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GTD — SCE Medical Oncology MCQ

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ModerateGynaecological CancersGTDSCE Medical Oncology

A 50-year-old woman with a hydatidiform mole (complete mole) undergoes suction evacuation. Post-evacuation serial HCG monitoring shows a plateau then rise (HCG 15,000 IU/L at 8 weeks). Chest X-ray shows multiple lung nodules. What is the diagnosis and management?

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Correct answer: E — Gestational trophoblastic neoplasia — risk-score and stage to determine single-agent or multi-agent chemotherapy

Persistent/rising HCG after molar evacuation with radiographic evidence of metastatic disease constitutes gestational trophoblastic neoplasia (GTN). Management is determined by the WHO/FIGO prognostic scoring system: low-risk (score ≤6) patients receive single-agent chemotherapy (methotrexate or actinomycin D), achieving cure in >95%. High-risk (score ≥7) patients require multi-agent chemotherapy (EMA-CO regimen). GTN is one of the most curable human cancers even when metastatic. UK management is centralised at Charing Cross and Sheffield trophoblastic disease centres.

Reference: ESMO 2024 GTD Guidelines; NICE NG; FIGO/WHO scoring system; Seckl et al Lancet 2010