The abnormal proliferation of gestational trophoblast tissue forms a spectrum of diseases from the usually benign partial hydatidiform molethrough to thehighly malignant choriocarcinoma and placental site trophoblast tumours. The biology, diagnosis and therapy of these diseases, combined with their psychological impact, makes trophoblast disease an extremely important and interesting area of gynaecological and oncology care. Despite the rarity of these illnesses, patients generally have very successful outcomes with overall cure rates in excess of 95%. Using the treatments that have been established for over 20 years, the majority of trophoblast patients including those with advanced metastatic disease can be treated with a high expectation of cure with minimal long-term toxicity.
With the effectiveness of the current medical therapies, the main developments in trophoblast disease management in theUK arenow aimed at improving thesupportive care. These areas include strategies for ensuring human chorionic gonadotrophin (hCG) monitoring after molar pregnancies, improvements in pathology reporting and maintaining clinical awareness for the early diagnosis of choriocarcinoma and placental site tumours.
Since 1973 the UK has had centralized surveillance, follow-up and treatment facilities and much of the content of this chapter is based on the experience from the National Trophoblast Tumour Centre at Charing Cross Hospital (CXH) in London.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.