Surgical Procedures: Surgery and Staging for Placental-Site Trophoblastic Disease

Autor: Lori Smith, CRNP
Última Vez Revisión: 12 de octubre de 2017

Placental site trophoblastic disease (PSTD) is a rare form of a type of uterine disease, called gestational trophoblastic disease or GTD. These cancerous tumors form from the trophoblastic cells, which make up the placenta during the process of implantation. This form of GTD can occur at any time following a pregnancy, including after a full term pregnancy, a molar pregnancy, ectopic pregnancy, abortion or miscarriage. In some cases the condition does not occur for several months or years following a pregnancy.

Most commonly placental-site trophoblastic tumors invade into the muscular layer of the uterus itself and require surgery as treatment. However, it can also spread to other parts of the body.

Diagnosis of PSTD

Once a diagnosis of placental-site trophoblastic disease has been made or if there is suspicion that the disease is present, your healthcare provider will typically obtain additional testing to determine the stage of cancer. These tests may include:

Physical Exam: This is a general physical exam, as well as, an evaluation of your medical history and symptoms. This includes a pelvic exam to evaluate the vagina, cervix, uterus, fallopian tubes and ovaries. A Pap smear may also be obtained.  

Radiologic Imaging: Imaging such as a CAT scan (CT scan), magnetic resonance imaging (MRI), pelvic and/or transvaginal ultrasound and/or chest X-ray may be used to further evaluate the extent of your cancer.

Blood Testing: Certain blood tests such as blood chemistry studies, serum tumor markers (beta human chorionic gonadotropin (β-hCG) and/or human placental lactogen (hPL) and other blood work may be recommended during the workup and treatment phases.

Urine Testing: Urine testing may be obtained to evaluate for β-hCG and/or other substances.

Procedures used in the diagnosis of PSTD

Certain procedures may be recommended during the initial evaluative phase (often called “work-up”), such as:

  • Lumbar Puncture: During a lumbar puncture (LP) or spinal tap, cerebrospinal fluid (CSF) is extracted from the spinal column for evaluation to see if the cancer has spread or metastasized. A needle, which is placed between two bones in the spine, removes the CSF for evaluation.
  • Dilation and Curettage: During a dilation and curettage or D&C, the cervix is dilated so that the endometrial tissue, which lines the uterus, can be removed and evaluated for cancer or other abnormalities. In some cases, a suction device may also be used to remove tissue.

Staging of PSTD

Placental-site trophoblastic disease spreads to other parts of the body by spreading to nearby tissues, or traveling through the lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread, and helps determine what treatment course will be recommended. Your oncologist will discuss with you the stage of your disease.

In most cases, surgery will be recommended. The surgical procedure recommended depends on several factors. Your surgeon will discuss with you in detail the recommended procedure.

The most common surgical procedures to treat placental-site trophoblastic disease include:

  • Dilation and Curettage: For some women who desire to have children in the future, a D&C may be an option, however, is not always possible. 
  • Hysterectomy: In most cases of placental-site trophoblastic disease, a hysterectomy or removal of the uterus will be recommended. This can be done by one of several approaches including:
    • Abdominal: During an abdominal hysterectomy, an incision in the abdomen is made to remove the uterus; this approach can have a higher risk of complications and longer recovery time.
    • Vaginal: During a vaginal hysterectomy, an incision is made in the upper vagina, and the uterus is removed through the incision. This approach offers fewer complications and a faster recovery.
    • Laparoscopic: At times during an abdominal or vaginal hysterectomy, an instrument called a laparoscope will be used. This is a lighted tube with a camera, which allows for your doctor to see the pelvic organs without needing a large incision. This procedure requires small incisions in the abdomen where the tool(s) is inserted. The laparoscopic approach is associated with less pain, a lower risk of infection and a shorter recovery time. However, laparoscopic procedures can take longer to perform and increase the risk of injury to the urinary tract and surrounding organs.
    • Robotic: During a robotic procedure, the surgeon controls a robotic arm to perform the surgery through small incisions; this procedure can take longer than the traditional approach.

Note: Your surgeon will discuss with you if your cancer is resectable (surgically removable) or unresectable (likely unable to be removed with surgery), which will determine the surgical procedure recommended. There may also be a need to remove other areas where the cancer has spread.

There may be a need for chemotherapy and/or follow-up testing after surgery. Your oncologist will discuss these recommendations with you as well.

What Are the Risks Associated with Surgery to Treat Placental-Site Trophoblastic Disease?

As with any surgical procedure, there are risks and side effects associated with undergoing surgery to treat placental-site trophoblastic disease. Risks and side effects associated with surgery may include:

  • Reaction to anesthesia
  • Bleeding
  • Blood clots
  • Infection
  • Cervical scarring (D&C specific)

Risks specific to hysterectomy may include:

  • Damage to the urinary tract, intestine or nerves
  • Wound complications
  • Injury to the urinary tract and/or surrounding organs
  • Nerve damage
  • Bowel obstruction
  • Death

Other risk factors are determined based on your health and the procedure being performed. Speak with your surgeon about the specific risk factors for your case.

What is Recovery Like?

Recovery from surgery to treat placental-site trophoblastic disease will depend on the extent and type of the procedure performed. A hospital stay may be required.

You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your healthcare provider will discuss your activity restrictions, depending on the surgery you have had.

How Can I Care for Myself?

Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.

Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms.

If you experience constipation, diet modifications, increased fluid intake, and over-the-counter medication to relieve constipation may be helpful.

Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.

  • A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
  • Find more relaxation exercises on OncoLink.

This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.

Referencias

Surgery for Gestational Trophoblastic Disease (February 9, 2016) Retrieved from https://www.cancer.org/cancer/gestational-trophoblastic-disease/treating/surgery.html

What Is Gestational Trophoblastic Disease? (February 9, 2016) Retrieved from  https://www.cancer.org/cancer/gestational-trophoblastic-disease/about/what-is-gtd.html

Placental site trophoblastic tumour. (Jun 22, 2016) http://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/placental-site-trophoblastic-tumours-pstts

Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version (July 28, 2016) Retrieved from https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq

Kim, SJ. Placental site trophoblastic tumour. Best Pract Res Clin Obstet Gynaecol. 2003 Dec;17(6):969-84. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14614893

Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version. (July 28, 2016) Retrieved from https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq#section/_21

Gestational Trophoblastic Disease Treatment (PDQ®)–Health Professional Version (February 25, 2015 ) Retrieved from https://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq#section/_92

Dilation and Curettage (D&C). (February 2016) Retrieved from https://www.acog.org/Patients/FAQs/Dilation-and-Curettage-DandC#is

Surgical Procedures: Hysterectomy. (November 23, 2015) Retrieved from http://www.oncolink.org/cancers/gynecologic/cervical-cancer/treatments/surgical-procedures-hysterectomy

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