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Treatment for hydatidiform moles will involve emptying the uterus of abnormal cells during a surgical procedure called dilation and curettage (D&C). This may be done in the operating room under the assistance of an ultrasound. The abnormal tissues can be removed and the pathologists will examine them under a microscope. Your doctor will need to monitor the pregnancy hormone (bHCG) levels in the body.
Treatment for the different types of GTN will be determined by your care team, taking into account:
- Your health and medical history
- Type and stage of GTN, and size of tumor
- Your expectations, preferences, and health goals, including if you wish to become pregnant
Combining all the information, your doctor will discuss with you your risk group. Hydatidiform moles often resolve after dilation and curettage (D&C) and don’t require additional treatment. After the D&C, your doctor will monitor your hCG level to ensure it normalizes. If the hCG rises, you will likely require evaluation and possibly treatment with chemotherapy.
For low-risk disease, patients usually receive less aggressive chemotherapy. Treatment is given until the b-hCG level is normal for at least 3 weeks after treatment ends. If the level does not normalize, or for high-risk disease, patients will undergo more aggressive chemotherapy regimens which typically include a combination of anti-cancer drugs. Rarely, radiation therapy, especially if cancer has spread to the brain, can also be given.
For the rare placental-site gestational tumor (PSTT) and epithelioid trophoblastic tumors (ETT), treatment for early-stage disease includes removing the uterus, or a total hysterectomy. Treatment for high-stage disease may include a combination of chemotherapy and surgery.
Once you complete the initial treatment for GTD (molar pregnancies as well as GTN), your doctor will closely monitor your blood b-hCG levels every week for a period of time, followed by monthly monitoring for up to 6 months, to ensure that the hormone level stays normal. You should discuss birth control methods with your doctor during this follow-up period.
When blood b-hCG levels rise during or after treatment, it’s a sign of recurrent or resistant GTN. Treatment and prognosis will depend on the location and extent of recurrence and your overall health status. Treatment usually involves single or multiple agents of chemotherapy or surgery.