Gestational Trophoblastic Neoplasia (GTN) Staging and Risk

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] FIGO stage + WHO risk score
   GTN diagnosed — FIGO anatomic stage + WHO risk score? (GTN diagnosis (post-molar hCG plateau/rise/persistence, or choriocarcinoma histology; includes invasive mole/choriocarcinoma/PSTT/ETT). Imaging: chest X-ray to count lung metastases (FIGO criterion), pelvic ultrasound/Doppler for myometrial invasion and vascularity; high-risk add CT chest-abdomen-pelvis + brain MRI. Metastases: lung 80%/vagina 30%/liver and brain 10% each. FIGO stage: I confined to uterus, II genital tract, III lung, IV other distant.)
   • FIGO I–III and WHO score ≤6 (low-risk) → Low-risk (score ≤6) · single-agent chemotherapy
   • WHO score ≥7 (high-risk) → High-risk (score ≥7) · combination chemotherapy
   • WHO score ≥13 (ultra-high-risk) or extensive brain/liver metastases → Ultra-high-risk (score ≥13/extensive metastases)
2. [End] Low-risk (score ≤6) · single-agent chemotherapy
   Low-risk GTN (FIGO I–III and WHO score ≤6): single-agent chemotherapy (methotrexate or actinomycin D), hCG monitoring to normal then consolidation; cure rate near 100%; resistance → switch agent or move to combination.
3. [End] High-risk (score ≥7) · combination chemotherapy
   High-risk GTN (WHO score ≥7): combination chemotherapy (EMA-CO) ± surgery/radiotherapy (e.g. brain metastases); complete CT chest-abdomen-pelvis + brain MRI staging; hCG monitoring to normal then consolidation.
4. [End] Ultra-high-risk (score ≥13/extensive metastases)
   Ultra-high-risk (WHO score ≥13 or extensive brain/liver metastases, stage IV): induction low-dose chemotherapy then EMA-CO/EP-EMA, multidisciplinary (prevent massive hemorrhage, manage brain metastases); higher mortality, refer to a specialist center.

Source guidelines & references

• GTN FIGO 2000 anatomic staging + WHO prognostic score (single-agent vs combination chemotherapy)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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