![Page 1: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/1.jpg)
Molar pregnancies and malignancies
Dr Amanda Tristram
Gynaecological Oncologist Wellington
![Page 2: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/2.jpg)
![Page 3: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/3.jpg)
![Page 4: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/4.jpg)
![Page 5: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/5.jpg)
![Page 6: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/6.jpg)
• High suspicion
• Guidelines
![Page 7: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/7.jpg)
Ms MP
• 37 year old presented to ED with haemoptysis
• Irregular bleeding 3 months ago
• Miscarriage conservative management 8 months ago
![Page 8: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/8.jpg)
Molar pregnancy
• “Complete mole” – all paternal
• “Partial mole” – only partly paternal
• (Remember – “Dad is the mole”)
![Page 9: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/9.jpg)
Molar pregnancy - Partial mole
• (Partly Dad)
• Three sets of chromosomes – one from each parent and extra Dad
• Less likely to cause ongoing problems
• Monitor HCG until normal
![Page 10: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/10.jpg)
Complete Mole
• (All Dad)
• Diploid – normal number of chromosomes but all Dad
• Follow up for 6 months after normal. If not sure, assume complete
![Page 11: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/11.jpg)
Gynaecological Oncology and Moles
• Refer all to MDM for review.
• Follow up will be locally according to unit protocol
• Refer back if persistent or rising HCG according to guidelines
![Page 12: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/12.jpg)
• Gestational trophoblastic disease• Hydatidiform moles
• Invasive moles
• Gestational choriocarcinoma
• Placental site trophoblastic tumour
Gestational trophoblastic neoplasia = gestational trophoblastic disease that needs chemotherapy
![Page 13: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/13.jpg)
![Page 14: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/14.jpg)
![Page 15: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/15.jpg)
![Page 16: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/16.jpg)
![Page 17: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/17.jpg)
![Page 18: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/18.jpg)
![Page 19: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/19.jpg)
![Page 20: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/20.jpg)
--> Day 1 actinomycin 0.5mg; methotrexate 100mg; etoposide 220mg (100mg/m2); methotrexate 440mg (200mg/m2)
--> Day 2 actinomycin 0.5mg etoposide 220mg (100mg/m2)
--> Day 8 Vincristine 1mg; cyclophosphamide 1320mg (600mg/m2)
![Page 21: Molar pregnancies and malignancies€¦ · Prophylactic Chemotherapy in Molar Pregnancy . 18 RISK ASSESSMENT IN GESTATIONAL TROPHOBLASTIC NEOPLASIA If a patient on follow-up meets](https://reader033.vdocuments.us/reader033/viewer/2022042711/5f72b31787dbfc7e7a478e82/html5/thumbnails/21.jpg)
• Doing well