Management of Gestational Trophoblastic Tumors (GTT) Sumita Mehta, Vijay Zutshi, Swaraj Batra
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1Management of Gestational Trophoblastic Tumors (GTT): A GYNECOLOGIST PERSPECTIVE
2Management of Gestational Trophoblastic Tumors [GTT]: A GYNECOLOGIST PERSPECTIVE
Editors Vijay Zutshi MD MICOG Senior Specialist Department of Obstetrics and Gynaecology MAMC and Lok Nayak Hospital, New Delhi Sumita Mehta DGO DNB Senior Research Associate Department of Obstetrics and Gynaecology MAMC and Lok Nayak Hospital, New Delhi Swaraj Batra MS FICOG Director - Professor and Head Department of Obstetrics and Gynaecology MAMC and Lok Nayak Hospital, New Delhi
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
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Management of Gestational Trophoblastic Tumors (GTT)
© 2006, Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2006
9788180617720
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Printed at Gopsons Papers Ltd, A-14, Sector 60, Noida 201 301, India
4Contributors 5Foreword
It is a great opportunity to see and read the excellent monograph on “Management of Gestational Trophoblastic Tumors” published through devoted efforts of the learned authors. This is a most welcome publication in the field of gynecology.
Gestational Trophoblastic Disease (GTD) includes a group of interrelated diseases as molar pregnancy, invasive mole, placental site trophoblastic tumor and choriocarcinoma—all these have varying propensities for invasion and spread. Gestational Trophoblastic Neoplasia (GTN) is recognized today as the most curable gyneco-logical malignancy, provided the cases are correctly diagnosed and appropriate therapy is administered early enough in the course of the disease. Considerable knowledge and experience have been gained and important advances have been made in the diagnosis, treatment and follow-up of patients with GTD. Only physicians in specialized centers can acquire adequate skill in diagnosing and treating these rare tumors.
This important monograph, through its well defined four sections, provides basic and relevant information on trophoblast in health and disease, reviews the advances made in the field of diagnosis and discusses principles of management based on clinical experience accumulated in the Dept. of Obstetrics and Gynecology of Maulana Azad Medical College and Hospitals. The scientific content of the book is of high caliber. The volume is suitably crafted to prove user friendly. The Editors, Dr V Zutshi, Dr S Mehta and Dr S Batra must be complimented for their excellent work. It is sincerely hoped that this brilliant publication will be of immense help to students and physicians practising obstetrics and gynecology.
Dr SN Mukherjee
DGO MD FACS FAMS FICOG FICMCH
Senior Consultant Obstetrician and Gynecologist
Formerly Professor and Head
Dept. of Obstetrics and Gynecology, JIPMER, Pondicherry
HP Medical College, Simla
University College of Medical Sciences and Safdarjung Hospital and Maulana Azad Medical College and LNJPN Hospital, New Delhi
6Preface
The trophoblast which normally is responsible for increase in size of blastocyst, can undergo abnormal changes. These changes can be from H.mole to choriocarcinoma. The persistent trophoblastic tumors/disease (PTD) like invasive mole to choriocarcinoma responds dramatically to chemotherapy. There is no other malignancy in which remission rate can be expected above 90 percent.
It is a relatively uncommon condition, and unless affiliated with a treatment center, most gynecologists never gain sufficient experience, to develop the judgment required to individualize the therapy appropriately.
Chapter 1 briefly covers the normal conception and implantation, trophoblast in health and disease. Human chorionic gonadotropin comes close to being the ideal tumor marker for trophoblastic disease. The details about its biochemistry, detection and common problems are discussed.
Chapter 2 covers the 11 cases managed at our center. It also gives the current FIGO criteria for diagnosis of PTD. Detailed pretreatment evaluation and scoring is discussed. Various management protocols for low-and high-risk PTD have been covered.
Chapter 3 has details about the prevention and treatment of toxicities due to chemotherapy.
Chapter 4 It shows normal beta hCG regression curve required during treatment of these patients on chemotherapy. It also depicts few ultrasound pictures of the cases and histological slides of invasive mole and choriocarcinoma.
Our endeavor has been to sensitize the practicing clinicians towards this disease so that proper follow up is done after evacuation of molar pregnancy, and to detect this disease well in time. One should also suspect PTD in a patient of reproductive age group, who presents with hemoptysis with chest findings, headache, neurological signs or 7bleeding per rectum, where no other diagnosis fits into the clinical picture. We hope this monogram is going to be useful for all doctors practicing Obstetrics and Gynecology
Vijay Zutshi
Sumita Mehta
Swaraj Batra