Supportive care for gestational trophoblastic disease
Supportive care helps people meet the physical, practical, emotional and spiritual challenges of gestational trophoblastic disease (GTD). It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Recovering from GTD and adjusting to life after treatment is different for each woman, depending on the extent of the disease, the type of treatment and many other factors. The end of treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for GTD may have the following concerns.
Pregnancy after treatment
Most women can have normal pregnancies after being treated for GTD, as long as they did not have their uterus removed (hysterectomy).
The chemotherapy drugs used to treat GTD do not appear to greatly affect fertility.
- There may be slightly higher rates of spontaneous abortion in women who had chemotherapy.
- The EMA-CO chemotherapy regimen may cause menopause to begin about 3 years early.
- EMA-CO – etoposide (Vepesid), methotrexate and dactinomycin (Cosmegen, actinomycin-D), followed by cyclophosphamide (Cytoxan) and vincristine (Oncovin)
- Research has shown that women who receive chemotherapy for GTD do not have increased risk of birth defects.
Women should wait a period of time after treatment before getting pregnant. An effective contraceptive method, usually oral contraceptives, is recommended during this time.
- Women who have had hydatidiform moles are usually advised to wait 6 months or longer before getting pregnant.
- Women with a malignant form of GTD are usually advised to wait 1-2 years before getting pregnant.
Women with a history of GTD have a higher risk of having another gestational tumour with future pregnancies. All future pregnancies in women with a history of GTD will be followed carefully.
- A woman will have an ultrasound in the first trimester of a pregnancy (usually 6-8 weeks) to check for a hydatidiform mole (molar pregnancy).
- Human chorionic gonadotropin (HCG) levels are checked 6 weeks and 10 weeks after normal birth, miscarriage (spontaneous abortion) or an abortion to see if they are normal.
- After birth, the placenta will be examined closely by a pathologist to look for any signs of GTD.
Some women may become pregnant sooner than is recommended after treatment (6 months or longer for hydatidiform mole and up to 2 years for malignant GTD). Most women will have a normal and healthy pregnancy. However, researchers have found that a pregnancy in the first 6 months after treatment for malignant GTD may have a higher risk of:
- stillbirth (fetus over 20 weeks gestational age)
- birth defects
A woman will have an ultrasound early in her pregnancy to look for signs of GTD.
Women who have been treated for GTD may also have concerns about the following:
- loss of pregnancy associated with a hydatidiform mole
- mood issues, such as anxiety, anger and confusion
Some women may find it helpful to speak to a counsellor to help them deal with any concerns.
Treatment given to improve the quality of life of people who have a serious illness (such as cancer).
The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, the side effects caused by treatment and the psychological, social and spiritual problems related to the disease or its treatment.