Trophoblastic neoplasia is a spectrum of disease ranging from benign hydatidiform mole (1 in 1200 pregnancies) to the malignant gestational trophoblastic neoplasias. They can arise from any type of pregnancy.

1. Failure to perform a complete history and physical examination.    
2. Over-reliance on diagnostic examinations and under-reliance on clinical suspicion and physical findings.    
3. Failure to perform a pelvic examination as part of the initial assessment.

8.1 Diagnosis

1) Clinico-pathologic Considerations

Two groups of patients can be identified at diagnosis. Low risk patients can be cured by combination chemotherapy. (See chemotherapy protocols). Others must be treated with intensive, multi-agent chemotherapy.

High Risk Group

• Antecedent term pregnancy    
• Brain metastasis    
• Liver metastasis    
• Metastasized to more than one organ site    
• Failed prior chemotherapy    
• HCG greater than 40,000 (post-evacuation)

Low Risk

• All others

2) Diagnostic Pathology

• History/physical, including pelvic examination    
• Chest X-ray    
•  HCG    
• Liver function tests    
• Lytes, creatinine    
• CT brain in all, if post term pregnancy    
• CT liver/or U/S in post molar pregnancy with positive chest X-ray