Stage IB (>50% myometrial invasion)

Standard Treatment

● TH + BSO

● Sentinel lymph node mapping or systematic pelvic lymphadenectomy

Adjuvant Therapy

Depending on grade & risk:

● Vaginal brachytherapy

● External beam radiation in selected cases

● Hormonal therapy for ER/PR positive tumors

Stage II–III

Primary Treatment

● Complete surgical staging

       ○ TH + BSO

        ○ Pelvic ± para-aortic lymph node dissection

       ○ Omentectomy for serous / clear cell histology

Adjuvant Therapy

● Pelvic radiation

● Chemotherapy (Carboplatin + Paclitaxel)

● Combined chemoradiation for high-risk cases

Stage IV or Metastatic Disease

Systemic Therapy Options

1. Chemotherapy: Carboplatin + Paclitaxel

2. Immunotherapy:

○ Pembrolizumab for MSI-H/dMMR tumors

; ○ Dostarlimab for recurrent dMMR tumors

3. Hormonal Therapy for ER/PR-positive cancers

○ Aromatase inhibitors

○ Progestins

4. Targeted Therapy:

○ Lenvatinib + Pembrolizumab for advanced disease

Palliative surgery or radiation

Used for bleeding, obstruction, or pain control.

Surgical Management

Surgical Management

Laparoscopic and robotic hysterectomy is standard for early-stage disease, offering:

● Faster recovery

● Less blood loss

● Shorter hospital stay

2. Sentinel Lymph Node Mapping

Using fluorescent dyes (ICG) to reduce morbidity of full lymphadenectomy.

3. Open Surgery

Reserved for:

● Advanced disease

● Large tumors

● Extensive adhesions

Performed by experienced surgical oncologists.

Systemic Therapy Details

1. Chemotherapy

Standard regimen:

● Carboplatin + Paclitaxel

● 3–6 cycles based on stage and risk

2. Immunotherapy

Most effective in:

● MSI-H

● MMR-deficient

● Tumors with high mutational burden

3. Targeted Drugs

● Lenvatinib targets tumor angiogenesis

● Combined with Pembrolizumab for platinum-resistant disease

4. Hormonal Therapy

Used in:

● Low-grade

● ER/PR positive tumors

● Elderly patients

● Patients unfit for surgery

Molecular Classification (ESMO 2025)

Modern endometrial cancer treatment includes molecular risk grouping:

● POLE-mutated

Excellent prognosis; minimal therapy needed.

● MSI-H / dMMR

Highly immunotherapy-sensitive.

● p53 abnormal

Aggressive, requires chemoradiation.

● NSMP (No Specific Molecular Profile)

Hormone-receptor–driven, intermediate risk.

This classification dramatically improves treatment personalization.

Fertility Preservation

Appropriate for:

● Grade 1 endometrioid carcinoma

● Stage IA (no myometrial invasion)

● Strong desire for pregnancy

● No contraindications

Approach:

● High-dose progestins (Megestrol / Medroxyprogesterone)

● LNG-IUS

● Close monitoring with 3–6 monthly biopsies

● IVF counseling and planned pregnancy after remission

Surgery recommended after childbearing is complete.

Recent Advances

1. Lenvatinib + Pembrolizumab combination

Significantly improves survival in advanced disease.

2. Immunotherapy for dMMR tumors

High response rates, durable remissions.

3. POLE & p53 testing now standard

Improves treatment selection.

4. Sentinel node mapping replacing extensive dissection

Reduces complications such as lymphedema.

5. Robotic surgery adoption

Enhanced precision in staging and dissection.

Our Expertise at Coimbatore Cancer Clinic

● Advanced ultrasound, MRI, PET-CT evaluation

● Expertise in laparoscopic and open oncologic hysterectomy

● Sentinel lymph node mapping

● Molecular profiling (MMR, MSI, p53, POLE)

● Access to modern chemotherapy, immunotherapy, targeted therapy

● Pathology support for complex subtypes

● Comprehensive survivorship and follow-up care

● Focus on patient comfort, recovery, and quality of life

When to Consult

Seek immediate evaluation for:

● Postmenopausal bleeding

● Bleeding between periods

● Heavy or irregular menstrual cycles

● Pelvic pain

● Thickened endometrium on ultrasound

These symptoms should never be ignored.

