Trophoblastic disease is a group of benign and malignant tumors that arise from trophoblasts of the placenta. The term contains pathologies such as bladder skid (partial and complete), invasive bladder skid, trophoblastic tumor of the placental site, chorioncarcinoma and trophoblastic epithelioid tumor. Diagnose pathology mainly with the help of ultrasound and CT, examinations that are designed to identify the concentration of hCG in the blood. Therapy is prescribed in the form of a hysterotomy, chemotherapy, removal of cystic drift.
Description of the disease
Trophoblastic disease in gynecological practice is rare - in 1-3% of cases out of a hundred - and is considered a very rare disease. The development of this pathology is impossible without the presence of pregnancy, since in most cases the uterus is the main place of localization. It should be noted that it has more than one shape. Considering the variety of forms, partial cystic skidding accounts for 5% of cases, chorionic cartiosis - 17%, full skidding - 72.2%, and other species - 5.3%.
During trophoblastic disease, proliferative pathologies of the outer layers of embryonic cells develop, which, in turn, are directly involved in the processes of creating the epithelial cover of the chorionic villi. Such a pathology can occur after pregnancy and at the stage of gestation. It can occur in a malignant and benign form. But anyway, pathology is a very dangerous condition, which can lead to quite negative results.
Factors that increase the risk of pathology
When the causes and risk factors of this disease were studied, it was found that a trophoblastic tumor is diagnosed more often in women at a certain age, anamnesis and obstetric history are characteristic, a geographical factor can play an important role in this. Thus, the circumstances of risk are:
- woman's age is 20-50 years, the most dangerous period is 40 years and older;
- second and subsequent pregnancies;
- history of spontaneous abortion.
Among women who live in eastern countries, this pathology is often found. If the patient has already revealed cystic drift, there is a risk of invasive drift and chorioncarcinoma. Metastasis is more likely to occur in those who for a long time observe the symptoms of pathology and the latent period.
Classification of trophoblastic disease
Based on the international classification, benign forms and malignant neoplasms of the disease are distinguished.
So, malignant neoplasm is divided into:
- invasive cystic drift;
- trophablastic tumor of the placental bed;
- chorioncarcinoma;
- single cell trophoblastic tumor.
Malignant neoplasm has a metastatic and non-metastatic clinical picture, low or high risk.
In turn, a benign form of trophoblastic disease in gynecology is divided into:
- partial cystic drift (mild form);
- full cystic drift.
Different character
The specification of trophoblastic disease shows that it can be of a different nature. One way or another, it will be equally important to consider the stages of development of the disease, which allow us to understand the level of danger of the disease.
As the clinical classification of FIGO shows, there are such stages:
- First stage. Only the uterus is affected, at this stage there are no metastases.
- Second stage. Metastases passed into the vagina, pelvis and appendages.
- Third stage. Metastases invaded the lungs, not to mention the affected genitals.
- Fourth stage. Various distant metastases occur (kidneys, liver, spleen, gastrointestinal tract, brain).
Forecast
If the uterine disease is cured on time and correctly, then everything will go away without complications. Chemotherapy gives a 70% result with a metastatic form and a 100% result with a course in a non-metastatic form.
In many cases, young women can fully maintain their generative functions. In order for the next pregnancy to proceed successfully, you must follow all the recommendations and prescriptions of the doctor. It is necessary to undergo an examination twice a year and constantly be under the supervision of a doctor, use contraception.
Relapses occur in only 4-8% of cases.
Any kind of disease is considered in oncology as an integral etiopathogenetic process. Possible causes of the appearance of trophoblastic disease may be influenza viruses, special properties of the egg, chromosomal aberrations, immunological factors, high activity of hyaluronidase, protein deficiency.
Who occurs more often?
Pathology most often occurs in women older than forty years (5 times more likely), women under 35 years of age suffer from this disease much less often. Other sources of risk can also be distinguished, among which are abortion, terminated pregnancy or childbirth. There is one pattern that this disease is most often observed in women from the East, but the representatives of the West are less prone to the appearance of this disease.
After the bladder skid has been transferred, the development of chorionic carcinoma may begin. With the full form of cystic drift, an invasive drift develops. Partial skidding has significantly less impact on this process.
After the end of gestation, abortion, miscarriage, childbirth or during pregnancy (normal or ectopic), changes in the structure of the trophoblast can occur.
Consider the main symptoms of trophoblastic disease.
