Once You Have Been Treated, Then What?
Hormone follow-up by measuring the level of human chorionic gonadotropin (hCG) in the blood continues until the hormone level is normal for three weeks, then should continue monthly for 12 months (24 months or patients with Stage IV disease). During that time the patient should avoid pregnancy. Women who conceive within 12 months of completing chemotherapy have an increased risk of miscarriage, particularly if they have received multiple chemotherapeutic agents. If pregnancy occurs before follow-up is complete, tumor relapse may be difficult to detect and diagnosis of relapse may be delayed.
The chemotherapy used for the treatment of malignant GTD is generally well tolerated without long-term side effects with two exceptions: 1) the use of multi-agent chemotherapy is associated with an earlier menopause, and 2) women with high-risk GTN who require multi-agent chemotherapy which includes a drug called etoposide and survive for more than 25 years should be advised that they may be at increased risk of developing secondary tumors, particularly acute myeloid leukemia, colon cancer, melanoma and breast cancer.