Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Prepared with OnCo (onco.cc/prep/placental-site-trophoblastic-tumour/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
16 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Serum hCG, Human placental lactogen by immunohistochemistryand p63, Interval since the antecedent pregnancy, Stage, depth of myometrial invasion and mitotic count, Genotyping to confirm gestational origin and identify the causative pregnancy), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (diagnosis), which of the standard options do you recommend and why?
- 6.For my situation (disease confined to the uterus), which of the standard options do you recommend and why?
- 7.For my situation (metastatic disease or interval over four years), which of the standard options do you recommend and why?
- 8.Am I a candidate for Etoposide, Cisplatin, Methotrexate or related drugs, and what side effects should I expect?
- 9.For my situation (resistant disease), which of the standard options do you recommend and why?
- 10.Am I a candidate for Pembrolizumab, and what side effects should I expect?
- 11.For my situation (follow-up), which of the standard options do you recommend and why?
- 12.Are there clinical trials I could join, for example of Pembrolizumab?
- 13.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 14.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 15.I read that “Numbers are too small for any trial; all treatment rests on registry series”. How does that affect my plan?
- 16.I read that “hCG is an unreliable marker, so recurrence can be missed”. How does that affect my plan?
The words I may hear
- Tumour markers (CEA, LDH, chromogranin, thyroglobulin): Substances released into the blood by some cancers that can be measured with a simple test, useful for tracking whether treatment is working or the cancer is coming back, but rarely good enough to diagnose or screen.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
Tests and results to bring
Diagnosis: Expert pathology with immunohistochemistry (human placental lactogen, p63, Ki-67) and genotyping; pelvic MRI, chest CT and FDG-PET; registration with a trophoblastic disease centre.
Biomarker results to ask for: Serum hCG (low or normal; high hCG-free beta subunit fraction), Human placental lactogen by immunohistochemistry (PSTT) and p63 (ETT), Interval since the antecedent pregnancy (over four years predicts poor outcome), Stage, depth of myometrial invasion and mitotic count, Genotyping to confirm gestational origin and identify the causative pregnancy, FDG-PET/CT for residual or metastatic disease.
Scans and tests linked to this cancer: CT (computed tomography), Histopathology & immunohistochemistry, MRI, PET/CT.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Disease confined to the uterus: Total hysterectomy with ovarian preservation; pelvic node sampling considered; fertility-sparing local resection only in exceptional cases with close follow-up. (Oncofertility and fertility preservation, Lymphadenectomy (lymph node dissection))
- Metastatic disease or interval over four years: Multi-agent platinum-based chemotherapy (EP-EMA or TP/TE) with resection of residual disease; EMA-CO alone is insufficient. (Etoposide, Cisplatin, Methotrexate, Dactinomycin (actinomycin D), Paclitaxel / nab-paclitaxel, Cytotoxic chemotherapy)
- Follow-up: Clinical review with hCG and imaging, because hCG alone can miss recurrence; prolonged surveillance for late relapse. (Tumour markers (CEA, LDH, chromogranin, thyroglobulin), MRI)
- Resistant disease: Surgical excision of chemoresistant deposits; high-dose chemotherapy with autologous stem cell rescue in selected cases; pembrolizumab in trials or on a case basis. (Autologous stem cell transplant (high-dose therapy), Pembrolizumab, PET/CT)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.