Symptoms
The main symptoms of the disease are:
- an increase in the size of the uterus, which does not coincide with the norms of gestational age (50%);
- bilateral tecalutein cysts (in 40% of cases);
- vaginal bleeding (about 90%).
In most cases, the course of cystic drift can be complicated by preeclampsia, toxicosis of the pregnant woman (constant vomiting), arterial hypertension, rupture of ovarian cysts, symptoms of hyperthyroidism (hyperthermia, tachycardia). Profuse bleeding also has a negative effect on this process . In some cases, with this form, pulmonary embolism and DIC appear.
If we consider the clinical anomalies of cystic drift in trophoblastic disease, then it is necessary to highlight:
- metastasis in the vagina, in the lungs, in the vulva;
- infiltrative growth;
- increased risk of transformation into a chorionic carcinoma.
Chorionocarcinoma can be dangerous because the uterine wall can be destroyed under its influence. Therefore, this form of the disease often causes severe bleeding. From chorionicarcioma, metastases quickly disperse in the organs of the small pelvis, then to the liver, kidneys, spleen, lungs, stomach, brain.
In turn, a trophoblastic tumor destroys the serous cover of the uterus, which then causes bleeding. This tumor promotes the penetration of metastases into the abdominal cavity, vagina and brain.
Epithelioid cell tumor is located in the cervical canal or on the bottom of the uterus. This tumor in its symptoms may resemble cervical cancer. This type of trophoblastic disease makes itself felt only after several years of termination of pregnancy.
What provoke metastases?
The occurrence of metastases provokes a headache, chest pain, cough with bloody sputum, stomach bleeding, anemia, intestinal obstruction, cachexia, intoxication, and so on.
There are such forms of pathology that they can cause abdominal pain, rupture and torsion of the legs of cysts, compression of nerve trunks, and perforation of the uterus.
You need to know that the symptoms of the disease can be different. But when the first signs appear, you should immediately consult a doctor.
Diagnosis of trophoblastic disease
Women with this disease had a pregnancy that ended in an abortion (artificial or spontaneous), tubectomy for an ectopic pregnancy, or childbirth.
Most women have complaints of acyclic uterine bleeding, headaches, amenorrhea, oligomenorrhea, menorrhagia, cough, chest and stomach pains, hemoptysis.
A gynecological examination determines the actual size of the uterus, which sometimes does not correspond to the postpartum period or gestational age. Often, a gynecologist can detect tumor nodes in the vagina, uterus, and pelvis using palpation.
To identify tumors with a small size of up to 5 mm, transvaginal ultrasound is ideal. A sign of the disease will be large tecalutein ovarian cysts.
Helper Methods
The detection of metastases in the pelvis and other organs is determined using auxiliary methods:
- CT
- MRI of the brain;
- Ultrasound of the abdominal cavity, kidneys, liver;
- PAT;
- CT of the lungs;
- chest x-ray.
If metastases are detected, you should seek the advice of an abdominal surgeon, neurosurgeon, urologist, pulmonologist.
How is trophoblastic disease treated?
Therapy
The scheme of therapeutic measures is determined for a given disease by its stage and form.
Treatment of cystic drift is carried out using vacuum extraction with the upcoming control curettage of the uterine cavity. After the cystic skid has been removed, contraception must be used for one year. Chemotherapy with a dynamic decrease in the level of hCG to a normal value is not prescribed.
Clinical recommendations for trophoblastic disease should be clearly observed.
Chemotherapy
If there is a pathology with malignant signs, then chemotherapy is prescribed. The scheme of such treatment may be as follows:
- "Cisplatin" and "Etoposide";
- "Dactinomycin" and "Methotrexate";
- “Methotrexate”, “Cisplatin”, “Dactinomycin”, “Vincristine”.
In cases of perforation of the walls of the uterus, bleeding from the initial tumor and resistance to chemotherapy, the surgical method is advisable. A hysterotomy that preserves organs is recommended for patients of reproductive age. In the case when the woman no longer plans to give birth to children, a radical hysterectomy or supravaginal removal is performed.
After the end of the therapeutic course of gestational trophoblastic disease, it is recommended to undergo hCG monitoring, ultrasound monitoring, and dynamic radiography of the lungs several times a year.
After transferring the pathology, women will be able to plan a pregnancy no earlier than 11-17 months.
We examined the main recommendations for trophoblastic disease.