Investigations are similar to those for hydatidiform mole with in addition, CT scans of the abdomen, pelvis and head for possible metastasis.
Treatment usually entails evacuation of the uterus followed by chemotherapy. Hysterectomy may be indicated if the patient is over 40 years of age.
The chemotherapeutic regime adopted is determined by the presence of metastatic disease. It normally includes cycles of methotrexate, actinomycin-D or cyclophosphamide.
Radiotherapy may also be indicated in patients with disease metastatic to the brain or liver.
The level of beta-hCG should be monitored monthly. For patients without metastases, follow-up is usually for 2 years. If metastatic disease was present, monitoring may be necessary for up to 5 years, usually on a quarterly basis after the initial two years.
Patients with primary tumours alone show a 90% success rate; this falls to 40-75% in those with metastatic disease.
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