Gestational Trophoblastic Disease

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with gestational trophoblastic disease (GTD) each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with a tumor are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this tumor and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with GTD?

Overall, GTD is rare. GTD occurs in about 110 to 120 per 100,000 pregnancies in the United States. Most of these are molar pregnancies, which more frequently affect Asian, Hispanic, and Native American women. Choriocarcinoma occurs in about 2 to 7 pregnancies out of every 100,000 pregnancies in the United States. Worldwide, the incidence of GTD widely varies between countries.

What is the survival rate for GTD?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from GTD. These are called survival statistics.

It is important to remember that statistics on the survival rates for people with GTD are only an estimate. They cannot tell an individual person if the tumor will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The prognosis for people with all types of GTD is good, even if the disease has spread to distant organs. Prognosis is the chance of recovery. The survival rates for GTD vary based on several factors. These include the stage and risk grouping of the tumor, a person’s age and general health, and how well the treatment plan works.

Talk with your doctor if you have any questions about this information. Learn more about understanding statistics .

Statistics adapted from the websites of the National Cancer Institute, National Organization for Rare Disorders, and Medscape. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations . It offers drawings of body parts often affected by GTD. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the factors that increase the chance of developing gestational trophoblastic disease (GTD). Use the menu to see other pages.

What are the risk factors for GTD?

A risk factor is anything that increases a person’s chance of developing disease. Although risk factors often influence the development of a tumor, most do not directly cause it. Some people with several risk factors never develop a tumor, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may increase the risk of GTD:

• Age during pregnancy. Being younger than 20 or older than 35 during pregnancy brings a higher risk of GTD. The risk increases with age.

• Previous molar pregnancy. A previous molar pregnancy (see Introduction ) may increase the risk of developing another GTD.

• Nutrition/diet. Some studies have linked low levels of carotene and vitamin A in a person’s diet with a higher risk of molar pregnancy.

• Blood type. Specific blood types — A and AB — may slightly increase the risk of GTD.

• Family history of molar pregnancy . There have been rare cases of people in the same family having 1 or more molar pregnancies.

The only known way to avoid GTD is to avoid pregnancy. When making such family planning decisions, it is important to remember that GTD is rare. Prior abortion is not a risk factor for developing GTD. People who have had a molar pregnancy in the past or who are worried about GTD for any reason are encouraged to talk with their doctors about the future risk of GTD.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems GTD can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, a tumor. They also do tests to learn if it is cancerous and, if so, if it has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of tumors, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How gestational trophoblastic disease (GTD) is diagnosed

There are different tests used for diagnosing GTD. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of disease suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose GTD:

• Pelvic examination. The doctor may feel the uterus, vagina, ovaries, bladder, and rectum to check for lumps or any unusual changes. This is similar to the physical exam done during an annual gynecologic checkup.

• Human chorionic gonadotropin (hCG) test. Tumor markers are substances found at higher-than-normal levels in the blood, urine, or body tissues of people with a tumor. Pregnancy normally causes high levels of hCG in the blood and urine. High levels of hCG in a person who is not pregnant could mean that GTD is present. hCG tests are also helpful tests to monitor a patient's recovery during and after treatment for GTD.

• Other lab tests. Additional blood and urine tests may be done, including tests to check the thyroid, liver, kidney, and bone marrow function.

• Ultrasound. Also called a sonogram, an ultrasound creates a picture of the internal organs using sound waves. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to take the pictures.

• X-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation. A chest x-ray may be done to see if the tumor has spread outside of the uterus.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is injected into a patient’s vein or given as a drink or pill to swallow.

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. In GTD, MRIs are most often used to take pictures of a patient’s brain.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is GTD, these results also help the doctor describe the disease in more detail. This is called staging.

The next section in this guide is Stage and Risk Grouping . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use to treat gestational trophoblastic disease (GTD). Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for GTD. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for GTD in the United States. Treatment options can vary from one place to another.

Clinical trials may also be an option for you, which is something you can discuss with your doctor. A clinical trial is a research study that tests a new approach to treatment. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How GTD is treated

For GTD, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For GTD, this often includes a gynecologic oncologist, which is a doctor who specializes in treating cancer of the female reproductive system. Other specialists may include a medical oncologist, surgeon, and radiation oncologist. Your care team may include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide care.

GTD is typically curable, especially when found early. The main treatments for GTD are surgery and/or chemotherapy.

Patients often have concerns about whether treatment may affect their sexual function and ability to have children, called fertility . Be sure to talk with your health care team about these topics before treatment begins.

Treatment options and recommendations depend on several factors, including the type, stage, and risk grouping of GTD and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for GTD because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for GTD are described below. Your care plan will also include treatment for symptoms and side effects, an important part of medical care.

