Types of treatment for persistent disease and choriocarcinoma

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.

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

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

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 procedure doesn't completely get rid of the molar tissue, you might 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.

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.

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.

You have the D and C operation at your local hospital. But if you need chemotherapy you will go to one of the 2 UK specialist centres

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

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.

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.

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