Surgical Procedures: Surgery and Staging for Gestational Trophoblastic Neoplasia (GTN)

What is Gestational Trophoblastic Neoplasia?

Gestational trophoblastic disease (GTD) happens when there is a problem with the tissue that forms during conception, when the egg joins the sperm. Instead of a fetus developing, a tumor starts to grow in the uterus. This tumor can be benign (noncancerous) or malignant (cancerous). This article will focus on cancerous gestational trophoblastic neoplasia (GTN).

What is staging and how is it done?

Staging is a way to find out if and where the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For gestational trophoblastic neoplasia, these tests may be:

Physical Exam: This is a general physical exam. Your provider will go over your health history and symptoms.

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Serum Blood Work: Blood samples may be taken to check chemistry studies and beta human chorionic gonadotropin (β-hCG).

Pelvic Exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A Pap test may also be done.

Ultrasound of the Pelvis: Looks at internal tissue and organs of the pelvis. Sometimes a transvaginal ultrasound (TVUS) will be done. For TVUS, an ultrasound transducer (probe) is inserted into the vagina.

Other Tests: You may be asked to give a urine sample to test for any changes and for beta human chorionic gonadotropin (β-hCG). You may also need a lumbar puncture (LP) to get a sample of your cerebrospinal fluid (CSF) to check for cancer.

GTN spreads to other parts of the body through the tissue, lymph, and blood systems. The stages of GTN range from stage 1 (stage I) through stage 4 (Stage IV).

GTN is often treated with surgery. The surgery you have depends on a few things, like the type of tumor, your age, and your overall health. Your care team will talk with you about which surgery is best for you.

Surgical Procedures for Gestational Trophoblastic Neoplasia

Common surgical procedures to treat GTN are:

• Dilation and curettage with suction evacuation: This is often used for women with a molar pregnancy. Also called a D&C, tissue lining the uterus is removed. The surgeon will scrape the inner wall of the uterus and use a vacuum suction to remove any other tissue within the uterus.
• Hysterectomy: The uterus and cervix are removed and, in some cases, one or both ovaries and fallopian tubes.

What are the risks of surgery for GTN?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding.
• Blood clots.
• Infection.
• Trouble with wound healing.
• Damage to nearby organs such as the urinary tract, bladder, or rectum.
• Early menopause with ovary removal.

Risks Specific to Dilation and Curettage (D&C)

• Uterine perforation (a hole develops in the uterus).
• Infection.
• Damage to the cervix.
• Uterine scarring (Asherman’s Syndrome) which can cause painful menses, stoppage of menses, miscarriages, and infertility.

What is recovery like?

Recovery from GTN surgery depends on the type of procedure you have had.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, organ anti-rejection and/or other conditions.

Your healthcare provider will talk with you about any changes you should make to your activity level or diet after surgery.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.