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Gestational Trophoblastic Disease Is Usually Cured by Chemotherapy

Dear Dr. Roach: My sister was diagnosed with gestational trophoblastic neoplasia. What is it? — A.C.

Answer: Gestational trophoblastic disease is a type of tumor that comes from cells of the placenta, the structure that normally supports a developing pregnancy. The most common GTD is called a hydatidiform mole. This type of tumor occurs when two sperm fertilize an egg that has no female chromosomes (a complete mole) or half the normal amount (a partial mole). These are tumors, not a normal pregnancy, although it appears to be a normal pregnancy at first. The diagnosis is made by ultrasound, and there is a blood test (beta HCG) that leads to suspicion. They are usually treated surgically with a dilatation and curettage (D and C).

Gestational trophoblastic neoplasias are similar to hydatidiform moles, but are considered cancers, since they have the potential to spread. Choriocarcinomas and placental trophoblastic tumors are similar cancers, also related to abnormal fertilization events, not normal pregnancies. Fortunately, these cancers are usually cured by chemotherapy. A gynecologic oncologist is the expert in treating this condition.

Dear Dr. Roach: I’m a 61-year-old woman who was diagnosed with notalgia paresthetica about five years ago. Several years later, my general practitioner told me to use capsaicin, which helps with the tingling feeling but sometimes my back feels like someone is pinching my spine and the skin tingles, bringing on a very uncomfortable feeling. Can you give me any more information about this skin condition? I am beginning to believe that it is getting worse. — Anon.

Answer: Notalgia paresthetica is common, but often not diagnosed, and usually causes an itching under one shoulderblade. It sometimes is associated with curvature of the spine (scoliosis). It isn’t curable, and often gets better and worse. Capsaicin, lidocaine patch and other creams usually provide some relief. Botulinum toxin and nerve block occasionally are used for people with more severe symptoms who don’t respond.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write t o P.O. Box 536475, Orlando, FL 32853-6475.