Synopsis
Recognise persistent gestational trophoblastic neoplasia from hCG and clinical signals, arrange specialist staging and support risk-adapted treatment with curative intent.
- GTN includes invasive mole, choriocarcinoma and rarer placental-site or epithelioid trophoblastic tumours; persistent disease is most often detected through abnormal hCG after molar evacuation.
- Current FIGO 2026 GTN criteria are an hCG plateau of less than 10% rise or fall across four measurements over at least three weeks, an hCG rise of more than 10% across three consecutive weekly measurements over at least two weeks, or histological gestational choriocarcinoma, placental-site trophoblastic tumour or epithelioid trophoblastic tumour. Charing Cross also uses centre-specific UK treatment triggers, including hCG above 20,000 IU/L more than four weeks after evacuation and individually reviewed persistence at six months, alongside major bleeding and specified metastases.
- GTN can follow a complete or partial mole, miscarriage, abortion, ectopic or term pregnancy, so persistent bleeding and hCG require obstetric-history review even months later.
- Confirm pregnancy status and assay validity, then let the national centre direct imaging, FIGO anatomical stage and WHO prognostic scoring.
- Scores of 0–6 remain the low-risk group, 7–12 are high risk and 13 or more are ultra-high risk. Scores 5–6 carry greater single-agent resistance, and FIGO 2026 identifies combinations of tumour type, metastases and pretreatment hCG for which patients may benefit from first-line multi-agent therapy despite the low-risk label.
- Low-risk post-molar disease is commonly treated with specialist methotrexate plus folinic acid, with response measured by serial hCG and therapy continued beyond biochemical normalisation.