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Placental site trophoblastic tumour

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This page tells you about a very rare type of tumour called a placental site trophoblastic tumour. There is information about

 

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Placental site trophoblastic tumours

A placental site trophoblastic tumour (PSTT) is a very rare type of pregnancy related tumour. These tumours develop in the womb from the cells that grow to form the placenta. They can happen after any type of pregnancy, including molar pregnancy, miscarriage, abortion, or a full term normal pregnancy. They can occur several months, or even years, after the pregnancy.

These tumours are slow growing and are usually curable. They are extremely rare. Fewer than 5 women are diagnosed in the UK with PSTT each year. In some women PSTT can spread beyond the womb. It is most likely to spread to the lungs or to the body structures surrounding the womb.

The main symptom of a PSTT is irregular bleeding from the vagina, which in some women follows a loss of periods (amenorrhoea). The tumours are diagnosed using blood tests, an ultrasound scan, and surgery to sample the womb lining. Women with PSTT tend to have high levels of a hormone called human chorionic gonadotrophin (hCG) in their blood. This hormone is produced by the tumour cells.

Treatment for placental site trophoblastic tumours

If the tumour is only in the womb the main treatment is surgery. Most women have removal of the womb (a hysterectomy). If your doctor can remove the whole tumour in this way it should cure the condition. In younger women who wish to have more children, sometimes it is possible to surgically remove just the tumour tissue. 

If the PSTT has spread to another part of your body, such as the area around the womb or the lungs, you will need chemotherapy after surgery. The treatment usually involves a combination of chemotherapy drugs. You have the treatment until the hCG level is normal and then for a further 8 weeks. After treatment your specialist will monitor you closely. You may need ultrasound scans, MRI scans or CT scans to check how well the treatment has worked and to monitor your progress.

 

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What a placental site trophoblastic tumour is

A placental site trophoblastic tumour is a type of gestational trophoblastic tumour (GTT for short). GTT is the term doctors use to describe a group of conditions in which abnormal cells grow inside a woman’s womb.

It is important to realise that GTTs are not the same as womb cancer. In womb cancer the cancer develops from the cells of the womb lining (the endometrium). In GTT the tumour develops from the tissue that forms in the womb when you are pregnant. Placental site tumours develop from the cells that grow to form the placenta. The cells are called trophoblast cells.

Placental site trophoblastic tumours (PSTTs) happen after pregnancy. They can happen after any type of pregnancy, including molar pregnancy, miscarriage, abortion, or a full term normal pregnancy. They can occur several months, or even years, after the pregnancy.

These tumours develop in the area where the placenta joined the lining of the womb (uterus). They can grow into the muscle layer of the womb. They are slow growing tumours and are usually curable. They are extremely rare, accounting for less than 1 in 100 (1%) of all GTTs. Fewer than 5 women are diagnosed in the UK with PSTT each year.

In some women PSTT can spread beyond the womb. It is most likely to spread to the lungs or to the body structures surrounding the womb.

 

Symptoms of PSTT

The main symptom of PSTTs is irregular bleeding from the vagina, which in some women follows a loss of periods (amenorrhoea).

 

Diagnosing PSTT

If you have vaginal bleeding or your periods have stopped your doctor will refer you for tests. You might have the following tests. 

Blood tests

Women with PSTT tend to have raised levels of a hormone called human chorionic gonadotrophin (hCG) in their blood. This hormone is produced by the PSTT cells.

Ultrasound scan

The ultrasound scan may show abnormal areas in the lining of the womb. A special type of scan called a Doppler ultrasound uses colour to show up body structures. The Doppler scan can show that there are more blood vessels than usual in the area of the tumour.

Surgery to sample the womb lining

You have the operation under general anaesthetic in hospital. Once you are asleep, the surgeon opens up (dilates) the entrance to the womb (cervix) and takes a sample of any abnormal areas. The doctor uses a small instrument called a curette to scrape the lining of the womb. They send the tissue they have removed to the laboratory. Under the microscope a pathologist can tell that the cells are a PSTT.

 

Treatment for placental site trophoblastic tumour

If the tumour is only in the womb the main treatment is surgery. Most women have removal of the womb (a hysterectomy). If your doctor can remove the whole tumour in this way it should cure the condition.

In younger women who wish to have more children, sometimes it is possible to surgically remove just the tumour tissue. But the tumour tissue may come back and they need to have regular blood tests to check levels of the hormones, hPL and hCG. If the levels of the hormones start to rise, or if they develop any other symptoms that the tumour has come back, they will need to have a hysterectomy.

If the PSTT has spread to another part of your body, such as the area around the womb or the lungs, you will need chemotherapy after surgery. The treatment usually involves a combination of chemotherapy drugs. The drugs used may include

  • Etoposide
  • Cisplatin
  • Methotrexate
  • Actinomycin D
  • Cyclophosphamide
  • Vincristine

The treatment is given until the hCG level is normal and then for a further 8 weeks.

 

Follow up after treatment

After treatment your specialist will monitor you closely. You may need ultrasound scans, MRI scans, CT scans and urine tests to check how well the treatment has worked and to monitor your progress.

 

More information and support

You can find detailed information about the treatments for gestational trophoblastic tumours, in the gestational trophoblastic tumour section. We also have a section about coping with gestational trophoblastic tumours.

If you would like information about coping with GTT, you can contact our cancer information nurses. They would be happy to help. You can also contact one of the organisations on our GTT organisations page. Some have free factsheets and booklets that they can send to you. They may also be able to put you in touch with a support group. 

You can also find details of counselling organisations that can tell you about counselling and help you find sources of emotional support in your area.

If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

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Updated: 22 June 2016