Σταδιοποίηση σε Gestational Trophoblastic Tumors

 

Gestational Trophoblastic Tumors

AJCC Stages

Stage

T

M

Risk Factors

I

T1

M0

Unknown

IA

T1

M0

Low risk

IB

T1

M0

High risk

II

T2

M0

Unknown

IIA

T2

M0

Low risk

IIB

T2

M0

High risk

III

Any T

M1a

Unknown

IIIA

Any T

M1a

Low risk

IIIB

Any T

M1a

High risk

IV

Any T

M1b

Unknown

IVA

Any T

M1b

Low risk

IVB

Any T

M1b

High risk

(T) Primary Tumor

TNM

FIGO

Definitions

TX

 

Primary tumor cannot be assessed

T0

 

No evidence of primary tumor

T1

I

Tumor confined to uterus

T2

II

Tumor extends to other genital structures (ovary, tube, vagina, broad ligaments) by metastasis or direct extension

(M) Distant Metastasis

M0

 

No clinical metastasis

M1

 

Distant metastases

M1a

III

Lung metastasis

M1b

IV

All other distant metastasis

Prognostic Scoring Index

Risk Factors

0

1

2

4

Age

< 40 years

≥ 40 years

 

 

Antecedent pregnancy

Mole

Abortion

Term pregnancy

 

Interval months from index pregnancy

< 4

4-6

7-12

> 12

Pre-treatment serum hCG (IU/L)

< 10³

10³ to < 104

104 to < 105

≥105

Largest tumor size in cm

< 3 cm

3 - 5

> 5

 

Site of metastases

Lung

Spleen, kidney

GI tract

Brain, liver

Number of metastases

 

1-4

5-8

> 8

Previous failed chemotherapy

 

 

Single drug

≥ 2 drugs

Χαρακτηριστικά Επέκτασης
  • Complete and partial hydatidiform mole
    • By definition, benign localized tumors with malignant potential
    • Confined to uterus without myometrial invasion
  • Invasive hydatidiform mole
    • CHM or PHM that invades myometrium
    • Hematogenous metastases can occur to lungs and brain
    • Vaginal metastases can occur via retrograde spread through parauterine veins
  • Choriocarcinoma
    • Highly vascular with possible hematogenous spread to lungs, brain, and liver
    • Vaginal metastases are more common than in IHM
  • Placental-site trophoplastic tumor
    • Tends to spread locally to uterus
    • Can involve lymph nodes, which is uncommon with other GTN

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Gestational trophoblastic disease (GTD) includes

  • Hydatidiform mole
    • Complete hydatidiform mole (CHM)
    • Partial hydatidiform mole (PHM)
  • Invasive hydatidiform mole (chorioadenoma destruens) (IHM)
  • Choriocarcinoma
  • Placental-site trophoblastic tumor (PSTT)

Gestational trophoblastic neoplasia (GTN) includes

  • Persistent hydatidiform mole
  • Invasive hydatidiform mole
  • Choriocarcinoma
  • Placental-site trophoblastic tumor