Trophoblastic disease

After treatment

Following the mole's removal, some cells will be left in the womb. These cells usually die off over time in around 90% of women.

To checkthe cells have died, all women who have had a molar pregnancy in the UK undergomonitoring of the hormone hCG (human chorionic gonadotrophin) via the National Trophoblastic Screening Centre's surveillance programme. hCG isthe pregnancy test hormone produced bya normal placenta, but also by themole cells, and is the hormone detected in a pregnancy test. It can also be detected in blood and urine tests.

Women on the surveillance programme send in blood or urine samples every two weeks. This is so they can be monitored for signs of persistent trophoblastic disease, which is a risk after all molar pregnancies (see below).

Persistent trophoblastic disease needs further treatment with chemotherapy.

For further information, go to the Charing Cross Hospital Trophoblast Disease Service or the Sheffield Trophoblastic Disease Centre websites.

Hormone monitoring will identify the small number of women who develop a persistent or invasive mole (see below). In these cases, levels of hCG will stay steady or rise, rather than fall.

Complications

Insome cases, the molar disease left after the evacuation of the uterus regrows rather than dies out, and is then known as a persistent disease.

This is oneof the malignant forms of gestational trophoblastic disease and includes invasive mole and choriocarcinoma. A further suction evacuation may help in a few patients, but chemotherapy is usually necessary to cure the problem.

The risk of needing further treatment is:

1 in 10 after a complete molar pregnancy
1 in 100 after a partial molar pregnancy

Invasive molar pregnancy is usually treated with chemotherapy in the form of methotrexate and folinic acid. Methotrexate is given as an intramuscular (into the muscle) injection, and folinic acid as a tablet.

The injection and tablet are given on alternate days for eight days, followed by a six-day rest period. The eight-day cycle of injections and tablets then begins again. This continues until six weeks after the hCG levels return to normal.

Between one and three in every 100 women may see the condition flare up again, so all women are put into a follow-up programme to monitor their hCG after treatment.

Persistent trophoblastic disease is different from normal types of cancer, and the curerate for women developing it after a molar pregnancy is about 100%. This means that around 100 in 100 women who develop persistent trophoblastic disease after molar pregnancy are cured.

There are two treatment centres on in Sheffield and one in London.For further information, go to the Charing Cross Hospital Trophoblast Disease Service or the Sheffield Trophoblastic Disease Centre website.