Choriocarcinoma and gestational trophoblastic disease

Throughout the world, the rates of GTN and choriocarcinoma are decreasing and survival has dramatically improved [28,70]. We now have improved guidelines to delineate more clearly those patients who should undergo treatment and who should be observed, and an improved FIGO staging system that combines FIGO staging with the modified Charing Cross/WHO risk factor scoring system. With low-risk GTN, survival approaches 100%. Appropriate surveillance is essential, as is timely and complete treatment with chemotherapy as indicated by risk-factor score. For patients with high-risk disease, and even those with choriocarcinoma, the prognosis is favorable with timely, appropriate staging and chemotherapy. Patients with a previous molar pregnancy should have an ultrasound to rule out another mole in subequent pregnancies, but except in rare circumstances such as familial GTN [135,136,153], they can expect to sustain normal pregnancies. The most important factors to assure successful therapy, as illustrated by the central referral practiced in the United Kingdom, are knowledge and experience with GTN and GTD, a reliable hCG assay, experience with chemotherapy, and patient compliance.