Treatment of trophoblastic disease combined. The main method of treatment is chemotherapy. Chemotherapy continues to reduce the level of chorionic gonadotropin. When sustainability of chemotherapy shows surgical treatment.
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Chemotherapy in the treatment of trophoblastic disease
Since its introduction to the medical practice of antimetabolites, chemotherapy has become the main method of treating malignant trophoblastic disease.
Indications for chemotherapy are:
- Histological diagnosis of chorioncarcinoma
- The presence of metastasis
- Stable or rising level of chorionic gonadotropin after bubble removal
- Improving the level of chorionic gonadotropin after pre-returning it to normal
The mode and type of chemotherapy are elected individually depending on the nature of the disease. Chemotherapy continues until the level of chorionic gonadotropin in serum drops to a normal level. After that, 1-3 cycles are carried out. Recently, a sensitive reaction to chorionic gonadotropin is used, and these additional courses may not be required in patients with a low risk. For patients from a high risk group, it is recommended to conduct 2-6 additional chemotherapy cycles.
Surgical methods of disease treatment
For treatment, surgical methods are used - scraping the walls of the uterine cavity, and in rare cases of advanced amputation or extirpation of the uterus.
The testimony to the operation serve:
- Chemotherapy resistance
- Toxicity with disease, limited breeches
- Vaginal bleeding
- Perforation of the uterus
- infection
In treatment, radiation therapy can be used when patients with metastases in the liver or brain can develop hemorrhages due to tumor necrosis during chemotherapy.
All patients should be observed monthly with the study of the level of chorionic gonadotropin, at least during the first year. A year later, patients with a high risk must be examined twice a year for 5 years, and then annually. The level of chorionic gonadotropin is checked each time.
The optimal period of pregnancy is at least 1 year after the last preventive course of chemotherapy for patients with the I-II of the stage of the disease and 1.5 years - for patients with the III-IV stage.
Ariter protection against unwanted and untimely pregnancy for women who have suffered a trophoblastic disease is hormonal contraception. This is regulated and normalized by the ovarian function, impaired due to the suffering disease and chemotherapy. Preparations used for the treatment of trophoblastic disease do not affect the chromosomal set of mother and child.
