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Gynecologic Oncology Program

Patient and Family Education

Gestational Trophoblastic Disease

Stages

If a patient has gestational trophoblastic disease, her doctor will do tests to find out if the cancer has spread from inside the uterus to other parts of the body. This process, called staging, helps the doctor to plan the patient's treatment.

Several classification systems have been developed for staging gestational trophoblastic disease. The one used most commonly in the United States describes the stages of the disease based on whether or not the cancer has metastasized (spread) and on the patient's prognosis (chances of recovery).

Because hydatidiform moles and placental-site gestational trophoblastic tumors are distinct growths requiring distinct therapies, they are treated as separate stages. Thus, the stages of gestational trophoblastic disease may be described as follows:

Hydatidiform mole: Abnormal tissue is found only in the space inside the uterus. Most patients will recover without needing more therapy but need to have their serum hCG followed weekly. Treatment usually involves removal of the mole using dilation and curettage (D&C) and suction evacuation. Surgery to remove the uterus (hysterectomy) is not usually performed but may be considered for older patients. In about 1 percent of cases, the patient may have a second mole with the next pregnancy.

Placental-site gestational trophoblastic tumor: Cancer has grown in the place where the placenta was attached and in the muscle of the uterus. Treatment will probably be surgery to remove the uterus (hysterectomy).

Nonmetastatic gestational trophoblastic disease: Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following a miscarriage, abortion, or delivery of a baby. Cancer has not spread outside the uterus. If the hCG levels do not fall appropriately, the patient may need chemotherapy. Surgery to remove the uterus (hysterectomy) is an option if the patient no longer wishes to have children.

Metastatic, good prognosis: Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following a miscarriage, abortion, or delivery of a baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumors are considered to have good prognosis if all of the following are true:

• The last pregnancy was less than four months ago.
• The level of beta hCG in the blood is low.
• Cancer has not spread to the liver or brain.
• The patient has not received chemotherapy earlier.
• The course of treatment for patients at this stage will involve chemotherapy and may include hysterectomy, if necessary.

Metastatic, poor prognosis: Cancer cells have grown inside the uterus from tissue remaining following treatment of a hydatidiform mole or following a miscarriage, abortion, or delivery of a baby. The cancer has spread from the uterus to other parts of the body. Metastatic gestational trophoblastic tumor is considered to have a poor prognosis if all of the following are true:

• The last pregnancy was more than four months ago.
• The level of beta hCG in the blood is high.
• Cancer has spread to the liver or brain.
• The patient received chemotherapy earlier and the cancer did not go away.
• The tumor began after the completion of a normal pregnancy.
• Treatment will probably be chemotherapy. Radiation therapy may also be given to places where the cancer has spread, such as the brain.

Recurrent: Recurrent disease is cancer that has come back (recurred) after it has been treated. It may come back in the uterus or in another part of the body. A woman who has been treated for gestational trophoblastic disease will need to have a series of follow-up tests to make sure that the disease has not returned or spread.

This page was last updated on: October 6, 2009.

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