DIAGNOSIS, TREATMENT AND FOLLOW-UP IN AREAS OF .pptVIP

DIAGNOSIS, TREATMENT AND FOLLOW-UP IN AREAS OF LIMITED RESOURCES Virach Wootipoom, MD Prince of Songkla University Songkhla, Thailand Limited resources Gynecologic Oncologists Laboratory (hCG) Imaging Chemotherapy Radiotherapy Surgery GTD variation The reason for this variation is not understood women over 40 years having at least a fivefold increase in risk. previous molar is a predisposing factor GTD in South-East Asia GTD used to be a common gynecological problem in South-East Asian countries. The true incidence is unknown because of the lack of a tumor registry in many countries. Gynecologic Oncologists Laboratory (hCG) Imaging Chemotherapy Radiotherapy Surgery Thailand Population (millions) : ………….… 63 Provinces : ……………………….…… 76 Gynecologic Oncologists : ……….. 110 Fellowship training centers : .…… 9 Fellowship Training (years) :. …. 2 Society : …………….…… TGCS Hydatidiform mole Diagnosis of HM Ultrasound has replaced all other noninvasive means for diagnosis. Ultrasound + hCG is suggestive. Today, US and hCG are available in nearly every areas of limited resources. Management of HM patients should be monitored with serum quantitative hCG values CBC chest X-ray coagulation tests renal and liver function tests Mole should be evacuated as soon as possible. Suction curettage preferred method of evacuation. Hysterectomy an alternative treatment in selected cases. reduces malignant postmolar sequelae. risk of postmolar GTN remains 3–5% these patients should be monitored postoperatively with serial hCG levels. Prophylactic chemotherapy May be appropriate for some specific circumstances in areas of limited resources High-risk cases Limpongsanurak S. Prophylactic actinomycin D for high-risk complete hydatidiform mole. J Reprod Med 2001;46:110–6 High-risk criteria Initial hCG 100,000 mIU/mL Size date Theca lutein cysts 6 cm Maternal age 40 Associated medical problems (toxemia, hyperthyroid, embolization, DIC) Limpongsanurak S. Prophylactic actinom