Frequently Asked Questions (FAQs)

1. Is endometrial cancer curable?

Yes. Most cases diagnosed early are completely curable with surgery.

2. Do all patients need chemotherapy?

No. Many early-stage cancers do not require postoperative treatment.

3. Can I have children after diagnosis?

Selected early-stage patients may undergo fertility-sparing therapy.

4. Is minimally invasive surgery safe?

Yes. Laparoscopic/robotic surgery is standard for early-stage disease

5. Should I get my uterus removed for safety?

Not necessary unless diagnosed with cancer or precancerous changes.

Disclaimer

This page provides general medical information for public education. Individual treatment plans must be made after consultation with qualified surgical and medical oncologists.

Vaginal Cancer – Causes, Symptoms, Diagnosis, Treatment & Latest Advances

Overview

Vaginal cancer is a rare gynecologic malignancy that arises from the cells lining the vagina. It accounts for less than 2 percent of female reproductive cancers. Most vaginal cancers develop in older women, typically between 50 and 80 years of age, and are often associated with persistent infection with high-risk Human Papillomavirus (HPV).

The two main types are:

1. Squamous Cell Carcinoma (SCC) – Most common (85–90 percent).

2. Adenocarcinoma – Less common; includes clear cell adenocarcinoma.

Other rare tumors include melanoma, sarcoma, and lymphoma involving the vagina.

At Coimbatore Cancer Clinic, our team of surgical oncologists and medical oncologists provides comprehensive and individualized management for vaginal cancer, including advanced imaging, biopsy, surgical treatment, radiation therapy coordination, chemotherapy, immunotherapy, and long-term supportive care following NCCN and ESMO 2025 guidelines.

Causes & Risk Factors

1. HPV Infection

Persistent high-risk HPV types (16 & 18) are strongly associated with vaginal cancer.

2. Age

Most cases occur in women above 50.

3. History of Cervical Precancer or Cancer

Previous cervical dysplasia or cervical cancer increases risk.

4. HPV-Related Conditions

● Vaginal intraepithelial neoplasia (VAIN)

● HPV-positive lesions in the cervix or vulva

5. DES Exposure (Diethylstilbestrol)

Women exposed in utero have higher risk of clear cell adenocarcinoma.

6. Immunosuppression

HIV/AIDS, long-term steroids, post-transplant status.

7. Smoking

Synergistic risk factor with HPV infections.

Symptoms & Warning Signs

Early-stage vaginal cancer may be asymptomatic. Common symptoms include:

1. Abnormal Vaginal Bleeding

● Postmenopausal bleeding

● Bleeding after intercourse

● Bleeding between periods

2. Abnormal Discharge

Foul-smelling, watery, or blood-stained discharge.

3. Pain

● Pelvic pain

● Pain during intercourse

● Abdominal or lower back pain

4. Urinary or Bowel Symptoms

● Difficulty passing urine

● Frequent urination

● Constipation or rectal bleeding (in advanced disease)

5. Lumps or Mass

A palpable mass or ulcer within the vagina.

Any unusual bleeding or discharge should prompt evaluation.

Diagnostic Evaluation

1. Pelvic Examination

Including speculum and bimanual exam to visualize lesions.

2. Colposcopy

Enhanced visualization of the vaginal epithelium, especially for VAIN or suspicious lesions.

3. Biopsy

Confirms diagnosis, determines histology and tumor grade.

4. Imaging

Imaging guides staging and treatment planning:

● MRI pelvis: best for local tumor extent

● PET-CT: detects lymph node or distant metastasis

● CT scan: chest/abdomen/pelvis for advanced disease

5. Cystoscopy / Proctoscopy

Used selectively when bladder or rectal invasion is suspected.

Staging (FIGO 2021)

● Stage I: Tumor confined to the vaginal wall

● Stage II: Tumor invades paravaginal tissues but not pelvic wall

● Stage III: Tumor extends to pelvic wall or causes hydronephrosis

● Stage IVA: Invades bladder/rectal mucosa

● Stage IVB: Distant metastasis

Accurate staging is essential for choosing appropriate therapy.

