Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners.
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.
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.
βHCG 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 βHCG follow-up. The birth control pill is the recommended method of contraception.
Hydatidiform Mole Mets to lung or other sites Plateauing or rising βHCG
Any women in their reproductive years with metastatic tumour and an elevated HCG.
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.
Patient in non metastatic group (rising HCG on follow-up, CXR normal) who does not wish chemotherapy.
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.
Patients should be reminded that it is their responsibility to keep their recommended follow-up appointments. The objectives of the follow-up visits are as follows:
These objectives are best met by having the initial follow-up examination performed by the Agency medical staff. When appropriate, arrangements will be made for follow-up by the referring physician.
Trophoblastic Neoplasia (Other Than Uncomplicated Hydatidirom Moles)
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