Obstetrician checks pregnancy

The National Comprehensive Cancer Network?, also known as NCCN?, a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, has released new treatment guidelines for a group of rare cancers that impact women during pregnancy.

Gestational trophoblastic neoplasia (GTN), also known as gestational trophoblastic disease (GTD), begins in the layer of cells called the trophoblast that normally surrounds an embryo. Early in normal development, the cells of the trophoblast form tiny, finger-like projections known as villi. The villi grow into the lining of the uterus. In time, the trophoblast layer develops into the placenta, the organ that protects and nourishes the growing fetus.

Approximately one out of every 1,000 pregnancies in the United States is impacted by the disease, though it is more common in many Asian and African countries. Due to the rare nature of the condition, and the small number of specialists worldwide, providers often are not aware of how to provide the best care for people with GTN.

New guidelines
?These guidelines are sorely needed,? explained David Mutch, MD, Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, who leads the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?) Committee for GTN.


?By compiling expert consensus, we can standardize the way this uncommon disease is treated. When treated properly, GTN can almost always be cured, but deviating from that standard can have severe consequences. Plus, by providing clear instructions for how best to treat GTN, we can streamline the insurance approval process for more efficient care,? Mutch added.

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Treatment options
The NCCN Guidelines? for GTN details treatments for several variations of the disease. For molar pregnancy (also known as a hydatiform mole, a rare mass that can form inside the womb during early pregnancy, resulting in an abnormal fetus), surgery is the first, and often only treatment required. It is generally performed via suction dilation and curettage.

Low-risk GTN is primarily treated with single-agent chemotherapy, although additional chemotherapy or surgery may be required for persistent disease. With high-risk GTN, treatment typically involves multi-agent chemotherapy, with possible radiation therapy for brain metastasis. Surgery can be used for chemotherapy-resistant disease.

Committee of experts
Mutch was joined on the GTN Committee by John Lurain, III, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University and R. Kevin Reynolds, MD, University of Michigan Rogel Cancer Center. The committee is a subset of the larger NCCN Guidelines Panel for Cervical, Uterine, and Vulvar Cancers, of which all three are members.

?We?re fortunate to have several recognized experts in GTN on our panel,? said Wui-Jin Koh, MD, Seattle Cancer Care Alliance, Chair of the NCCN Guidelines Panel for Cervical, Uterine, and Vulvar Cancers, and incoming Chief Medical Officer for NCCN.

?These rare, potentially aggressive malignancies are highly curable. That?s why it?s so important to correctly diagnose, treat, and monitor people with GTN. When patients are appropriately managed ? as described in these standardized guidelines ? not only do they generally achieve excellent long-term outcomes, but fertility can also be preserved for the majority of patients,? Koh said.

Availability of expertise
?If someone with a rare type of cancer doesn?t live near one of the world?s experts on that disease, it doesn?t mean their treatment path can?t be based on that expertise,? said Robert W. Carlson, MD, Chief Executive Officer, NCCN.

?NCCN Guidelines provide care recommendations for 97% of all cancer patients, plus numerous additional recommendations covering screening, prevention, and supportive care. We have plans to add several more new guidelines in the next year, to build out our library of NCCN Harmonized Guidelines for regions with different resource levels, and to publish more translations for non-English speaking clinicians. We know that people with cancer all over the world are relying on NCCN Guidelines to make sure they get the best possible care for their cancer,? Carlson added.

Virtual library
The NCCN Guidelines for GTN bring the total number of NCCN Guidelines to 72. The guidelines are the most frequently-updated medical guidelines in the world, with new versions released at least once a year, and more often as needed. These evidence and expert consensus-based guidelines are downloaded millions of times a year by oncologists and other clinicians worldwide.

Last Editorial Review: August 9, 2018

Featured Image: Doctor checking pregnancy. Courtesy: ? 2010 ? 2018 Fotolia. Used with permission.

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