The first 60 days: Gestational trophoblastic neoplasia
Cancers that grow from placental tissue after a pregnancy. They make a hormone (hCG) that acts as a perfect blood test, and they were the first solid cancer ever cured by chemotherapy. Immunotherapy now rescues the few that resist drugs. Below, week by week, is what OnCo's record of Gestational trophoblastic neoplasia says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Low-risk GTN (FIGO score 0-6), High-risk GTN (score ≥7), Chemotherapy-resistant GTN, PSTT / ETT.
- Medical oncologistNamed in the standard of care for: Low-risk GTN (FIGO score 0-6), High-risk GTN (score ≥7), Chemotherapy-resistant GTN, PSTT / ETT.
- Transplant and cell therapy teamNamed in the standard of care for: High-risk GTN (score ≥7), Chemotherapy-resistant GTN, PSTT / ETT.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.High-risk GTN (score ≥7)NCCN category Category 2A, NCCN Guidelines: Gestational Trophoblastic Neoplasia
EMA-CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine); induction low-dose EP for ultra-high-risk; EP-EMA or TP/TE at relapse; surgery for resistant foci.
- 2.Low-risk GTN (FIGO score 0-6)NCCN category Category 2A, NCCN Guidelines: Gestational Trophoblastic Neoplasia
Single-agent methotrexate (8-day regimen) or pulsed actinomycin D; switch agent on resistance; consolidate 3 cycles after hCG normalisation.
Hysterectomy; platinum-etoposide chemotherapy if metastatic or >4 years from antecedent pregnancy.
PD-1/PD-L1 blockade (pembrolizumab, avelumab), high-dose chemotherapy with stem-cell rescue in selected cases, hysterectomy or metastasectomy.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Serum hCG, FIGO 2000 prognostic score, Hyperglycosylated hCG / hCG-free beta, Genotyping to confirm gestational origin, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Complete and partial hydatidiform mole, Invasive mole, Gestational choriocarcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Low-risk GTN (FIGO score 0-6)
- For my situation (low-risk gtn (figo score 0-6)), which of the standard options do you recommend and why?Guideline options include: Single-agent methotrexate (8-day regimen) or pulsed actinomycin D; switch agent on resistance; consolidate 3 cycles after hCG normalisation.
- Am I a candidate for Methotrexate, Dactinomycin (actinomycin D), and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
High-risk GTN (score ≥7)
- For my situation (high-risk gtn (score ≥7)), which of the standard options do you recommend and why?Guideline options include: EMA-CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine); induction low-dose EP for ultra-high-risk; EP-EMA or TP/TE at relapse; surgery for resistant foci.
- Am I a candidate for Etoposide, Methotrexate, Dactinomycin (actinomycin D) or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Chemotherapy-resistant GTN
- For my situation (chemotherapy-resistant gtn), which of the standard options do you recommend and why?Guideline options include: PD-1/PD-L1 blockade (pembrolizumab, avelumab), high-dose chemotherapy with stem-cell rescue in selected cases, hysterectomy or metastasectomy.
- Am I a candidate for Pembrolizumab, Avelumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
PSTT / ETT
- For my situation (pstt / ett), which of the standard options do you recommend and why?Guideline options include: Hysterectomy; platinum-etoposide chemotherapy if metastatic or >4 years from antecedent pregnancy.
- Am I a candidate for Cisplatin, Etoposide, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, Avelumab?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Late diagnosis where hCG surveillance after molar pregnancy is absent (much of the world)”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Fertility and psychological burden of a pregnancy-related cancer”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Gestational trophoblastic neoplasia: the full pageCancers that grow from placental tissue after a pregnancy. They make a hormone (hCG) that acts as a perfect blood test, and they were the first solid cancer ever cured by chemotherapy. Immunotherapy now rescues the few that resist drugs.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Cancer during pregnancy: About 1 in 1,000 pregnancies is complicated by cancer, most often breast, cervical, lymphoma, melanoma or leukaemia.
- Rare cancers: Rare cancers are those with fewer than about 6 new cases per 100,000 people per year.
Every term links to the glossary.