What Is Gestational Trophoblastic Disease?

Written by Marijke Vroomen Durning, RN
Medically Reviewed by Zilpah Sheikh, MD on March 25, 2025
7 min read

Gestational trophoblastic disease (GTD), also called malignant gestational trophoblastic disease, is a rare group of diseases that causes tumors to grow in the uterus after an egg has been fertilized. These tumors are often benign (noncancerous).

From about weeks three to eight of pregnancy, the tiny group of cells growing in your uterus is called an embryo. Normally, cells on the inside grow into a fetus. Cells on the outside turn into the placenta, which passes nutrients from the mother to the baby. Those outside cells are called trophoblast cells.

The most common kind of GTD occurs early in pregnancy, but some may happen even months or years after you have a full-term baby. In most cases, GTD can be treated, even if it’s cancerous.

Hydatidiform moles (HMs)

Also called a molar pregnancy, HMs are the most common type of GTD. At first, they can seem like a normal pregnancy. You can have a positive pregnancy test if you have a molar pregnancy because the tissue produces hormones similar to those produced during a normal pregnancy. You may even feel like you’re pregnant, but there’s no baby growing — only a group of cysts (fluid-filled sacs). Most HMs are found within the first trimester of pregnancy.

There are two types of molar pregnancies. Most HMs aren’t cancer, but they can sometimes lead to it. There are:

  • Complete hydatidiform moles (CHMs)
  • Partial hydatidiform moles (PHMs)

“Complete moles do not contain fetal tissue, but partial moles often do,” says Peter Ledakis, MD, a specialist in medical oncology and hematology at The Institute for Cancer Care at Mercy Medical Center in Baltimore, MD. “They occur in about 1 in 500 to 1,500 pregnancies. The risk is higher in very young and over 40-year-old women.”

Invasive moles

Also called persistent moles, these belong to a group called gestational trophoblastic neoplasia (GTN). They are almost always cancerous. Invasive moles usually start as CHMs but develop into cancer and grow into the muscle wall of the uterus, called the myometrium. Fewer than 1 in 5 women who have a CHM removed go on to develop an invasive mole. Very rarely, the moles start as PHMs instead. Although this is a type of cancer, invasive moles do not usually spread beyond the uterus.

Choriocarcinoma

Gestational choriocarcinoma is a rare cancer that often starts as an HM. There is an even rarer form of choriocarcinoma that isn’t related to pregnancy, called non-gestational choriocarcinoma. It is an aggressive cancer that can spread throughout the body. Very rarely, it can spread to a baby.

Although gestational choriocarcinoma usually starts as an HM, it can also form from tissue that’s left in the uterus after an abortion, miscarriage, or delivery of a full-term baby, but this is rare.

Placental-site trophoblastic tumors (PSTTs)

PSTTs are very unusual and begin in specialized cells in the placenta. They can start during pregnancy, such as other types of GTD, but they can also form after having an HM removed, a full-term pregnancy, abortion, or miscarriage. While unlikely to spread, these types of tumors can grow into the uterine wall.

Epithelioid trophoblastic tumors (ETTs)

Like PSTTs, epithelioid trophoblastic tumors (ETTs) are also very rare, but when they do occur, it’s most often after a normal pregnancy. They can spread to the uterus and other parts of the body, but they might not be found for months or even years after a pregnancy.

Normally, when a sperm and egg join together, each one gives a set of chromosomes to a new cell that starts to grow and divide. Chromosomes are bundles of genes that hold your DNA. In most cases of GTD, this process doesn’t go right, but doctors aren’t sure why. The cause for GTD, even after the delivery of a full-term baby, is also not clear.

Researchers do know that in the case of complete molar pregnancies, the sperm fertilizes the egg and the father’s chromosomes are copied, but the mother’s chromosomes are missing or don’t work. In partial molar pregnancies, the embryo has too many chromosomes (69 instead of 46) because the father’s chromosomes are doubled — there are two sets. And while the mother’s chromosomes are present, they don’t work. 