Treatment – Stage-wise (NCCN 2025)

Treatment

Treatment depends on stage, tumor size, location, histology, and patient fitness.

Stage 0 (VAIN 3 – High-Grade Dysplasia)

● Laser ablation

● Topical 5-FU

● Imiquimod therapy

● Local excision

Regular follow-up is crucial to prevent progression.

Stage I

Upper Vaginal Tumors

● Radical hysterectomy + upper vaginectomy

● Pelvic lymph node assessment

Lower Vaginal Tumors

● Wide local excision with reconstruction if necessary

● In selected cases, primary radiation therapy is preferred due to functional concerns

Stage II

● Radiation therapy (EBRT + Brachytherapy) is the mainstay

● Surgery may be considered for small, resectable upper vaginal tumors

● Concurrent cisplatin-based chemoradiation may improve outcomes

Stage III–IVA

These stages often require combined-modality therapy due to local extension.

Standard Treatment:

● Concurrent chemoradiation

    ○ External beam radiation

    ○ Weekly cisplatin

    ○ Intracavitary or interstitial brachytherapy

Surgery

Reserved for:

● Residual or recurrent disease

● Small operable upper vaginal lesions

Stage IVB (Metastatic Vaginal Cancer)

Systemic Therapy

● Carboplatin + Paclitaxel

● Cisplatin-based combinations

● Immunotherapy for PD-L1 positive, MSI-H, or dMMR tumors (Pembrolizumab, Dostarlimab)

Palliative Radiation

For bleeding, pain, or obstruction.

Special Considerations in Surgical Management

Surgery is challenging due to proximity to the bladder, rectum, and urethra. Experienced surgical oncologists perform:

● Radical vaginectomy

● Partial vaginectomy

● Radical hysterectomy + vaginectomy

● Reconstruction with flaps (gracilis, VRAM) when required

Minimally invasive approaches may be used in selected cases.

Systemic Therapy Details

1. Chemotherapy

Carboplatin + Paclitaxel is widely used for advanced or metastatic disease.

2. Immunotherapy

Highly effective in:

● dMMR tumors

● MSI-High cancers

● PD-L1 positive tumors

3. Targeted Therapies

Investigational in vaginal cancer but useful in HPV-related tumors.

Radiation Therapy

Radiation is a cornerstone of treatment.

Components

1. External Beam Radiation (EBRT)

2. Brachytherapy (intracavitary or interstitial)

Benefits

● Organ preservation

● Excellent control of localized tumors

● Ideal for patients unfit for surgery

We coordinate radiation therapy with leading centers.

Recurrent Vaginal Cancer

Management options include:

● Surgical excision of localized recurrence

● Re-irradiation in select cases

● Systemic chemotherapy

● Immunotherapy for dMMR/MSI-H tumors

● Palliative care for symptom control

Survival & Prognosis

Depends on:

● Stage

● Tumor size and location

● Lymph node involvement

● Histological type

● Response to chemoradiation

Early-stage disease has excellent outcomes with appropriate treatment.

Our Expertise at Coimbatore Cancer Clinic

● Expert evaluation of suspicious lesions and VAIN

● High-quality imaging, biopsy, and histopathology

● Minimally invasive and open surgical options

● Coordination of radiation therapy planning

● Evidence-based chemotherapy and immunotherapy

● Psychological, nutritional, and rehabilitation support

● Long-term surveillance programs

We focus on organ preservation, patient safety, and high-quality recovery.

When to Consult

Seek evaluation if you have:

● Unexplained vaginal bleeding

● Postcoital bleeding

● Persistent discharge

● Pelvic pain

● Visible or palpable vaginal lesion

Early diagnosis significantly improves outcomes.

Frequently Asked Questions (FAQs)

1. Is vaginal cancer preventable?

HPV vaccination and regular gynecologic visits reduce risk.

2. Is surgery always required?

No. Many vaginal cancers are best treated with radiation or chemoradiation.

3. What is the survival rate?

Early detection offers excellent outcomes; advanced cases require multimodality therapy.

4. Does vaginal cancer spread quickly?

It usually spreads locally first; hence early symptoms like bleeding should not be ignored.

5. Can HPV cause vaginal cancer?

Yes. Persistent high-risk HPV infection is the leading cause.

