Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A malignant neoplastic tumor of the chorion (trophoblast), which constitutes the placenta. It is characterized by abnormal proliferation of trophoblasts (syncytiotrophoblasts and cytotrophoblasts) and rapid hematogenous metastasis. It may develop mainly after a molar pregnancy, miscarriage, or full-term pregnancy, but its cause has not been fully established.
- Main symptoms: Irregular or recurrent vaginal bleeding (the most common symptom), uterine enlargement, nausea and vomiting, fatigue, and symptoms of anemia. If metastasis is present, symptoms involving the lungs (cough, hemoptysis, shortness of breath), central nervous system (headache, neurological deficits, seizures), liver, or kidneys may occur.
- Key diagnostic findings: Abnormally high quantitative blood β-hCG levels (suspected when much higher than in a normal pregnancy), findings of an intrauterine lesion on pelvic ultrasound, and chest and head imaging to search for metastases.
Treatment Methods
- Treatment principles: Treatment is selected according to the FIGO/WHO risk score and stage (localized vs. metastatic, low-risk vs. high-risk). Chemotherapy is the mainstay of treatment in most cases, while surgery and radiotherapy are used as adjunctive or selective treatments.
- Surgery
- Curettage (removal of an intrauterine lesion): For diagnostic and therapeutic purposes, particularly removal of retained tissue.
- Hysterectomy: Considered when the patient no longer wishes to become pregnant, for bleeding control, or in older patients or those with refractory disease.
- Chemotherapy
- Low risk (WHO score <7): Single-agent therapy (methotrexate ± leucovorin or actinomycin D) has a high cure rate.
- High risk (WHO score ≥7) or extensive systemic metastases: Multi-agent therapy (e.g., EMA-CO: etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) is recommended.
- Supportive care during treatment: Blood transfusions, antiemetics, infection prevention, etc.
- Radiotherapy: May be used as an adjunct for localized metastases that are difficult to control with chemotherapy, such as brain metastases.
- Follow-up after treatment: Blood β-hCG should be monitored regularly (monitoring for a certain period even after complete remission) — contraception is recommended for the period advised to reduce the risk of recurrence even after β-hCG becomes negative.
- Lifestyle management and precautions: Contraception is essential during treatment and for a certain period after remission (usually 6–12 months is recommended); chemotherapy is generally avoided during pregnancy (except in special circumstances).
Checklist Before an Outpatient Visit (Including Example Questions)
- Items and information to prepare
- A list of currently used medications, including prescription drugs, over-the-counter drugs, and herbal medicines
- Past medical history (pregnancy history, history of miscarriage or molar pregnancy, surgical history)
- Recent test results (β-hCG levels, pelvic ultrasound images, chest X-ray/CT, etc.) and the dates of the tests
- A record of when symptoms began and their characteristics (amount of bleeding, presence or absence of pain, respiratory or neurological symptoms, etc.)
- Reproductive plans (whether you wish to become pregnant in the future)
- Materials to provide to the doctor at the outpatient visit
- Medical records and pathology reports from previous hospitals, if available
- If possible, an imaging CD or summary of the results when bringing imaging studies
Example questions (for outpatient visit preparation)
- “Do I have test records showing my recent β-hCG levels and their trend?”
- “Could any medications (or supplements) I am taking affect chemotherapy?”
Examples of General Questions to Ask the Doctor
- “What are my stage and WHO/FIGO risk score, and what is the recommended standard treatment plan?”
- “What is the expected treatment duration and what side effects can be expected? How can the side effects be managed?”
- “What is the recurrence surveillance plan after treatment (frequency and duration of β-hCG testing), and what contraception method is recommended during that period?”
- “When can I plan a pregnancy, and to what extent could this affect my chances of becoming pregnant in the future (fertility)?”
Examples of Disease-Specific Questions
- “Based on my β-hCG trend (level and rate of decline), how do you determine complete remission? How long is it expected to take to determine remission?”
- “For a low-risk patient, which single-agent therapy is more appropriate—methotrexate or actinomycin D—and what are the reasons for the choice and the differences in expected side effects?”
(Note: As a general recommendation, individualized treatment is determined by a specialist after considering the stage, WHO score, general condition, and other factors. Seek emergency medical care immediately in the event of emergency bleeding, severe anemia, or systemic symptoms.)