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Cancers that grow from placental tissue after a pregnancy. They make a hormone (hCG) that acts as a perfect blood test, and they were the first solid cancer ever cured by chemotherapy. Immunotherapy now rescues the few that resist drugs.
Gestational trophoblastic neoplasia (GTN) follows a molar pregnancy (complete or partial hydatidiform mole) or, less often, any pregnancy, and includes invasive mole, choriocarcinoma, placental-site and epithelioid trophoblastic tumours. Serum hCG tracks disease burden with unique precision, so diagnosis is usually made from a plateau or rise in hCG after molar evacuation without histology. The FIGO 2000 prognostic score separates low-risk (single-agent methotrexate or actinomycin D) from high-risk disease (multi-agent EMA-CO), with ultra-high-risk patients started on low-dose induction etoposide-cisplatin to prevent early death.
GTN is highly immunogenic (paternal antigens, PD-L1 expression), and PD-1 blockade produced durable complete remissions in chemotherapy-resistant disease (pembrolizumab, Ghorani 2017; avelumab TROPHIMMUN 2020), now in guidelines. Placental-site and epithelioid tumours are chemo-resistant and treated by hysterectomy. Outcomes depend on centralised care with hCG registries (Charing Cross, Sheffield, Brewer).
Molar pregnancy in ~1 per 1,000 pregnancies (higher in Asia); GTN requiring chemotherapy in ~1 per 40,000 pregnancies; cure rates approach 100% in low-risk and >90% in high-risk disease.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Single-agent methotrexate (8-day regimen) or pulsed actinomycin D; switch agent on resistance; consolidate 3 cycles after hCG normalisation.
EMA-CO (etoposide, methotrexate, actinomycin D / cyclophosphamide, vincristine); induction low-dose EP for ultra-high-risk; EP-EMA or TP/TE at relapse; surgery for resistant foci.
PD-1/PD-L1 blockade (pembrolizumab, avelumab), high-dose chemotherapy with stem-cell rescue in selected cases, hysterectomy or metastasectomy.
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Query for this cancer: (TITLE:"Gestational trophoblastic neoplasia" OR ABSTRACT:"Gestational trophoblastic neoplasia" OR TITLE:"GTN" OR ABSTRACT:"GTN" OR TITLE:"Choriocarcinoma" OR ABSTRACT:"Choriocarcinoma" OR TITLE:"Molar pregnancy" OR ABSTRACT:"Molar pregnancy" OR TITLE:"Placental site trophoblastic tumour" OR ABSTRACT:"Placental site trophoblastic tumour" OR TITLE:"Gestational Trophoblastic Disease" OR ABSTRACT:"Gestational Trophoblastic Disease") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Gestational trophoblastic neoplasia, not a curated reading list.
The first solid tumour cured by chemotherapy.
Model for centralised GTD registries.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Fatal if given intrathecally: label all syringes.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce to 75% for CrCl 15-50.
See all on the product pages:AvelumabCisplatinCyclophosphamideDactinomycin (actinomycin D)EtoposideMethotrexatePembrolizumabVincristine·Printable cards in the navigator
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