The stage of the disease is usually determined after extensive diagnostic evaluation, including history, physical examination, measurement of the hCG level, and routine biochemical and hematologic evaluation. In patients with choriocarcinoma and metastases, the hCG level is often measured in the cerebrospinal fluid to detect asymptomatic central nervous system involvement. Stool guaiac tests are often used to detect metastatic spread to the gastrointestinal tract. Almost all gestational trophoblastic neoplasms can be cured with current treatment methods. The type of treatment depends on the stage of disease and the level of hCG, which is a measure of tumor volume.
Treatment usually continues until the level of hCG is normalized.
Depending on the extent of disease and the serum level of hCG, patients with stage I, II, or III disease are treated by evacuation of their pregnancy or with chemotherapy. The desire to remain fertile is a factor in the selection of treatment for patients with stage I disease. For patients with stage II or III disease, treatment options include single-agent and combination chemotherapy. Patients with stage IV disease require intensive combination chemotherapy along with selective use of tumor-reductive surgery and radiation therapy. Nearly 75 percent of stage IV patients undergo remission.