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Types of treatment for persistent disease and choriocarcinoma

Men and women discussing gestational trophoblastic tumours

This page tells you about treatment for persistent trophoblastic disease (PTD) or choriocarcinoma. There is information below about

 

A quick guide to what's on this page

Types of treatment for persistent trophoblastic disease and choriocarcinoma

Persistent trophoblastic disease (PTD) and choriocarcinoma are types of pregnancy related tumours called gestational trophoblastic tumours (GTTs). There is treatment available for all types and stages of GTT. And nearly all of them are cured.

Women who had a molar pregnancy will have had a small operation called a D and C to remove the molar tissue from the womb. If the molar tissue comes back you will need treatment for persistent trophoblastic disease. 

Your doctor decides on your treatment depending on whether there is a low or high risk of the PTD coming back again after treatment.

If you have low risk disease you usually have a course of chemotherapy injections into the muscle of your bottom. For most women this cures their GTT. But a small number may need further chemotherapy treatment with drugs through a drip into a vein.

If you have high risk disease you will have chemotherapy treatment into a vein. If your disease has spread to your brain, you may need chemotherapy injected into the fluid around your spinal cord.

Some women may need to have surgery if their PTD or choriocarcinoma does not respond to chemotherapy, or if the tumour is causing excessive bleeding.

Doctors very rarely use radiotherapy to treat GTT. But you might have it to treat disease that has come back and is affecting the brain, or disease that has not responded to chemotherapy.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating persistent trophoblastic disease and choriocarcinoma section.

 

 

What PTD and choriocarcinomas are

Persistent trophoblastic disease (PTD) and choriocarcinoma are types of pregnancy related tumours called gestational trophoblastic tumours (GTT for short). Treatment is available for all types and stages of GTT. And nearly all of them are cured. The important thing is to begin treatment as soon after your diagnosis as possible.

 

The main treatments

If you had a molar pregnancy, you will have had a small operation called a D and C. The surgery removes the tissue that can develop into persistent trophoblastic disease. 

If this doesn't completely get rid of the molar tissue, you may need further treatment with chemotherapy. About 10 to 15 out of 100 women (10 to 15%) need chemotherapy after the D and C. There is information about the treatments for molar pregnancy elsewhere in this section.

If you need chemotherapy treatment you will either have chemotherapy treatment for low risk GTT or chemotherapy treatment for high risk GTT. A few women need surgery and an even smaller number may have radiotherapy.

Your doctors will plan your treatment according to:

  • the type of GTT you have
  • how far your tumour has grown or spread (the stage)
  • your levels of the hormone hCG in your blood and urine
  • the length of time since your pregnancy
  • whether you have had previous treatment for GTT
  • your general health and level of fitness
  • your age

 

 

Chemotherapy for low risk disease

If staging shows that you are in the low risk group you’ll need the low risk treatment after your D and C operation. You usually have a course of chemotherapy injections into the muscle of your bottom (buttock). For most women this cures their GTT. 

But some women may need further chemotherapy treatment by drip into a vein (intravenous treatment). About 8 out of 10 women (80%) who need chemotherapy treatment after a molar pregnancy will be in the low risk group.

Read more detailed information about the chemotherapy treatment. 

 

 

Chemotherapy for high risk disease

If you are in the high risk group you will have the high risk treatment. You have this chemotherapy treatment into a vein (intravenously).

If your GTT has spread to your brain (which is very unusual), you may need chemotherapy injected into the fluid around your spinal cord. This is called intrathecal chemotherapy.

Find out more about the chemotherapy treatment

 

Surgery and radiotherapy

Some women may need to have surgery, such as a hysterectomy for one or more of the following reasons:

  • their GTT does not respond to chemotherapy
  • the GTT is causing a lot of vaginal bleeding

There is information about hysterectomy in the surgery for persistent trophoblastic disease and choriocarcinoma section.

Doctors very rarely use radiotherapy to treat GTT. But you might have it to treat disease that has come back in the brain, or disease elsewhere in the body that has not responded to chemotherapy.

 

The medical and nursing team

Usually a team of doctors and other health professionals work together. They consider your case and decide together on the best treatment for you. They specialise in different aspects of treatment, but work together as a multi disciplinary team (MDT). The team may include:

  • a surgeon who specialises in cancer of the womb, ovaries, cervix and vagina
  • one or more specialists in chemotherapy and radiotherapy (medical or clinical oncologist)
  • a gynaecology specialist nurse
  • physiotherapists
  • psychologists or counsellors
  • social workers

 

 

Where you have treatment

You have the D and C operation at your local hospital. But if you need chemotherapy you will go to one of the UK specialist centres:

  • Charing Cross Hospital in London
  • Weston Park Hospital in Sheffield
  • Ninewells Hospital in Dundee

The amount of time you need to spend in hospital depends on the treatment you have. You are likely to need to stay in hospital for at least a week at the start of treatment. The overall course of treatment usually lasts between 3 and 6 months. You may be able to have much of the treatment as an outpatient at your local hospital.

 

More information

There is information about chemotherapy, surgery and radiotherapy for persistent disease and choriocarcinoma in this section.

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Updated: 23 June 2016