Disclaimer

This information is for public education only. Individual treatment plans require consultation with qualified surgical and medical oncologists.

Vulvar Cancer – Causes, Symptoms, Diagnosis, Treatment & Recent Advances

Overview

Vulvar cancer is an uncommon gynecologic malignancy that develops in the external female genital organs, including the labia majora, labia minora, clitoris, and perineum. Although rare, its incidence is increasing due to a rise in HPV-related precancerous lesions in younger women and longer life expectancy in older women.

There are two major pathways:

1. HPV-associated vulvar cancer

Seen in younger women; associated with VIN (Vulvar Intraepithelial Neoplasia).

2. Non-HPV–associated vulvar cancer

Occurs in older women; often arises from chronic inflammatory conditions such as lichen sclerosus.

The most common type (>90 percent) is squamous cell carcinoma (SCC). Less common types include melanoma, Bartholin gland carcinoma, Paget’s disease–associated cancers, and adenocarcinoma.

At Coimbatore Cancer Clinic, our team of surgical and medical oncologists provides comprehensive management including specialized surgical excision, sentinel lymph node biopsy, reconstruction, radiation therapy coordination, chemotherapy, and individualized survivorship support. We follow evidence-based NCCN and ESMO 2025 guidelines for optimal care.

Causes & Risk Factors

1. Human Papillomavirus (HPV)

High-risk types such as HPV 16 and 18 are associated with VIN and invasive cancer.

2. Chronic Vulvar Conditions

● Lichen sclerosus

● Lichen planus

● Chronic dermatitis

These increase the risk of non–HPV vulvar cancer.

3. Age

Two peaks:

● Younger women: HPV-related

● Older women: non-HPV keratinizing SCC

4. Smoking

Reduces immune resistance to HPV; increases progression to cancer.

5. Immunosuppression

HIV infection, chronic steroid use, post-transplant state.

6. Previous Gynecologic Malignancy

History of cervical, vaginal, or anal precancer or cancer.

Symptoms & Warning Signs

Early symptoms are subtle and may be mistaken for infection or skin irritation.

Common Symptoms

● Persistent vulvar itching

● Burning sensation

● Pain or soreness

● Skin color changes (white plaques, red patches)

● Ulcers or growths

● Bleeding or discharge

Advanced Symptoms

● Pain on sitting or walking

● Enlarged groin lymph nodes

● Difficulty urinating

● Foul-smelling discharge

Any persistent vulvar lesion or itching warrants medical evaluation.

Diagnostic Evaluation

1. Clinical Examination

Inspection of the vulva for lesions, ulcers, pigmentation, or masses.

2. Vulvar Biopsy

Gold standard for diagnosis; determines:

● Type of cancer

● Depth of invasion
● Margins (if excisional biopsy done)

3. Colposcopy

Helps identify multifocal HPV-related lesions.

4. Imaging Studies

● MRI pelvis: best for local staging

● Ultrasound groin: evaluates lymph nodes

● CT or PET-CT: identifies metastasis

5. Sentinel Lymph Node Mapping

ICG or dye-based mapping for selected early-stage patients.

Staging (FIGO 2021)

● Stage I: Tumor confined to vulva/perineum

● Stage II: Spread to adjacent structures (lower urethra, vagina, anus)

● Stage III: Lymph node involvement

● Stage IV: Upper urethral, bladder, rectal, pelvic bone invasion, or distant metastasis

Staging guides treatment decisions.

Treatment – Stage-wise (NCCN 2025)

Stage IA (Microinvasive Carcinoma)

● Wide local excision (WLE) with ≥1 cm margin

● Lymph node evaluation not required if invasion <1 mm

Stage IB–II

Primary treatment is surgery, tailored to preserve function and appearance.

Surgical Options

1. Wide Local Excision (WLE)
  For small tumors with clear margins.

2. Radical Local Excision
  Removal of tumor with adjacent deeper tissues.

3. Modified Radical Vulvectomy
  For larger tumors; preserves as much anatomy as possible.

Lymph Node Management

Depends on tumor size, depth, and location:

● Sentinel lymph node biopsy (preferred for unifocal tumors <4 cm)

● Inguinofemoral lymphadenectomy (if sentinel node positive or mapping not feasible)

Radiation Therapy

May be required for:

● Close or positive margins

● Lymph node involvement

● Deep stromal invasion

Stage III–IVA

Locally advanced disease requires combined-modality therapy.

