hormone called human chorionic gonadotropin (hCG) than a pregnant woman without GTD. If the cancer has spread to other tissues or organs, your body may produce more or less of certain substances to indicate the disease.

Determining the stages of the disease

After you are diagnosed with GTD, your doctor may order additional tests to see if the cancer has spread to other parts of your body. Staging is the process of finding out how far and how much the cancer has spread. These results help doctors determine what stage of cancer you have.

The stages of cancer are written in Roman numerals as I, II, III, and IV. The higher the number, the more extensive the cancer has spread.

Tests used to determine the stages of `GTD` can be:

• CT scan (Computed tomography - CT scan): This uses a series of X-rays and a computer to create a three-dimensional (3D) image of tissue and bones.
• MRI scan (Magnetic resonance imaging - MRI): This uses a magnet and radio waves to make detailed pictures of your body. The doctor may inject a substance called gadolinium into your veins, because this substance makes cancer cells more visible in the picture.
• Chest X-ray: This uses a focused radiation beam to examine your lungs, other organs inside your chest, and bones.

How is GTD treated?

Treatment options for Gestational Trophoblastic Disease vary. There are several factors that affect it. Such as:

• The type of `GTD`, the size of the tumor, and its location.
• Whether the tumor has spread, or what its stage is.
• Whether the tumor occurred during pregnancy, or after a miscarriage or childbirth.
• Your overall health.
• Your medical history and whether you have previously been treated for GTD.
• Your plans for having children.

Your doctor will determine the most appropriate treatment for your condition. Here are some specific treatments for GTD:

• Surgery: Surgery to remove abnormal tissue and cells from the uterus. The most common surgery for GTD is a dilation and curettage (D&C) . This involves opening the cervix and cleaning the uterus.
• Chemotherapy: Chemotherapy, or "chemo," is the use of drugs to destroy cancer cells.
• Radiation therapy: Radiation therapy uses strong energy beams to kill cancer cells and shrink tumors.
• Hysterectomy: A hysterectomy is a surgical procedure that removes your uterus. Sometimes, other organs, such as the fallopian tubes and ovaries, may also be removed.

You and your doctor should discuss the available treatments, as well as the risks and side effects of those treatments.

Can GTD recur?

Yes, Gestational Trophoblastic Disease can recur. Depending on the type of GTD you had initially and how you responded to treatment, there is a small risk of recurrence. That's why doctors will continue to monitor you after treatment.

Can I have a baby after GTD?

Yes, absolutely! Most people with a history of `GTD` can go on to have normal, healthy pregnancies. However, depending on your history, your doctor may recommend some additional testing in subsequent pregnancies.

Can GTD be prevented?

There is no way to actually prevent Gestational Trophoblastic Disease. This is something we cannot control.

Risk factors for developing GTD

Although Gestational Trophoblastic Disease is a rare condition, there are some factors that you cannot control that can increase your risk of developing it. These factors include:

• Your age. People over 35 years old and those under 20 years old are at slightly higher risk of developing GTD.
• If you have had previous molar pregnancies .
• If someone in the family has had molar pregnancies, that means family history is involved.

So, what are the things we need to remember from all of this?

When you find out you have Gestational Trophoblastic Disease (GTD), it's normal to feel scared, worried, and sad. It can also be difficult to cope with the loss of your pregnancy and receiving such a complex diagnosis at the same time.

But remember, your doctor will perform various tests, understand your exact condition, and determine the most appropriate treatment. The important thing is that in most cases, `GTD` is a treatable condition. Your chances of getting pregnant again (if you want to) are also very good.

Seek support from your family, friends, and doctors during this difficult time. And don't hold anything back, and don't be afraid to ask questions. You are not alone, we are all with you.

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