Molar Pregnancy and Gestational Trophoblastic Neoplasia

Overview Molar pregnancy and gestational trophoblastic neoplasia ( GTN ) comprise a group of interrelated diseases that includes complete hydatidiform mole ( CHM ) and partial hydatidiform mole ( PHM ), invasive mole, choriocarcinoma ( CCA ), placental site trophoblastic tumor ( PSTT ), and epithelioid trophoblastic tumor ( ETT ). Molar pregnancy and GTN produce a distinct tumor marker, human chorionic gonadotropin ( hCG ), which can be used for diagnosis, monitoring the effects of therapy, and follow‐up to detect relapse. Complete and partial moles are noninvasive, localized tumors that develop as a result of an aberrant fertilization event that leads to a proliferative process. The other trophoblastic tumors which as a group are referred to as GTN represent malignant disease because of their local invasion and metastases. GTN most commonly develops from a molar pregnancy but can arise de novo after any gestation. Although these tumors are rare, it is important for medical oncologists to understand their natural history and management because of their life‐threatening potential in reproductive‐age females and their high degree of curability with preservation of reproductive function if treated early and appropriately. 1,2 Despite the advances made in the management of GTN over the past six decades, patients with protracted delays in diagnosis, particularly after nonmolar pregnancies, still present with extensive tumor burdens and are at substantial risk for treatment failure and death.