Primary Options:

1. Radical surgical excision + lymphadenectomy

2. Chemo-radiation to shrink tumor, followed by surgery if needed.

3. Reconstruction with skin flaps(V-Y advancement and gracilis flap.)

Chemo-radiation typically uses cisplatin as a radiosensitizer.

Stage IVB (Metastatic Disease)

Systemic Therapy Options

● Carboplatin + Paclitaxel

● Cisplatin + 5-FU

● Pembrolizumab for PD-L1 positive, dMMR, or MSI-H tumors

● Immunotherapy + chemotherapy combinations (selected cases)

Palliative Care

Radiation or surgery for symptom control (bleeding, pain).

Surgical Management Detail

1. Wide Local Excision

● Preferred for early disease

● Aim: ≥1 cm pathological margin

● Minimally invasive reconstruction options

2. Sentinel Lymph Node Biopsy

Advantages:

● Reduces morbidity

● Avoids full groin dissection

● Recommended for tumors <4 cm, unifocal

3. Inguinofemoral Lymphadenectomy

Indicated when:

● Sentinel node is positive

● Multifocal disease

● Tumor >4 cm

4. Reconstruction

Performed when large defects occur after wide excision or radical vulvectomy.

Flap options:

● V-Y advancement flap

● Lotus petal flap

● Gracilis flap

Performed to restore comfort, anatomy, and sexual function.

Systemic Therapy Details

Chemotherapy

Used in:

● Nodal involvement

● Locally advanced disease

● Metastasis

● Palliation

Common regimens:

● Carboplatin + Paclitaxel

● Cisplatin + 5-FU

Immunotherapy

Highly effective in:

● PD-L1 positive tumors

● MSI-H / dMMR cancers

Agents include:

● Pembrolizumab

● Dostarlimab

Targeted therapy is investigational but promising in HPV-driven cancers.

Radiation Therapy

Essential for:

● Nodal disease

● Residual disease after surgery

● Locally advanced tumors

● Unfit surgical candidates

Usually delivered as:

● External Beam Radiation Therapy (EBRT)

● Boost to primary and nodal sites

Concurrent cisplatin enhances effectiveness.

Vulvar Intraepithelial Neoplasia (VIN)

VIN is a precancerous condition. High-grade VIN (HSIL) requires treatment:

● Laser ablation

● Imiquimod cream

● Wide local excision

● Photodynamic therapy (select cases)

Regular follow-up is essential.

Recurrence & Surveillance

Recurrence can occur locally or in lymph nodes.

Surveillance schedule:

● Every 3–6 months for 2 years

● Every 6–12 months thereafter

● Annual pelvic exams long-term

Recurrence treatment:

● Surgical re-excision

● Radiation or chemotherapy

● Immunotherapy for recurrent metastatic disease

Prognosis

Depends on:

● Stage

● Tumor size

● Lymph node involvement (most important factor)

● Margins of resection

● Histologic subtype

Early detection significantly improves prognosis.

Our Expertise at Coimbatore Cancer Clinic

● Skill in vulvar oncologic surgery, sentinel mapping, and reconstructive techniques

● Coordination of advanced radiation planning

● Evidence-based chemotherapy and immunotherapy

● Expertise in managing HPV-related lesions and VIN

● Individualized treatment plans respecting function and quality of life

● Long-term follow-up and survivorship care

● Compassionate counseling and symptom management

When to Consult

Seek medical evaluation for:

● Persistent vulvar itching

● Any ulcer or sore that does not heal

● Skin color changes or thickened patches

● Pain during urination or intercourse

● Bleeding or discharge

● A lump or growth in the vulvar area

Early evaluation prevents progression.

Frequently Asked Questions (FAQs)

1. Is vulvar cancer caused by HPV?

Yes—HPV is a major cause of vulvar cancers in younger women.

2. Do all patients need lymph node removal?

No. Many early cancers can be staged with sentinel lymph node biopsy.