READ MORE BELOW

• Surgery

• Chemotherapy

• Physical, emotional, social, and financial effects of GTD

• Remission and the chance of recurrence

• If treatment does not work

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often the first treatment used for a molar pregnancy and may be the only treatment necessary. A gynecologist or gynecologic oncologist who specializes in removing a tumor using surgery will typically perform the operation.

For GTD, the extent of surgery depends on the stage of the tumor. Common surgical options include:

• Suction dilation and curettage (D&C). During D&C, the doctor dilates the cervix and removes the tissues inside the uterus using a small vacuum-like device. After that, the walls of the uterus are scraped to remove any remaining molar tissue. The patient may receive a drug called oxytocin that helps the uterus contract to normal size. A D&C is used when there is a molar pregnancy and allows for preservation of future fertility. Side effects may include some vaginal bleeding, infection, scarring inside the uterus, cramping, and blood clots. Talk with your health care team about what to expect from this procedure and how side effects can be managed.

• Hysterectomy. A hysterectomy is the surgical removal of the uterus and uterine cervix. In most cases of GTD, a hysterectomy is not necessary because a cure is possible with other treatments, including D&C and chemotherapy (see below). A hysterectomy is usually recommended to reduce the risk of recurrence or to treat a placental-site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT). Types of hysterectomy include:

  • Simple hysterectomy: The removal of the uterus and cervix.

  • Supracervical hysterectomy: The removal of the body of the uterus while preserving the uterine cervix.

  There are different techniques used to perform a hysterectomy, including a traditional incision in the stomach or a technique that uses several smaller incisions, called a laparoscopic hysterectomy. Side effects may include pain, bleeding, and infection. Talk with your health care team about possible side effects and how they can be relieved. Pregnancy is not possible after a hysterectomy.

Following surgery for GTD, the patient's human chorionic gonadotropin (hCG) level (see Diagnosis ) will be monitored with blood tests to make sure that it returns to normal levels. If the hCG level remains high or increases after an initial drop, it may mean that tumor cells are still present, either in a portion of the original tumor—called a persistent or invasive mole—and/or in another area that the GTD has spread to. If this occurs, additional treatment such as chemotherapy will be recommended. If the GTD surgery shows the presence of choriocarcinoma, chemotherapy is started immediately. Choriocarcinoma is cancerous and always needs chemotherapy.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery .

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Chemotherapy

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. A gynecologic oncologist may also give chemotherapy to treat GTD.

Chemotherapy is the type of systemic therapy used for GTD. Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells. Chemotherapy is usually very effective in treating a molar pregnancy and some types of gestational trophoblastic neoplasia (GTN), but it is not as effective with PSTT and ETT. Sometimes, chemotherapy is used as a single treatment, and in other cases, it may be combined with surgery (see above).

Common ways to give chemotherapy include an intramuscular (IM) injection (or shot), an intravenous (IV) tube placed into a vein using a needle, or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Common drugs used in chemotherapy for GTD include:

• Methotrexate (Rheumatrex, Trexall)

• Dactinomycin (Cosmegen)

• Etoposide (available as a generic drug)

• Cyclophosphamide (available as a generic drug)

• Vincristine (Vincasar)

• Cisplatin (available as a generic drug)

Similar to surgery, the type of chemotherapy depends on the stage grouping of GTD, including whether the tumor is low risk or high risk. A low-risk invasive mole or a cancerous GTD that has spread can often be treated successfully with methotrexate alone or in combination with leucovorin (Fusilev). Another drug that can be used is dactinomycin, especially if the patient’s liver is not fully healthy. About 30% of patients with low-risk disease will need additional treatment with a second drug.

Patients with high-risk metastatic disease generally receive combination chemotherapy with more than 1 drug. Common combinations include:

• EMA-CO: etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine

• EMA-EP: etoposide, methotrexate, dactinomycin, etoposide, and cisplatin

Treatment results are measured by testing the hCG levels. Chemotherapy is usually continued until hCG levels are normal. Additional cycles of chemotherapy are given after hCG levels are normal to reduce the risk of recurrence. In most instances, patients require 3 to 4 cycles of chemotherapy.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, mouth sores, hair loss, loss of appetite, neuropathy (numbness and tingling in the fingers and toes), and oto-toxicity, which is the loss of high-frequency hearing and/or ringing in the ears. These side effects usually go away after treatment is finished. Talk with your doctor beforehand about the possible side effects from the specific drug(s) given and how side effects may be relieved or reduced.

Learn more about the basics of chemotherapy .

