diagnosis, treatment and follow-up in areas of limited resources

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1、DIAGNOSIS,TREATMENTANDFOLLOW-UPINAREASOFLIMITEDRESOURCESVirachWootipoom,MDPrinceofSongklaUniversitySongkhla,ThailandGestationalTrophoblasticLesionsLimitedresourcesGynecologicOncologistsLaboratory(hCG)ImagingChemotherapyRadiotherapySurgeryLancetOncol2003;

2、4:670–78IncidenceofhydatidiformmolefromselectedstudiesLancetOncol2003;4:670–78Ratiosofchoriocarcinomafromselectedstudies*Age-standardisedincidenceratesofchoriocarcinomaper100000womenfromcancerregistry-basedstatisticsindifferentareasoftheworld.LancetOncol

3、2003;4:670–78GTDvariationThereasonforthisvariationisnotunderstoodwomenover40yearshavingatleastafivefoldincreaseinrisk.previousmolarisapredisposingfactorGTDinSouth-EastAsiaGTDusedtobeacommongynecologicalprobleminSouth-EastAsiancountries.Thetrueincidenceis

4、unknownbecauseofthelackofatumorregistryinmanycountries.GynecologicOncologistsLaboratory(hCG)ImagingChemotherapyRadiotherapySurgeryDIAGNOSIS,TREATMENTANDFOLLOW-UPINAREASOFLIMITEDRESOURCESPopulation(millions):………….…63Provinces:……………………….……76GynecologicOnco

5、logists:………..110Fellowshiptrainingcenters:.……9FellowshipTraining(years):.….2Society:…………….……TGCSThailandHydatidiformmoleUltrasoundhasreplacedallothernoninvasivemeansfordiagnosis.Ultrasound+hCGissuggestive.Today,USandhCGareavailableinnearlyeveryareasoflim

6、itedresources.DiagnosisofHMManagementofHMpatientsshouldbemonitoredwithserumquantitativehCGvaluesCBCchestX-raycoagulationtestsrenalandliverfunctiontestsMoleshouldbeevacuatedassoonaspossible.Suctioncurettagepreferredmethodofevacuation.Hysterectomyanalterna

7、tivetreatmentinselectedcases.reducesmalignantpostmolarsequelae.riskofpostmolarGTNremains3–5%thesepatientsshouldbemonitoredpostoperativelywithserialhCGlevels.ManagementofHMProphylacticchemotherapyMaybeappropriateforsomespecificcircumstancesinareasoflimite

8、dresourcesHigh-riskcasesLimpongsanurakS.ProphylacticactinomycinDforhigh-riskcompletehydatidiformmole.JReprodMed2001;46:110–6High-riskcriteriaInitialhCG>100,000mIU/mLSize>dateThecaluteincysts>6cmMaternalage>40Associatedmedi