Gestational Trophoblastic Disease (GTD)

As much as I try to keep this blog cheerful, I feel it's time I share with my family and friends the medical issues we have encountered recently. One involves myself and the other involves my brother. I'll start with myself...

As some of you may know, we were able to conceive again in late August. We were very excited and hoped that this pregnancy would hold since I had two miscarriages in the last year. All the signs were good throughout the month of September - the pregnancy hormone hCG was rising appropriately and I was experiencing lots of nausea (a good sign, but not a good sign if you know what I mean). But late in September I started spotting again, just like the last two miscarriages. We were crushed as each day produced more spotting than normal. A sonogram in early October showed no movement from the fetus. It was definitely another miscarriage. I had a D&C on October 4th to remove the fetus.

The doctor called the next day and said the pathologist said I had had a Molar Pregnancy (also known as a hydatidiform mole) - there are two types Complete Molar and Partial Molar and I had a Partial Molar. I am posting here a definition I found on the internet: "an abnormal growth of the membrane that encloses the embryo and gives rise to the placenta. If a mole develops, the embryo is usually either absent or dead. The mole itself is a collection of cysts that contain a jellylike substance and resemble a cluster of grapes. Hydatidiform moles may change into a type of cancer called choriocarcinoma or gestational trophoblastic tumor. " In very basic terms, the cells of the placenta are growing at a high abnormal rate. My doctor had Jeremy and I go through a chromosome test to make sure there were no abnormalities, but the tests came back clean. The hCG level now had to be monitored. It should go back down to zero when a female is not pregnant, but after having a molar pregnancy, it may keep rising which means the cells are still growing thus leading to Gestational Trophoblastic Disease (GTD). Once a person gets GTD, if they don't act quickly, it can progress into a cancer called chriocarcinoma and spread throughout the body. The good news is it reacts well to chemotherapy and the cure rate is extremely high if found early. the bad news is, once you get GTD, regardless of whether or not it is malignant, the only way to cure it is with chemotherapy medication.

One week after my D&C my hCG was down to about 1800, two weeks later it had risen to 2200 raising an alarm in my doctor. She wanted to act fast because the sooner you treat GTD the better the results. We picked an oncologist and started the paperwork. However, I requested one more blood test to see what rate my hCG level was rising. That test came back and it showed by hCG level had dropped to 950! This was extremely good news. My doctor said to hold off on the oncologist visit until we got more blood test results. Each time I have to wait a week between blood tests. The next test was the week before the Thanksgiving holiday and it was at 128. I will have another test this week and pray that it is close to zero.

Even though it looks like we may have skirted past GTD this time, once you have a molar pregnancy you are more likely to have it again and you are required to wait a minimum of 6 months before trying again. I may or may not get it the next time we try to become pregnant. If I get it again, this time it may turn into GTD. We have to make a decision on whether we are going to take that risk. If you would like to read more information i've included two very informative links below:

Gestational Trophoblastic Disease (GTD):
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_gestational_trophoblastic_disease_49.asp?sitearea=

Molar Pregnancy:
http://www.emedicine.com/med/topic1047.htm
http://www.obgyn.net/women/women.asp?page=/women/articles/molarpreg_dah