The medications used to treat GTD are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with medications to treat the tumor, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

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Physical, emotional, social, and financial effects of GTD

A tumor and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of GTD, may receive this type of care. And it often works best when it is started right after a diagnosis. People who receive palliative and supportive care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy or surgery, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Medical care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Remission and the chance of recurrence

A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions of GTD are permanent, it is important to talk with your doctor about the possibility of the tumor returning. The risk of recurrence for GTD overall is low, but it may be 10% to 15% for those with a high-risk tumor. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence .

If GTD returns after the original treatment, it is called recurrent GTD. It may come back in the uterus (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatment described above, such as surgery or chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent GTD. Treatment is often effective for a recurrent GTD. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent GTD sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

GTD is usually curable. However, recovery is not always possible. If a cancerous GTD cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced disease and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with GTD. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about gestational trophoblastic disease (GTD) and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about gynecologic tumors, which are tumors in the female reproductive system; ways to prevent them; how to best treat them; and how to provide the best care to people diagnosed with these tumors. The following areas of research may include new options for patients through clinical trials. Because GTD is uncommon, GTD-only clinical trials may be hard to find. However, several clinical trials are available to people with different types of tumors, particularly other gynecologic tumors, including GTD. Always talk with your doctor about the best diagnostic and treatment options for you.

• New drug therapies. Researchers are studying new medications for the treatment of GTD and other gynecologic tumors, including the use of immunotherapy. Immunotherapy is designed to boost the body's natural defenses to fight the cancer.

• New treatment combinations. Doctors continue to evaluate different combinations of current treatment options and different drugs, including the integration of new approaches to surgery, which are being studied in clinical trials.

• Causes of GTD. Researchers are working to learn more about what causes GTD, including possible chromosome changes or problems.

• Earlier diagnosis. Research is being done to produce more sensitive blood tests to find human chorionic gonadotropin (hCG) levels at smaller amounts. This could help diagnose GTD at an earlier stage.

• Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current treatments for GTD to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in GTD, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to review research about immunotherapy for GTD announced at the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting.

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers guidance on how to cope with the physical, emotional, social, and financial changes that GTD and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after treatment for gestational trophoblastic disease (GTD) is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with GTD does not end when active treatment has finished. Your health care team will continue to check that the tumor has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Follow-up treatment for GTD always includes measuring human chorionic gonadotropin (hCG) levels in the blood. Patients are encouraged to talk with their doctors about the recommended amount of time to wait before becoming pregnant after their body has normal levels of hCG.

• After a molar pregnancy, patients will typically have their hCG levels checked every week until the levels are normal for 3 weeks in a row. After that, hCG levels will be checked every month until the levels are normal for 6 consecutive months.

• After gestational trophoblastic neoplasia (GTN), patients will typically have their hCG levels checked every week until the levels are normal for 3 weeks in a row. After that, hCG levels will be checked every month until the levels are normal for 12 consecutive months.

During this time of testing, you should use reliable birth control to avoid pregnancy. Talk with your doctor about how long you should use birth control during your follow-up care for GTD and your plans to become pregnant in the future.

People with a history of GTD should have an hCG check after each pregnancy, even if the pregnancy was completely normal.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of GTD first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects, called late effects, may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If chemotherapy was given, talk with your doctor about possible long-term side effects based on the specific drug(s) used. Different drugs and doses can cause different side effects. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the GTD treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their gynecologic oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of tumor, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your GTD care will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a diagnosis of GTD. Use the menu to choose a different section to continue reading in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team to help you better understand your diagnosis of GTD, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your medical care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of gestational trophoblastic disease (GTD) do I have?

• Can you explain my pathology report (laboratory test results) to me?

• What is the stage of the tumor? What does this mean?

• Is it low risk or high risk? What does this mean?

• Is it cancerous?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What types of research are being done for GTD in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the tumor, help me feel better, or both?

• What are the possible side effects of each treatment, both in the short term and the long term?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Will I be able to become pregnant after treatment? Should I talk with a fertility specialist before GTD treatment begins?

• Do you recommend that I wait after treatment to try to become pregnant? If so, how long should I wait? Is it OK to use birth control pills or other methods during this time?

• Could this treatment affect my sex life? If so, how and for how long?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• If I’m worried about managing the costs of medical care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I contact?

Questions to ask about having surgery

• What type of surgery will I have?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this surgery?

• What can be done to prevent or relieve the side effects?

Questions to ask about having chemotherapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• How often will I receive it?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the tumor will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

• If I become pregnant in the future, are there specific tests or exams that I need? How often will I need them?

The next section in this guide is Additional Resources . It offers more website resources that may be helpful to you. Use the menu to choose a different section to read in this guide.