3. Will my anatomy change after surgery?

Surgical reconstruction options help restore appearance and comfort.

4. Can vulvar cancer be cured?

Early-stage disease is highly curable with surgery.

5. Can itching alone be a sign of vulvar cancer?

Persistent itching, especially with skin changes, should be evaluated

Disclaimer

This page provides general information for patient education. Individual treatment decisions should be made in consultation with qualified surgical and medical oncologists.

Gestational Trophoblastic Neoplasia (GTN) – Causes, Symptoms, Diagnosis, Treatment & Latest Advances

Overview

Gestational Trophoblastic Neoplasia (GTN) is a rare but highly curable group of pregnancy-related tumors that arise from trophoblastic tissue—the cells that normally develop into the placenta. GTN can occur after any type of pregnancy: molar pregnancy (most common), miscarriage, ectopic pregnancy, or even full-term delivery.

Uniquely, GTN is one of the most chemo-sensitive and curable malignancies, with cure rates exceeding 90–95 percent even in advanced stages.

GTN includes:

1. Invasive mole

2. Choriocarcinoma

3. Placental site trophoblastic tumor (PSTT)

4. Epithelioid trophoblastic tumor (ETT)

The first two types respond extremely well to chemotherapy, while PSTT and ETT may require surgery.

At Coimbatore Cancer Clinic, our team of surgical and medical oncologists offers advanced diagnostics, risk-based therapy, fertility-preserving strategies, and long-term hCG monitoring following NCCN and FIGO guidelines.

Causes & Risk Factors

1. Prior Molar Pregnancy

The strongest risk factor. About 15–20 percent of complete moles develop into GTN.

2. Maternal Age

● Increased risk in teenagers

● Highest risk in women >40 years

3. Previous GTN

Recurrence risk is slightly increased.

4. Abnormal Fertilization Events

Complete mole: empty egg + paternal genome

Partial mole: egg + two sperm

5. Geographic Variation

Higher incidence in Asian populations.

Symptoms & Warning Signs

GTN may develop soon after pregnancy or months to years later.

Common Symptoms

● Abnormal uterine bleeding

● Prolonged heavy bleeding after miscarriage or delivery

● Persistent elevated hCG levels

● Pelvic pain

● Enlarged uterus or ovarian cysts (theca lutein cysts)

Symptoms of Metastatic GTN

● Shortness of breath (lung metastasis)

● Cough or hemoptysis

● Neurological symptoms (rare brain metastasis)

● Abdominal pain or liver dysfunction

Any woman with abnormal bleeding after a pregnancy should be evaluated for GTN.

Diagnostic Evaluation

1. Serum hCG Levels

The hallmark of diagnosis. Persistent or rising hCG after treatment of a molar pregnancy strongly suggests GTN.

2. Pelvic Ultrasound

Assesses retained molar tissue, invasion, and uterine involvement.

3. Chest X-ray / CT Chest

Lungs are the most common site of metastasis.

4. CT/MRI Abdomen & Pelvis

Determines extent of disease spread.

5. Brain MRI

Performed when symptoms or high-risk features are present.

6. Histopathology

Not always required, as many GTN cases are diagnosed based on clinical and hCG criteria alone.

Classification (FIGO 2021)

GTN is classified as:

● Low-risk GTN

● High-risk GTN

● Ultra–high-risk GTN

Based on:

● Age

● Type of antecedent pregnancy

● Interval from pregnancy

● hCG level

● Tumor size

● Metastatic sites

● Prior chemotherapy

This risk scoring guides chemotherapy selection.

Treatment – Stage-wise & Risk-based (NCCN 2025)

GTN is one of the few cancers cured primarily with chemotherapy.

Low-Risk GTN (FIGO score ≤6)

Single-Agent Chemotherapy

1. Methotrexate regimen (most common)

2. Actinomycin-D (alternative)

Response rates >90 percent.

Treatment Duration

Chemotherapy is continued:

● Until hCG normalization

● Then 2–3 additional consolidation cycles

Fertility Preservation

All standard treatments preserve fertility.

High-Risk GTN (FIGO score ≥7)

Multi-Agent Chemotherapy

Standard regimen:

● EMA-CO

  Etoposide

  Methotrexate

  Actinomycin D

  Cyclophosphamide

  Vincristine

Alternative regimens:

● EMA-EP

● BEP (selected cases)

Cure rate remains high (>80–90%).

