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Chapter 093. Gynecologic Malignancies (Part 9)

Clinical Presentation Molar pregnancies are generally associated with first-trimester bleeding and excessive uterine size. About 45% of patients have ovarian theca-lutein cysts present on ultrasound. The β-hCG levels are generally markedly elevated. Fetal parts and heart sounds are not present. The diagnosis is generally made by the passage of grapelike clusters from the uterus, but ultrasound demonstration of the hydropic mole can be diagnostic. Patients suspected of a molar pregnancy require a chest film, careful pelvic examinations, and weekly serial monitoring of β-hCG levels. Gestational Trophoblastic Neoplasia: Treatment Patients with hydatidiform moles require suction curettage coupled with postevacuation monitoring of β-hCG. | Chapter 093. Gynecologic Malignancies Part 9 Clinical Presentation Molar pregnancies are generally associated with first-trimester bleeding and excessive uterine size. About 45 of patients have ovarian theca-lutein cysts present on ultrasound. The 0-hCG levels are generally markedly elevated. Fetal parts and heart sounds are not present. The diagnosis is generally made by the passage of grapelike clusters from the uterus but ultrasound demonstration of the hydropic mole can be diagnostic. Patients suspected of a molar pregnancy require a chest film careful pelvic examinations and weekly serial monitoring of 0-hCG levels. Gestational Trophoblastic Neoplasia Treatment Patients with hydatidiform moles require suction curettage coupled with postevacuation monitoring of 0-hCG levels. In most women 80 the 0-hCG titer progressively declines within 8-10 days of evacuation serum half-life is 2436 h . Patients should be monitored on a monthly basis and should not become pregnant for at least a year. Patients found to have invasive mole at curettage are generally treated with hysterectomy and chemotherapy. Approximately half of patients with choriocarcinoma develop the malignancy after a molar pregnancy and the other half develop the malignancy after abortion ectopic pregnancy or occasionally after a normal full-term pregnancy. Chemotherapy is used for gestational trophoblastic neoplasia and often as chemoprophylaxis after molar evacuation to reduce postmolar tumors. It is also used in hydatidiform mole if 0-hCG levels rise or plateau or if metastases develop. Patients with invasive mole or choriocarcinoma require chemotherapy. Several regimens are effective for low-risk patients including methotrexate at 30 mg m2 intramuscularly on a weekly basis until 0-hCG titers are normal. However methotrexate 1 mg kg every other day for four doses followed by leukovorin 0.1 mg kg intravenously 24 h after methotrexate is associated with a cure rate of 90 and low toxicity. Intermittent .