Coupon Accepted Successfully!


Indications of hysterectomy

  1. Lesions confined to the uterus in women aged> 35 years, not desirous of fertility
  2. Placental site trophoblastic tumor
  3. Intractable vaginal bleeding
  4. Localized uterine lesion resistant to chemotherapy
  5. Accidental uterine perforation during uterine curettage.
    It is preferable to start chemotherapy surgery on day 3 followed by chemotherapy as per schedule.


Lung resection (thoracotomy) is done in pulmonary metastasis in drug resistant cases.


Craniotomy is for control of bleeding.



Patients with brain metastases require whole-brain radiation therapy (3000 cGy over 10 days). Intrathecal high dose methotrexate may be administered to prevent hemorrhage and for tumor shrinkage.

Liver metastasis: Interventional radiology (hepatic artery ligation or embolization) or whole liver radiation (2000 cGy over 10 days) along with chemotherapy may be effective. Hepatic metastasis has a poor prognosis.



The cure rate is almost 100 percent in low risk and about 70 percent in high risk metastatic groups.

Follow up is mandatory for all patients at least for 2 years. Serum hCG is measured weekly until it is negative for three consecutive weeks. Thereafter it is measured monthly for 6 months and 6 monthly thereafter for life.



For non-metastatic GTN: 2-3 percent


Good prognosis' metastatic disease: 3-5 percent and


Poor prognosis' disease: 21 percent.


Recurrence following 12 months of normal hCG level is < 1 percent.

Some Commonly Used Terminologies

  1. Remission: 3 consecutive normal weekly hCG values.
  2. Response: > 10% decline in hCG during one cycle treatment.
  3. Plateau: ± 10% change in hCG during one cycle.
  4. Resistance: 10% rise in hCG during one cycle or plateau for two cycles of chemotherapy.

Placental Site Trophoblastic Tumor (Pstt)

Characteristics of PSTT

  1. The tumor arises from the intermediate trophoblasts of the placental bed and is composed mainly of cytotrophoblastic cells.
  2. Syncytiotrophoblastic cells are generally absent. So there is persistent low level of hCG.
  3. hPL (human placental lactogen) is the tumor marken.
  4. Patient presents with vaginal bleeding.
  5. Local invasion into the myometrium and lymphatics occurs.
  6. PSTT is not responsive to chemotherapy. Hysterectomy is the preferred treatment.

Test Your Skills Now!
Take a Quiz now
Reviewer Name