You may be more likely to get a GTD if you:

  • Get pregnant when you’re younger than 20 or older than 35
  • Had a molar pregnancy in the past
  • Have a history of miscarriages

Common signs and symptoms include:

  • High blood pressure along with headaches and swelling in your hands and feet — a condition known as preeclampsia
  • Pain, pressure, or discomfort in your pelvis
  • Larger-than-expected uterus in the early stages of pregnancy
  • Shortness of breath, feeling very tired, and dizziness due to vaginal bleeding
  • Showing earlier than expected because of a larger uterus
  • Throwing up and upset stomach, much worse than in a normal pregnancy
  • Vaginal bleeding not related to your menstrual cycle
  • Ovarian cysts
  • Passing tissue through the vagina that may look like a bunch of small sacs (grape-like)
  • No feeling of a baby moving when it’s expected
  • Fever
  • Dry cough
  • Chest pain
  • Difficulty breathing
  • Yellowing of the skin (jaundice)

“GTD may cause stimulation of the thyroid gland and hyperthyroidism,” Ledakis adds. These could lead to symptoms such as: 

  • Fast, irregular heartbeat
  • Shakiness
  • Sweating
  • Weight loss

Ledakis also points out that if the GTD is cancerous and has spread (metastasized), the symptoms would be related to where the cancer has spread. “First site of metastases is usually the lungs, but they can also metastasize to the brain, bones, etc.,” he says.

You find out you have GTD from the routine tests you get when you’re pregnant. Your doctor will ask about your symptoms and do a physical (pelvic) exam.

You may then get:

  • Urine and blood tests to look for signs of tumors or other problems and to check your level of human chorionic gonadotropin (hCG) hormone. “A sign of malignancy is a persistently very high or rising HCG even after completion or termination of pregnancy,” Ledakis says.
  • Pap test (Pap smear), a common gynecological test that checks the cervix for cancerous or precancerous cells
  • Pelvic ultrasound, which can show if there’s a normal fetus or not
  • Imaging tests, such as X-ray, CT scan, MRI, or PET scan, to check if GTD has spread

Once you’ve been diagnosed with GTD, your doctor may want further tests to see if cancer is present and whether it is contained or has spread. These could include imaging tests as well as a lumbar puncture (spinal tap) to see if anything has spread to the brain or spinal cord.

How your GTD is treated depends on what type it is, whether it has spread, and whether you may want to have children in the future. “Since most women with gestational trophoblastic neoplasia are young, one of the goals of treatment is to preserve fertility,” Ledakis says.” Most women can have a normal pregnancy after they’re treated for GTD.

Surgery

Surgery is often the first step for tumors that haven’t spread. Dilation and curettage (D&C) is a common treatment where your doctor widens the cervix and scrapes the uterus with a tool called a curette. You can usually go home the same day.

If you don’t wish to have any more children, a hysterectomy — surgery to remove your uterus — is another option. This isn’t common with HMs, but it’s standard for PSTTs and ETTs to make sure all the cancer cells get removed.

Chemotherapy

Chemotherapy may be used if GTD has spread into the uterus or other parts of the body. It’s often done after surgery to help prevent cancer from coming back. “Treatment for low-risk disease utilizes the drug methotrexate and sometimes dactinomycin,” Ledakis explains. “Treatment for high-risk and stage IV (metastatic) disease usually is multidrug chemo regimens. The five-year survival is quite high – in some studies over 80%.”

Radiation therapy

Radiation therapy uses high-energy beams from X-rays or other sources to kill cancer cells. It’s typically only used if GTD has spread and chemotherapy isn’t working well.

Although most GTD tumors are not cancerous, some – like HMs – can cause cancer. Other complications that could occur include:

  • Infections, which could lead to sepsis
  • Preeclampsia (very high blood pressure that occurs only in pregnancy)
  • Shock (very low blood pressure)

Gestational trophoblastic disease is a rare condition that occurs during pregnancy. While a pregnancy test comes back as positive and you might even feel like you’re pregnant, you’re actually not. A group of cells forms into a tumor instead. Most of the time, these tumors are not cancerous — they’re benign, but some can be. So, it’s important to be checked by your doctor if something doesn’t seem right after you get a positive pregnancy test.

When does gestational trophoblastic disease happen?

Gestational trophoblastic disease begins a few weeks after the egg is fertilized. It’s usually diagnosed within the first three months of what would have been a pregnancy.

Is gestational trophoblastic disease fatal?

In general, GTD isn’t fatal because most tumors aren’t cancerous. Some can develop into cancer. If the cancer spreads and doesn’t respond to treatment, it could be fatal. However, some studies report a five-year survival rate (the number of people alive five years after diagnosis) of over 80%.

Can gestational trophoblastic disease come back?

If you’ve had GTD, there’s a risk of it coming back.