Gestational Trophoblastic Disease Treatment (GTD)

Penn Medicine's Abramson Cancer Center offers a comprehensive cancer program that provides women with more options for treating gestational trophoblastic disease (GTD), or placental cancer. Specialists at the Jordan Center for Gynecologic Cancers are dedicated to identifying gestational trophoblastic disease, eliminating it and preventing the condition from recurring.

Our treatment options for GTD include:

Chemotherapy for GTD

Penn Gynecologic Oncology offers the latest advances in chemotherapy for treating GTD. Chemotherapy may be given to treat GTD before or after surgery, or alone.

In addition to managing a patient’s medical oncology treatment, our gynecologic oncologists at the Jordan Center for Gynecologic Cancer work closely with dedicated chemotherapy nurse practitioners. Nurse practitioners offer specialized care for patients undergoing chemotherapy, making sure they receive seamless, coordinated care from the first chemotherapy session through follow-up care.

Clinical Trials for GTD

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Radiation Therapy for GTD

Radiation therapy, which uses high-energy X-rays to kill cancer cells, is generally not used to treat GTD except in special circumstances. For example, radiation may be used in certain cases to treat cancer that has spread to other parts of the body.

For those cases in which radiation therapy is used, Penn Radiation Oncology has the latest equipment and technology available to treat cancer. Our radiation oncologists are recognized leaders in using techniques that target radiation precisely to the treatment area while sparing normal tissue.

Surgery for GTD

If you have been diagnosed with GTD, your physician may need to perform surgery to remove the tumor.

After surgery, doctors follow patients closely with regular blood tests to make sure the level of beta-HCG in the blood falls to normal levels. If the blood level of beta-HCG increases or does not return to normal, more tests will be done to see if the tumor has spread. Treatment depends on whether you have nonmetastatic disease or metastatic disease.

If you need surgery to remove a tumor, the doctor may remove the cancer using one of the following operations:

  • Suction curettage, also called a dilation and curettage (D & C) with suction evacuation, may be performed if the doctor suspects a molar pregnancy.
  • Hysterectomy may be an option for women who do not wish to become pregnant in the future. The ovaries usually are not removed in the treatment of GTD.

Suction Curettage

A dilation and curettage (D & C) with suction evacuation may be performed if the doctor suspects a molar pregnancy. This surgical procedure is usually performed under local anesthesia. The cervix is dilated and the endometrial lining of the uterus is cleared with a suction cannula.

Hysterectomy

At Penn, our minimally invasive techniques, such as robotic-assisted surgery, have become the standard of care for treating gynecologic cancers. For some types of cancer, surgeons remove the body of the uterus and the cervix in a procedure known as a hysterectomy.

A hysterectomy may be performed as an open procedure, known as an abdominal hysterectomy, with the uterus removed through an incision in the abdomen. If lymph node sampling is needed, this can be done through the same incision as the abdominal hysterectomy.

When the uterus is removed through the vagina, it is called a vaginal hysterectomy. Often done as a minimally invasive procedure using a laparoscope, the vagina and any lymph nodes can be removed using a laparoscope.

A variety of surgical options are used to perform a hysterectomy. Penn surgeons consider the patient's medical history, stage of cancer and current health condition to determine the type of surgery needed.

  • Abdominal hysterectomy
  • Vaginal hysterectomy
  • Laparoscopic hysterectomy
  • Laparoscopically assisted vaginal hysterectomy
  • Robotic-assisted hysterectomy

Partial Hysterectomy

In a partial, or supracervical, hysterectomy just the upper part of the uterus is removed. The adjacent tissues are left intact and the cervix is left in place.

Simple Hysterectomy

In a simple hysterectomy, the loose connective tissue around the uterus (parametrium), the tissue connecting the uterus and sacrum (uterosacral ligaments) and the vagina remain intact.

Radical Hysterectomy

In a radical hysterectomy, the entire uterus as well as the tissues next to the uterus (parametrium and uterosacral ligaments) and the upper part (about an inch) of the vagina (near the cervix) are removed.

Usually performed abdominally, radical hysterectomy can also be performed through the vagina. Most patients undergoing a radical hysterectomy also have a lymph node dissection, in which lymph nodes are removed either through the abdominal incision or by laparoscopic lymph node sampling.

Other Treatments for GTD

In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, our integrative oncology services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you ways to enhance the quality of your life, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Our cancer specialists are knowledgeable and supportive of complementary cancer treatments. Our cancer team works with you and your family to integrate these supportive programs into the overall care plan, while ensuring your health and safety.

The Abramson Cancer Center's range of integrative supportive services is designed to help you cope with the cancer experience and improve your overall sense of well-being.

Services include:

Joan Karnell Supportive Services at Pennsylvania Hospital offers an extensive variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Oncology Clinic helps to manage cancer related symptoms. Integrative support programs include:

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients. Palliative care can be used to complement traditional cancer therapies, or can be used when curative therapies are no longer an option to treat symptoms and improve quality of life.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end of life care. Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families.

Penn Home Care and Hospice Services

Penn Medicine offers a full range of “at home” health care services, including specialized therapies and medications, for patients with cancer and cancer-related conditions.