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Combinations of anti‐cancer drugs to treat high‐risk cancers arising from the placenta, known as high‐risk gestational trophoblastic neoplasia (GTN)

GTN is a cancer that most often arises after a molar pregnancy but can arise after any type of pregnancy. Molar pregnancies occur due to abnormal growth of placental tissue that is usually benign and treated by evacuation of the womb (D&C). However, in less than 10% of molar pregnancies in the UK, the growth remains after D&C and transforms into a cancer (GTN) that needs treatment with anti‐cancer drugs (chemotherapy). GTN can be low‐risk or high‐risk. Anti‐cancer drugs are very effective, especially in low‐risk GTN, which is usually cured with single‐drug treatment. However, high‐risk GTN needs to be treated with combinations of anti‐cancer drugs for the best effect. These drugs can produce toxic side effects that are more likely to occur when used in combination with each other. The most commonly administered drug combination is abbreviated as EMA/CO, which stands for Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin® (vincristine), but several other combinations are also in use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gestational Trophoblastic Disease Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of gestational trophoblastic disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 26, 2015

Gestational Trophoblastic Disease Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of gestational trophoblastic disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 25, 2015

Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage

The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. The guideline includes guidance on when senior and/or specialist advice should be sought in order to avoid errors and unnecessary delay.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2012

Antenatal Care: Routine Care for the Healthy Pregnant Woman

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008

Systematic Reviews in PubMed

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