About the center of expertise
In our nationally - and even internationally - recognized expertise center, women with (possible) gestational trophoblastic disease can turn to us for advice, research, and possible treatment. Gestational trophoblastic diseases is a group of disorders that arise in the trophoblast. Trophoblast cells are the cells that form the placenta.
For many years, we have performed the hCG pregnancy hormone determination for this disorder for the entire country. Patients are also registered in our national molar registration.
During a healthy pregnancy, an embryo (the future baby) and a placenta arise from the fertilized egg. However, in rare cases something can go wrong during or shortly after fertilization, causing the embryo to stop growing, while the placenta continues to grow. As a result, many small blisters fill the uterine cavity. This condition is called a molar pregnancy. A molar pregnancy is in itself a benign condition. As many as possible molar cysts will be removed from the uterine cavity, if it turns out that the embryo is no longer viable, The body itself usually removes the remaining cysts.
Sometimes, however, the molar cysts do not go away or even start growing again. This happens to 10-15% of the women who had a molar pregnancy. In this case, there is a persistent trophoblast (permanent molar tissue) or trophoblast tumor. These are malignant cells. In about half of the women, these spread via the blood to the lungs. In rare cases, the malignant cells spread to the vagina, brain or liver. A trophoblast tumor usually occurs after a molar pregnancy, but can also occur after a miscarriage or an otherwise healthy pregnancy.
The trophoblast tumor is rare: this condition is diagnosed in about thirty women in the Netherlands every year.
Radboudumc has extensive experience in patient care and scientific research in the field of gestational trophoblastic diseases, a group of syndromes that arise in the placenta. Radboudumc’s center of expertise in gestational trophoblastic diseases was established in 2015.
Radboudumc’s center of expertise in gestational trophoblastic diseases is a collaboration between doctors and other healthcare providers from various Radboudumc departments. An important task is advising all Dutch gynecologists who counsel patients with a gestational trophoblastic disease. We also try to keep the lines of communication with the doctors in a patient's vicinity open as much as possible.
The Netherlands has had a registration system for gestational trophoblastic diseases since 1975. The central molar registration is located at Radboudumc, as well as the national reference laboratory for provisions of the hCG (a pregnancy hormone). Every molar pregnancy must be reported and registered here.
Our specialists are in close contact with their colleagues elsewhere in the world, which keeps our knowledge and skills in the field of gestational trophoblastic diseases up to date.
The Ministry of Health, Welfare and Sport has acknowledged the center of expertise in gestational trophoblastic diseases.
Molar registrationThe Netherlands has had a registration system for gestational trophoblastic diseases since 1975. The central molar registration is located at Radboudumc, as well as the reference laboratory for hCG determinations. Every molar pregnancy must be reported and registered here.
You can register your patients via firstname.lastname@example.org
Disorders and treatments
Information for patients
Your first appointmentYour general practitioner or treating specialist will refer you to our center of expertise. You will then be sent information at home about:
- the outpatient clinic
- date and time of your appointment
Your visitDuring your first visit, we will first do a few tests to determine the existence of a molar pregnancy. These tests may include:
- Physical exam
During an initial consultation, if a molar pregnancy is suspected, an external examination will be carried out to feel how big the uterus is and such. Usually, an internal examination and a gynecological examination of the vagina and the cervix will follow.
A transvaginal ultrasound (vaginal ultrasound, internal ultrasound) looks for signs of a molar pregnancy or other abnormalities.
- Tissue examination
During a curettage, molar cysts can be removed from the uterine cavity. A pathologist will examine the tissue to determine whether it is a trophoblast tumor.
- Laboratory tests
If a molar pregnancy is suspected, a blood test is done. The concentration of the hCG (a pregnancy hormone) in the blood will be one of the things that are determined.
- CT scan and MRI scan
Sometimes additional examination is required. Further examination allows us to detect any metastases and to determine the correct treatment.
Your case managerAfter the first contact with the gynecologist, you will meet your case manager. The case manager is the person you and your loved ones can initially contact during the entire treatment process. Together with you, the case manager keeps an overview of the examinations and treatments you receive. If you have any questions or concerns, you can discuss them with the case manager.
All case managers are specialized oncology nurses.
What to bring for your first appointment
- Insurance papers
- Form of identification
- Referral letterBring the referral letter from your general practitioner or another care provider, if one was given to you.
During your first visit to the Radboudumc, please report to the central registration desk in the main entrance hall. Here your personal information is checked and recorded in the hospital system.
Where to check in?Enter the medical center via the main entrance. You will reach the Obstetrics & Gynecology outpatient clinic, by following route number 782. You check in at the desk there.
Follow-up appointmentIf you have had a molar pregnancy, the hCG concentration in your blood will need to be checked every week until it normalizes.
Research and education
EducationOur center of expertise provides education for students of Medicine, of Biomedical Sciences, and of other programs. We also offer medical specialists (in training) the opportunity to do an internship. It is also possible for students to carry out academic research within our center of expertise.
Further education and trainingOur center of expertise also contributes to further training of medical specialists, general practitioners and (oncology) nurses through Q and A evenings and refresher training symposia.
ResearchWithin our center of expertise, we conduct international scientific research to improve diagnostics and care for women with gestational trophoblastic diseases.
- Prof. dr. L. F.A.G. Massuger
- Mw. dr. P.B. Ottevanger
- Prof dr. G.C.J. Sweep
- Dr. A.E. van Herwaarden
- Dr. J. Bulten
Over the past ten years, four theses on gestational trophoblastic diseases have been written at Radboudumc:
- N.E. van Trommel - Refinements in the Management of Persistant Trophoblastic Disease
- L.G.W. Kerkmeijer - Human chorionic gonadotropin in the prediction of persistant trophoblastic disease
- C. Lybol - Improving Management of gestational trophoblastic neoplasia
- Y.K. Eysbouts - Detection and classification of gestational trophoblastic neoplasia