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Molar Pregnancy

What Is It?
After a sperm fertilizes an egg, new tissues develop that normally form the fetus and placenta. A
molar pregnancy, also known as gestational trophoblastic disease, occurs when the tissue that
was supposed to form the placenta grows abnormally and can form a tumor that can spread
beyond the womb or uterus.
In a "complete mole," no normal fetal tissue forms. In a "partial mole," incomplete fetal tissues
develop alongside molar tissue. These two conditions are noncancerous (benign) and make up 80
percent of cases. Three malignant forms of gestational trophoblastic disease occur, including
invasive molar pregnancy, choriocarcinoma and placental site trophoblastic tumors. Almost all
molar pregnancies, even the cancerous type, can be cured.
Most molar pregnancies are noncancerous and confined to the uterus (hydatidiform moles). In this
type of mole, the abnormal placental tissue has villi, clusters of tissue swollen with fluid, giving it
the appearance of a cluster of grapes. If a fetus begins to develop along with a hydatidiform mole,
it typically has many malformations and almost never can be delivered as a living baby.
A more aggressive tumor associated with molar pregnancies is an invasive mole, also called
chorioadenoma destruens. The invasive mole contains many villi, but these may grow into or
through the muscle layer of the uterus wall. Rarely, invasive moles can cause bleeding by
perforating the uterus through its whole thickness. In 15% of cases, an invasive mole can spread
to tissues outside of the uterus.
Pregnancy tissues can develop into a cancer called choriocarcinoma, though this is rare. Fifty
percent of choriocarcinomas form during a molar pregnancy. Others form during a tubal pregnancy,
an aborted pregnancy, a miscarriage or a healthy pregnancy. Choriocarcinomas can cause
persistent bleeding in the weeks or months after delivery, but this happens very rarely. (Most
bleeding like this is not caused by a choriocarcinoma). Choriocarcinomas associated with molar
pregnancies almost always follow complete moles rather than partial moles.
All forms of molar pregnancy, including choriocarcinoma, are more common in women of Asian or
African ethnicity.
In the United States, molar pregnancies occur in about one in 1,250 pregnancies.
Choriocarcinoma occurs in one in 40,000 pregnancies.
Symptoms
Hydatidiform moles can exaggerate the usual symptoms of pregnancy. Many of the symptoms are
similar to those associated with miscarriage, and most women with molar pregnancies first
believe they have miscarried. Invasive moles and choriocarcinomas can cause symptoms during
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or after pregnancy, and symptoms can develop after a hydatidiform mole has been removed.
The most common symptom is vaginal bleeding, especially between the 6th and 16th weeks of
pregnancy. Another symptom is bleeding that continues for a long time after delivery. Small
amounts of bleeding can show up as a watery brown discharge from the vagina. Sometimes, a
piece of tissue containing grapelike shapes will pass through the vagina, though this is not
common. It is important to remember that most vaginal bleeding during or after pregnancy is not
associated with a molar pregnancy. However, you should report any bleeding during pregnancy to
your health care professional.
A mole or choriocarcinoma also can cause the following symptoms:
Abdominal swelling, caused by the uterus becoming larger, that occurs more rapidly than
expected for the first trimester of pregnancy
Excessive vomiting during pregnancy
Fatigue, often caused by anemia from heavy bleeding
Sudden severe abdominal pain caused by internal bleeding
Pelvic cramping or vaginal discharge
Shortness of breath, coughing or blood in coughed-up secretions because choriocarcinoma
very rarely spreads to the lungs before it is diagnosed.
There are many other causes for these symptoms most are associated with normal
pregnancies so if you have such problems don't assume you have a molar pregnancy. Always
speak with your health care professional.
Diagnosis
Your doctor may suspect you have a molar pregnancy based on symptoms you have during or
following pregnancy, or because your uterus is unusually large. Your doctor may suspect a molar
pregnancy if you have a high level of human chorionic gonadotropin (HCG), the hormone
measured in a routine pregnancy test. All pregnancies with high levels of HCG are not moles,
however, and some molar pregnancies do not have high levels of HCG.
