Hydatidiform Mole
The treatment of choice is uterine evacuation followed by weekly HCG. Chest X-ray is mandatory (if positive, chemotherapy is needed see Section 10.5). No other imaging investigations needed unless directed by symptoms. 10%-20% of cases of hydatidiform mole will need treatment.
HCG is performed weekly until normal for two weeks, then monthly to one year. Pregnancy should be avoided for one year from diagnosis, i.e., whilst on HCG follow-up. The birth control pill is the recommended method of contraception.
Indications for Chemotherapy
Hydatidiform Mole
Mets to lung or other sites
Plateauing or rising HCG
Post Non-Molar Pregnancy
Any women in their reproductive years with metastatic tumour and an elevated HCG.
Chemotherapy Protocols Role of Surgery
Second evacuation is seldom curative. Complication rate by perforation is up to 15%. Therefore, given the effectiveness and low toxicity, in comparison, of Methotrexate and Actinomycin, repeat evacuation is not recommended.
Emergencies:
- CNS mets with hemorrhage - neurosurgery
- Life threatening uterine bleeding - hysterectomy
Hysterectomy as Treatment
Patient in non metastatic group (rising HCG on follow-up, CXR normal) who does not wish chemotherapy.
Estrogen Replacement Therapy - Site Specific Information
Some gynecologic tumours are consiered to be hormone responsive (i.e., some low grade uterine sarcomas). Estrogen replacement in this group of patients should be for symptomatic control. A thorough discussion with the patient of the potential risks and anticipated benefits of such treatment should take place.
Recommendation: continuous estrogen plus progestogen.