Question

Management of high risk GTN.

Hint:

High-risk GTN requires aggressive treatment with chemotherapy and close monitoring to improve the chances of successful remission.

Answer 1

Gestational Trophoblastic Neoplasia (GTN) is a group of rare diseases that arise from the cells that would normally form the placenta during pregnancy. High-risk GTN refers to cases where the cancer is aggressive or resistant to treatment. Proper management is critical to improving outcomes.
Step 1: Diagnosis of High-Risk GTN:
1. Clinical Presentation: High-risk GTN often presents with abnormal bleeding, elevated beta-hCG levels, and a history of molar pregnancy, abortion, or normal pregnancy.
2. Imaging and Histopathology: Ultrasound, CT scans, and biopsy are used to assess the extent of the disease and identify metastases.
3. Risk Scoring: The FIGO (International Federation of Gynecology and Obstetrics) scoring system is used to classify the risk based on the patient's clinical status.
Step 2: Treatment Approach:
1. Chemotherapy: The first-line treatment for high-risk GTN is chemotherapy, typically with a combination of methotrexate and dactinomycin. For resistant cases, additional agents such as etoposide or cisplatin may be used.
2. Surgical Intervention: In some cases, surgery (e.g., hysterectomy) may be necessary if chemotherapy is not effective.
3. Radiation Therapy: This may be used in cases where there is localized metastasis, particularly in the brain or lungs.
Step 3: Monitoring and Follow-Up:
Frequent monitoring of beta-hCG levels is essential during and after treatment to assess the response to therapy and detect any recurrence.