Question
A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?
| A. |
Hysterectomy
|
| B. |
EMACO regimen
|
| C. |
Inj. Methotrexate
|
| D. |
Multiple dose of Inj. Methotrexate
|
Show Answer
|
Correct Answer » B
Explanation
|
|
- A history of molar pregnancy followed by cannonball lung lesions indicates metastatic gestational trophoblastic neoplasia (GTN), most commonly choriocarcinoma.
- Lung is the most common site of metastasis in GTN.
- Presence of metastasis places the patient in the high-risk category (FIGO/WHO scoring).
- High-risk GTN requires multi-agent chemotherapy.
- The standard and most widely used regimen is EMA-CO:
- Etoposide
- Methotrexate
- Actinomycin-D
- Cyclophosphamide
- Vincristine (Oncovin)
- This regimen achieves high cure rates (>90%) even in metastatic disease.
Explanation of Other Options:
A. Hysterectomy
- Not first-line in metastatic disease
- May be considered in selected resistant or localized uterine disease, not initial management
C. Injection Methotrexate (single-agent)
- Used only in low-risk GTN (non-metastatic or low score)
- Inadequate for metastatic disease
D. Multiple-dose Methotrexate
- Still single-agent therapy
- Not appropriate for high-risk or metastatic GTN
