American Medical Association Family Medical Guide - American Medical Association [588]
Trophoblastic Tumors
Trophoblastic tumors (often called hydatidiform moles) are a rare type of growth in the placenta that may occur during or after pregnancy. (The placenta is the organ that develops in the uterus during pregnancy and links the blood supplies of the pregnant woman and fetus.) Trophoblastic tumors can also develop in placental tissue left in the uterus after childbirth or a miscarriage. Trophoblastic tumors are usually benign (noncancerous). Occasionally, however, they may invade the wall of the uterus or spread to other parts of the body.
Symptoms
The main symptoms of a trophoblastic tumor are irregular vaginal bleeding, nausea, and vomiting during or after a pregnancy or after termination of a pregnancy. See your doctor right away if you have any of these symptoms.
Diagnosis
If you have symptoms of a trophoblastic tumor, your doctor may order an ultrasound of the uterus. A trophoblastic tumor causes excessive production of the pregnancy hormone human chorionic gonadotropin (HCG), which is normally made by the cells of the placenta during pregnancy. HCG passes into the blood and can easily be detected in the same blood test that is used for confirming a pregnancy (see page 504).
Treatment
If a trophoblastic tumor is present in your uterus, your doctor will remove the growth surgically during a D and C (see page 869). No further treatment is necessary for a benign tumor, other than frequent checkups and blood tests (to check for HCG) for a year to make sure the tumor has not recurred. Your doctor will recommend that you avoid pregnancy during this time; he or she may prescribe oral contraceptives or another reliable form of birth control.
If the tumor is malignant, the doctor may recommend chemotherapy (see page 23), perhaps in addition to a hysterectomy (see previous page). You may have chemotherapy after a hysterectomy to prevent the cancer from spreading and to kill any cancer cells that have spread. After this treatment you will need to have regular checkups. Your chances for a complete cure are good.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) occurs when bacteria or viruses infect the uterus and spread to the fallopian tubes, ovaries, and surrounding tissues. The infection is usually introduced through the vagina during sexual intercourse with an infected person. The sexually transmitted diseases chlamydia (see page 477) and gonorrhea (see page 480) are very common causes of PID. Pelvic infections are most common in young, sexually active women and least common in women who have reached menopause. If the infection is not treated, an abscess (a pus-filled sac) may form in a fallopian tube or ovary, causing scarring and potentially damaging the fallopian tubes. Blockage of the fallopian tubes from the infection can cause infertility (see page 493).
Symptoms
An acute or sudden pelvic infection causes severe pain and tenderness in the lower abdomen and may also cause a high fever. A chronic pelvic infection may cause mild, recurring pain in the lower abdomen and sometimes pain in the back, along with a low-grade fever. In both acute and chronic forms of PID, you may experience pain during intercourse, have irregular periods, and have a heavy, foul-smelling vaginal discharge.
Diagnosis
To diagnose PID, a doctor will perform a pelvic examination and take samples of fluid from inside the cervix. Laboratory analysis of this fluid will help identify the infectious organism that is causing the condition. He or she will also order an ultrasound (see page 111)