Gestational Trophoblastic Disease

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Treating Gestational Trophoblastic Disease TOPICS

Surgery for gestational trophoblastic disease

Suction dilation and curettage (D&C)

This procedure is often used to diagnose a molar pregnancy and may be the first treatment given for a hydatidiform (HY-duh-TIH-dih-form) mole. It can be the only treatment needed. It is done in an operating room in a hospital or other type of surgical center.

Most often, general anesthesia is used (where you are asleep). Using a special instrument, the doctor enlarges (dilates) the opening of the uterus (the cervix) and then inserts a vacuum-like device that removes most of the tumor. The doctor then uses a long, spoon-like instrument (curette) to scrape the lining of the uterus to remove any molar tissue that remains. During this procedure you may receive an intravenous (IV) infusion of a drug called oxytocin. This causes the uterus to contract and expel its contents.

After the procedure, most women can go home on the same day. Potential complications of a suction D&C are not common but can include reactions to anesthesia, bleeding from the uterus, infections, scarring of the cervix or uterus, and blood clots. A rare but serious side effect is trouble breathing caused when small pieces of trophoblastic (troh-fuh-BLAS-tik) tissue break off and travel to the blood vessels in the lungs. Most women will have cramping in the pelvis and some vaginal bleeding or spotting for up to a day after the procedure.

Hysterectomy

This type of surgery removes the uterus (womb). It is an option for women with hydatidiform moles who do not want to have any more children, but it isn't often used. It is also the standard treatment for women with placental site trophoblastic tumors and epithelioid (ep-ih-THEE-lee-oyd) trophoblastic tumors. Removing the uterus ensures that all of the tumor cells in the uterus are gone − including any that had invaded the muscle layer (myometrium). But since some tumor cells may have already spread outside the uterus, it does not guarantee that all tumors cells are removed from the body.

The ovaries are usually left in place. Rarely, when there are theca-lutein cysts (fluid-filled sacs) in the ovaries, these cysts will be removed as well. This operation is called an ovarian cystectomy.

There are 3 approaches to remove the uterus:

Abdominal hysterectomy: During this operation, the uterus is removed through an incision that is made in the front of the abdomen (belly).

Vaginal hysterectomy: Less often, if the uterus is not too large, it may be detached and removed through the vagina. In some cases, the surgeon may make a small cut in the abdomen to insert a laparoscope − a long, thin instrument with a video camera on the end − to aid with the operation. This is known as a laparoscopic-assisted vaginal hysterectomy. Because there is no large abdominal incision, recovery is often quicker than with an abdominal hysterectomy.

Laparoscopic assisted vaginal hysterectomy: For this surgery, several small holes are made in the abdomen and long, thin instruments (including one with a video camera on the end) are inserted into them to perform the operation. The uterus is then removed through a small hole made in the vagina. Again, recovery is usually quicker than with an abdominal hysterectomy. As with a vaginal hysterectomy, this approach can only be used if the uterus is not too large.

For all of these operations, the patient is either asleep (general anesthesia) or sedated and numbed below the waist (regional anesthesia). A hospital stay of about 2 to 3 days is common for an abdominal hysterectomy. Complete recovery takes about 4 to 6 weeks. The usual hospital stay for a vaginal hysterectomy is 1 to 2 days with a recovery time of 2 to 3 weeks. A similar recovery is expected for a laparoscopic hysterectomy.

Hysterectomy results in the inability to have children. Some pain is common after surgery but can usually be well controlled with medicines. Complications of surgery are unusual but could include reactions to anesthesia, excessive bleeding, infection, or damage to the urinary tract, the intestine, or to nerves.

Surgery (suction D&C or hysterectomy) removes the source of disease within the uterus, but it does not get rid of cancerous cells that may have already spread outside the uterus to other parts of the body. To be certain that no cancer cells remain, blood HCG levels are carefully checked at regular time points after surgery. If HCG levels stay the same or start to rise, doctors often recommend that women receive chemotherapy. Most women with hydatidiform moles do not require chemotherapy.

Surgery for metastatic tumors

Even when gestational trophoblastic disease has spread to distant areas of the body, it can often be treated effectively with chemotherapy. But in some rare cases, surgery may be used to remove tumors in the liver, lung, brain, or elsewhere, especially if chemotherapy is not shrinking the tumor(s).


Last Medical Review: 02/06/2014
Last Revised: 03/03/2014