Hydatidiform mole is a tumor that forms in the uterus as a mass of cystsresembling a bunch of grapes. Hydatidiform moles occur during the childbearing years, and they do not spread outside the uterus. However, a malignancy called choriocarcinoma may start from a hydatidiform mole. In its early stages, a hydatidiform mole may look like a normal pregnancy. Diagnosis is based on a history of lack of fetal movement, a pelvic examination, an ultrasound, and a blood test to look for high levels of the hormone beta human chorionic gonadotropin (hCG). hCG in the blood of a woman who is not pregnant can be a sign of a hydatidiform mole.
Treatment includes removal of the mole by dilation and curettage (D & C) and suction evacuation and surgery to remove the uterus (hysterectomy). In the United States, more than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential. Highly effective means of contraception are recommended to avoid pregnancy for at least 6 to 12 months. In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease (PTD). The moles may intrude so far into the uterine wall that hemorrhage or other complications develop.
It is for this reason that a post-operative full abdominal and chest x-ray will often be requested. In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly-growing, and metastatic (spreading) form of cancer. Over 90% of women with malignant, non-spreading cancer are able to survive and retain their ability to conceive and bear children. In those with metastatic (spreading) cancer, remission remains at 75 to 85%, although their childbearing ability is usually lost. The national prevalence rate of hydatidiform mole is 2. 4/1,000 pregnancies during the years 2002-2008.
At the University of Philippines-Philippine General Hospital (UP-PGH) the prevalence rate of hydatidiform mole is 14/1,000 pregnancies. The national prevalence rate of choriocarcinomas and other gestational trophoblastic neoplasias (GTNs) has remained almost constant at 0. 56/1,000 pregnancies. Again, UP-PGH showed a high prevalence for choriocarcinoma and other GTNs at 4. 3/1,000 pregnancies. Because patients with GTD are invariably indigent, modifications to standard treatment practices have been adapted to bring down the cost of chemotherapy without sacrificing survival and remission rates.