Staging persistent trophoblastic disease and choriocarcinoma
Staging persistent disease and choriocarcinoma
Persistent trophoblastic disease and choriocarcinoma belong to a group of tumours called gestational trophoblastic tumours (GTTs). The tests and scans that your doctor carries out will give information about the stage. This means whether the disease has spread, and if so, how far. Staging is important because treatment is decided according to the stage.
The number stages of gestational trophoblastic tumours
There are 4 main stages. Stage 1 is an early tumour that affects only the womb. Stage 2 is when the tumour has spread outside the womb to genital areas nearby, such as the vagina and ovary. In stage 3 the disease has spread to the lungs and may or may not be affecting the local area around the womb. In stage 4 the disease has spread (metastasised) to other parts of the body.
With persistent trophoblastic disease or choriocarcinoma your doctors look at certain risk factors that help them to decide about chemotherapy treatment. These factors include
- Your age
- The type of pregnancy you had
- The time between the end of pregnancy and your diagnosis
- The level of a hormone called human chorionic gonadotrophin (hCG) in your blood
- The size of your tumour
- How much the tumour has spread.
You can view and print the quick guides for all the pages in the treating persistent trophoblastic disease and choriocarcinoma section.
The stage of persistent trophoblastic tumour (PTD) or choriocarcinoma means whether the tumour is just in the womb or has spread to other areas of the body. Staging is important because treatment is decided according to the stage. The tests and scans that your doctors carry out give them information about the stage.
The staging system used for gestational trophoblastic tumours is called the FIGO staging system. This system looks at the stage of disease and scores risk factors to work out which treatment you need. It uses a numbering system for both the stage and risk factor score.
If your hCG levels go back to normal soon after removal of the molar pregnancy, your doctor won't need to give you a stage. In most women the hCG level virtually disappears within 4 to 6 weeks of removing a molar pregnancy. Once the molar tissue has gone it can’t produce hCG. So apart from follow up blood and urine tests to check whether the molar tissue has come back, you won’t need any further treatment.
But you will need further tests to help stage your disease if:
- your hCG level stays the same on 4 measurements over a period of 3 weeks or longer
- your hCG goes up on 2 measurements in a row, over a period of at least 2 weeks
- your hCG level is more than 20,000 IU/L (international units per litre) at more than 4 weeks after surgery
- your hCG level stays high for 6 months or longer, even if the level is coming down
- there is evidence of choriocarcinoma in the tissue sample taken during removal of a molar pregnancy
- you have heavy vaginal bleeding and/or severe abdominal pain
There are 4 main stages. Stage 1 is an early tumour and stage 4 the most advanced.
This is the earliest stage of GTT when the tumour is only in the womb (uterus).
This is when the tumour has spread outside the womb to genital areas nearby, such as the vagina or ovary. It has not spread outside the pelvis.
The GTT has spread to the lungs and may or may not be in the local area around the womb.
The disease has spread (metastasised) to other parts of the body, such as the liver or brain.
When you are diagnosed with GTT your doctors look at certain risk factors that help them decide about chemotherapy treatment and which drugs are best for you. The scores for each risk factor are 0,1,2 and 4. These risk factors are:
- age – the younger you are, the lower your score
- the type of pregnancy you had – a molar pregnancy is low risk, an abortion or miscarriage means a slightly higher risk, and full term pregnancy gives a higher score
- time between the pregnancy event and your diagnosis – less than 4 months is a low score and more than a year is a higher score
- the hCG level in the blood – the higher the level of hCG the greater the score
- the amount of tumour spread – the more areas of your body the tumour has spread to, the higher the score
- the parts of your body affected– tumour spread to the lungs or vagina is a low score, to the spleen or kidneys is a slightly higher score, and spread to the brain or liver is higher again
- the size of the tumour– the larger the tumour, the greater the score
- previous chemotherapy – if you have already had chemotherapy for your GTT but it has come back, this increases your score further
The doctors add up your scores to give a total and they group women into two groups – high risk or low risk. Low risk means your risk factor score is 6 or less, and high risk means your score is 7 or more.
Most women needing treatment after a molar pregnancy will have a low risk score.
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