Surgery

Used in selected cases:

● Resistant uterine disease

● Localized recurrence

● PSTT/ETT (low chemotherapy response)

Radiation Therapy

Used for:

● Brain metastases

● Bone metastases

● Hemorrhage control

Ultra-High–Risk GTN

Patients with:

● Massive tumor burden

● Brain or liver metastases

● hCG >1,000,000 IU/L

Management includes:

● Intensive chemotherapy

● ICU-level supportive care

● Brain radiation if needed

● Multidisciplinary approach

Surgical Management

Surgery is usually not first-line, except for the less chemo-sensitive subtypes.

1. Hysterectomy

Considered in:

● Women who have completed childbearing

● Resistant uterine disease

● PSTT or ETT

2. Resection of Metastasis

For isolated lung or liver metastases not responding to chemotherapy.

3. Evacuation of Retained Molar Tissue

Performed carefully under ultrasound guidance.

Systemic Therapy Details

1. Methotrexate

Highly effective in low-risk GTN.

2. Actinomycin-D

Used when MTX fails or causes toxicity.

3. EMA-CO Regimen

Mainstay for high-risk GTN.

4. Immunotherapy

Emerging role:

● Pembrolizumab in refractory GTN

● Especially useful in PD-L1 positive tumors

5. Targeted Therapy

Still investigational, but early results are promising.

hCG Monitoring & Follow-Up

hCG monitoring is critical because it detects recurrence early.

After Treatment

● Weekly hCG until normal

● Monthly hCG for 6–12 months

● Avoid pregnancy for at least 6–12 months after treatment

● Effective contraception recommended during monitoring

Recurrence Risk

Low with proper follow-up.

Fertility & Pregnancy After GTN

Excellent outcomes:

● Most women retain normal fertility

● Pregnancy after treatment is usually safe

● No increased risk of congenital abnormalities

Women are advised to:

● Wait until hCG levels remain normal for 6–12 months

● Undergo early pregnancy scans in future pregnancies

Special Considerations: PSTT & ETT

These rare tumors:

● Produce low hCG

● Spread via lymphatics

● Respond poorly to chemotherapy

Primary Treatment:

● Hysterectomy

● Lymph node dissection

● Adjuvant chemotherapy in high-risk cases

Recent Advances

1. Immunotherapy for Resistant Disease

Pembrolizumab has shown excellent results in chemotherapy-resistant GTN.

2. Improved Risk Stratification

Helps tailor therapy intensity and reduce toxicity.

3. High-sensitivity hCG Assays

Detect relapse earlier.

4. Fertility-Preserving Options

Allow many women to maintain reproductive potential.

5. Enhanced Supportive Care

Better management of chemotherapy toxicity improves cure rates.

Our Expertise at Coimbatore Cancer Clinic

● Comprehensive evaluation and diagnosis of GTN

● Expert hCG interpretation and follow-up

● Risk-adapted chemotherapy with high cure rates

● Fertility-preserving treatment strategies

● Collaboration with ICU teams for high-risk GTN

● Close surveillance and long-term follow-up

● Emotional and psychological support for patients and families

Our team ensures safe, effective, and compassionate care throughout treatment.

When to Consult

Seek evaluation for:

● Persistent bleeding after delivery/miscarriage

● Elevated hCG after molar evacuation

● Very high hCG without intrauterine pregnancy

● Symptoms of metastasis (cough, headache, abdominal pain)

● Abnormal ultrasound after pregnancy

Frequently Asked Questions (FAQs)

1. Is GTN curable?

Yes. Cure rates exceed 90–95 percent with modern therapy.

2. Will I lose my fertility?

No. Most women retain fertility, especially in low-risk GTN.

3. How long does treatment last?

Usually a few months, depending on response to chemotherapy.

4. Do I need surgery?

Only in selected cases, especially PSTT/ETT or resistant disease

5. Is follow-up important?

Yes. hCG monitoring is essential to detect recurrence early.

Disclaimer

This page is intended for patient education. Individual treatment decisions must be made in consultation with qualified surgical and medical oncologists.