An ultrasound of the pelvis typically can confirm a diagnosis of a molar pregnancy. Ultrasound
uses sound waves to show an image of the contents within the uterus.
If you have a molar pregnancy, further testing will be done to determine the type of mole and the
possibility of it having spread outside the uterus. Testing may include X-rays, computed
tomography (CT) scans or magnetic resonance imaging (MRI) scans to view the chest, abdomen,
pelvis and brain. Additional blood tests may be needed. A pathologist will look at the molar tissue
under a microscope once it is removed to confirm the diagnosis.
Expected Duration
Treatment for some molar pregnancies can take several months. Following treatment, you will
need to have repeated blood tests and checkups over one to two years, to be sure that all molar
tissue has been treated and that the problem has not returned.
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Prevention
Although any woman who becomes pregnant is at some risk of developing one of these
uncommon conditions, the risk appears to be higher in pregnant women who are younger than age
20 or older than age 40.
The best way to prevent complications from an invasive mole or a choriocarcinoma is to receive
routine prenatal care by a qualified health care professional, so that problems can be identified as
early as possible.
Treatment
The results of diagnostic tests will help to determine a treatment plan. Options for treatment
almost always include surgery to remove the tumor. More aggressive types of molar pregnancy
may require chemotherapy and/or radiation therapy. About 85% of hydatidiform moles can be
treated without chemotherapy. Treatment options include:
Suction dilation and curettage (D and C) This is a surgical procedure used to remove
noncancerous hydatidiform moles. The opening in the cervix is dilated and the inside uterus
lining is scraped (curetted) clean using suction and another spoonlike instrument.
Removal of the uterus (hysterectomy) This is used rarely to treat hydatidiform moles but
may be elected particularly if the woman does not want to become pregnant again.
Chemotherapy with a single drug This treatment with medication toxic to the molar tissue
is used to treat a molar pregnancy tumor that has features suggesting a good prognosis.
Chemotherapy with multiple drugs Treatment with several medications, each toxic to the
molar tissue, is generally required to treat invasive tumors with poorer prognosis.
Radiation treatment This uses high-strength X-ray beams to destroy cancer cells in the
exceedingly rare case when a tumor has spread (metastasized) to the brain.
When To Call A Professional
For any pregnancy, make sure you have appropriate prenatal care beginning in the first trimester,
with regular checkups. Report any bleeding, excessive vomiting, or abdominal pain during
pregnancy to your doctor. If you have prolonged vaginal bleeding after childbirth, an abortion or a
miscarriage, contact your doctor for an evaluation.
Prognosis
With appropriate treatment, all hydatidiform moles are curable, and nearly all cases of more
aggressive molar tumors can be cured. Even with tumors whose features categorize them as
having a poor prognosis, 80% to 90% are cured with a combination of surgery and, if needed,
chemotherapy.
It is important for women with molar pregnancies to be evaluated periodically after the problem
has been treated. Women are advised not to attempt pregnancy for some time in order to be sure
that levels of HCG remain at zero and that no further treatment is needed. There is a risk that a
molar pregnancy can come back after treatment. Recommendations are changing and vary by
hospital.
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It is usually possible for women to have a normal, healthy pregnancy after treatment for a molar
pregnancy.
Additional Info
American Cancer Society (ACS)
1599 Clifton Rd., NE
Atlanta, GA 30329-4251
Toll-Free: (800) 227-2345
http://www.cancer.org/
National Cancer Institute (NCI)
Building 31
Room 10A03
31 Center Dr., MSC 2580
Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
http://www.nci.nih.gov/
Office of Rare Diseases
National Institutes of health
31 Center Dr., MSC 2084
Building 31, Room 1B-19
Bethesda, MD 20892-2084
Phone: (301) 402-4336
Fax: (301) 480-9655
http://rarediseases.info.nih.gov/
Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a health
professional. Use of this content is subject to specific Terms of Use & Medical Disclaimers.
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