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If a woman is treated with radiotherapy, that is surely the end of her fertile days?
No. The ovaries will be shielded effectively against radiation and fertility after treatment is not usually affected. (Preserving fertility after cancer treatment is discussed in more detail here).
What is the effect on fertility after chemotherapy?
There might be reduced fertility following chemotherapy. Hormonal manipulation, sometimes employing the oral contraceptive pill, may help to counteract the adverse effects on the ovary. Combination treatment, where both radiotherapy and chemotherapy have been used, tends to have a more adverse effect on fertility.
Even among those who successfully conceive, the rates of both miscarriage and fetal malformation are increased.
What is the advice regarding future pregnancy after successful treatment of Hodgkin's disease?
It is considered wise to wait for at least two years before trying to conceive again. This is because if there is a recurrence in this period, it would inevitably require very aggressive treatment, which will be incompatible with pregnancy.
Even among those who successfully conceive, the rates of both miscarriage and fetal malformation are increased.
What is the advice regarding future pregnancy after successful treatment of Hodgkin's disease?
It is considered wise to wait for at least two years before trying to conceive again. This is because if there is a recurrence in this period, it would inevitably require very aggressive treatment, which will be incompatible with pregnancy.
Molar pregnancy
What is trophoblastic disease?
This is a group of conditions that occur almost exclusively in pregnancy. They range from the benign but potentially malignant hydatidiform mole (molar pregnancy) to the frankly malignant choriocarcinoma.
So what exactly is hydatidiform mole (molar pregnancy)?
This is a condition where, following conception, the baby (embryo) does not form. Instead, placental tissue consisting only of vesicles (sacs filled with clear fluid) develop. The "pregnant" woman will have normal pregnancy symptoms and body changes. In fact, in some cases, symptoms such as nausea and vomiting may be quite pronounced and may be the first warning of something amiss. It is important to emphasize from the outset that molar pregnancy is not a malignant condition. It appears in this chapter for reasons explained below.
What is in a name?
Hydatidiform mole is , well, a mouthful. It comes from the Greek word hydatis (water drop) and a Latin word mola (mass). It is a descriptive term since a typical molar pregnancy looks like a bunch of grapes or a mass of water drops.
What about a ‘partial’ mole?
The description above refers to a ‘complete’ mole which is the commonest form. The other variety is what is known as a ‘partial’ mole. In this, there is evidence of embryo development but the embryo dies early. The placental tissue then undergoes the changes described above leading inevitably to a miscarriage. It is exceedingly rare for malignant transformation to follow a partial mole. A persistent or invasive (non-malignant) mole can follow a partial mole and that may be treated with a course of chemotherapy.
What are the symptoms of molar pregnancy?
There may be exaggerated pregnancy symptoms. This is by no means always the case. More commonly, the woman will have light vaginal bleeding or a brownish discharge. More than half of such patients are found to have a uterus which feels bigger than the apparent gestation of the pregnancy. A significant proportion, however, will have the uterus feeling smaller than the gestation.
The diagnosis will be confirmed by an ultrasound scan which shows a characteristic image. Very occasionally the patient will pass some vesicles.