estational trophoblastic disease (GTD) arises from abnormal placenta and is composed
of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD
have been noted in various countries. In addition to histology, molecular geneti
studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by
ultrasound has resulted in changes in clinical presentation and decreased morbidity
from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is
essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duratio
of hCG monitoring varies depending on histology type and regression rate. Low-risk
GTN (FIGO Stages I–III: score <7) is treated with single-agent chemotherapy but may
require additional agents; although scores 5–6 are associated with more drug
resistance, overall survival approaches 100%. High-risk GTN (FIGO Stages II–III: score
>7 and Stage IV) is treated with multiple agent chemotherapy, with or without adjuvant
surgery for excision of resistant foci of disease or radiotherapy for brain metastases,
achieving a survival rate of approximately 90%. Gentle induction chemotherapy helps
reduce early deaths in patients with extensive tumor burden, but late mortality stil
occurs from recurrent resistant tumors.