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Journal Publishes ACOG-endorsed Evidence-Based Review on GTD

Gynecologic Oncology Feature
Jan 5, 2022

Last month Gynecologic Oncology published, “Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation,” which has been reviewed and endorsed by the American College of Obstetricians and Gynecologists (ACOG), and it is an update of ACOG practice bulletin #53. “ACOG practice bulletins represent the standard of care management for a wide variety of gynecologic and obstetrical clinical situations and act as a guideline for practicing obstetricians/gynecologist for how to manage these clinical scenarios,” explained co-author Neil Horowitz, MD. “By endorsing this review, ACOG is essentially educating gynecologists on the natural history and management of molar pregnancy, how to manage them, how to follow them, how to diagnose gestational trophoblastic neoplasia (GTN), and when to refer to gyn oncology for management of GTN.”

“Commonly, comprehensive gynecologists are the first providers to identify, diagnose and manage GTD (molar pregnancy),” said co-author Ramez Eskander, MD. “As such, it is critical that they are equipped in also following these patients, identifying when there is concern for GTN, and referring to gynecologic oncologists when appropriate.

“Gynecologic oncologists are commonly referred patients who have suspected GTN,” Dr. Eskander added. “These patients may present with rising beta hCG values, vaginal bleeding, and at times, pelvic pain and cramping. Commonly however, they are asymptomatic and identified as having a plateau or rise in hCG assessments after management of GTD.”

“Patients occasionally will present after a term or non-molar pregnancy with more widespread disease in which case they could have any number of symptoms associated with the sites of metastases,” said Dr. Horowitz. “It is important to remember that for women of reproductive age who have metastatic disease of unknown origin one must rule out GTN with hCG evaluation.”

Dr. Eskander added that although it is uncommon, it is important for gynecologic oncologists to be well versed in the identification and management of GTN. “This is one of the rare malignancies, where despite metastatic disease, cure rates remain high with appropriate management, highlighting the relevance of this document,” he said. “In addition, we continue to explore ways to improve outcomes in patients with difficult to treat, recurrent GTN, and immunotherapy may emerge as a promising strategy.”

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