What is Recurrence of gestational trophoblastic tumor can be associated with all except and explain in detail?
Ans. is c i.e. Plateau of hCG (most probably) The examiner here is asking about recurrence of gestational trophoblastic tumor & not about occurrence of gestational trophoblastic tumor post evacuation of H. mole. In most of the books the criteria for diagosis of postmolar gestational trophoblastic tumor is given - Criteria for diagnosis of post molar gestational trophoblastic tumor as prescribed by FIGO oncology committee in 2002 Relapsed (Recurrent), high risk disease is defined by rising hCG after complete serological response to EMA/CO chemotherapy i.e. having atleast 6 weeks of normal hCG values post chemotherapy. Resistant, or refractory, cases are those that have a rising or plateaued hCG while on EMA/CO So by definition Plateau of hCG is seen in resistent and not relapsed cases hence I am chosing it as the option of choice Also know: Management of Recurrent Gestational Trohoblastic neoplasia Diagnosis Careful radiological assessment should be done in such patients to identify the sites of potentially resectable disease FDG -- PET may be used to locate sites of disease in cases showing serological relapse without visible abnormality on conventional imaging. Treatment Treatment is usually surgical resection followed by postoperative chemotherapy. If no site of relapse is identified. hysterectomy should be done as the most likely site of relapse is uterus . The most effective second line chemotherapy is EMA/EP i.e. Etoposide, actinomycins & methotrexate alternating weekly with etoposide and cisplatin This regimen is toxic but has a repoed remission rate of >80% An emerging less toxic alternative is fonightly regimen of paclitaxel + cisplatin alternating with paclitaxel + Etoposide.