Introduction

Overview

Organization

Scope

Moving Forward

PART I: THE ESSENTIALS

Chapter 1. The Essentials on Gestational Trophoblastic Tumors: Guidelines

Overview

What Are Gestational Trophoblastic Tumors?

Stages of Gestational Trophoblastic Tumor

How Is Gestational Trophoblastic Tumor Treated?

Treatment by Stage

To Learn More

About PDQ

More Guideline Sources

Vocabulary Builder

Chapter 2. Seeking Guidance

Overview

Associations and Gestational Trophoblastic Tumors

Cancer Support Groups

The Cancer Information Service

Finding Cancer Resources in Your Community

Finding Doctors Who Specialize in Cancer Care

Selecting Your Doctor

Working with Your Doctor

Finding a Cancer Treatment Facility

Additional Cancer Support Information

Vocabulary Builder

Chapter 3. Clinical Trials and Gestational Trophoblastic Tumors

Overview

Recent Trials on Gestational Trophoblastic Tumors

Benefits and Risks

Clinical Trials and Insurance Coverage

Clinical Trials and Medicare Coverage

Increasing the Likelihood of Insurance Coverage for Trials

If Your Insurance Claim Is Denied after the Trial Has Begun

Government Initiatives to Expand Insurance Coverage for Trials

Keeping Current on Clinical Trials

General References

Vocabulary Builder

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

Chapter 4. Studies on Gestational Trophoblastic Tumors

Overview

E-Journals: PubMed Central

The National Library of Medicine: PubMed

Vocabulary Builder

Chapter 5. Books on Gestational Trophoblastic Tumors

Overview

The National Library of Medicine Book Index

Chapters on Gestational Trophoblastic Tumors

General Home References

Vocabulary Builder

Chapter 6. Multimedia on Gestational Trophoblastic Tumors

Overview

Bibliography: Multimedia on Gestational Trophoblastic Tumors

Vocabulary Builder

Chapter 7. Physician Guidelines and Databases

Overview

NIH Guidelines

What Are Gestational Trophoblastic Tumors?

Cellular Classification

Stage Information for Hydatidiform Mole

TNM Definitions

AJCC Stage Groupings

Prognostic Group Classification

WHO Scoring System for Metastatic GTTs

Treatment Option Overview

NIH Databases

Other Commercial Databases

Specialized References

Vocabulary Builder

PART III. APPENDICES

Appendix A. Researching Your Medications

Overview

Your Medications: The Basics

Learning More about Your Medications

Commercial Databases

Drug Development and Approval

Understanding the Approval Process for New Cancer Drugs

The Role of the Federal Drug Administration (FDA)

Getting Drugs to Patients Who Need Them

Contraindications and Interactions (Hidden Dangers)

A Final Warning

General References

Vocabulary Builder

Appendix B. Researching Alternative Medicine

Overview

What Is CAM?

What Are the Domains of Alternative Medicine?

Finding CAM References on Gestational Trophoblastic Tumors

Additional Web Resources

General References

Vocabulary Builder

Appendix C. Researching Nutrition

Overview

Food and Nutrition: General Principles

Finding Studies on Gestational Trophoblastic Tumors

Federal Resources on Nutrition

Additional Web Resources

Vocabulary Builder

Appendix D. Finding Medical Libraries

Overview

Preparation

Finding a Local Medical Library

Medical Libraries Open to the Public

Appendix E. Your Rights and Insurance

Overview

Your Rights as a Patient

Patient Responsibilities

Choosing an Insurance Plan

Medicare and Medicaid

Financial Assistance for Cancer Care

NORD’s Medication Assistance Programs

Additional Resources

Vocabulary Builder

ONLINE GLOSSARIES

Online Dictionary Directories

GESTATIONAL TROPHOBLASTIC TUMORS GLOSSARY

General Dictionaries and Glossaries

INDEX

Overview

Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.” The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ:

Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.

As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning:

The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Gestational Trophoblastic Tumors has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to gestational trophoblastic tumors, from the essentials to the most advanced areas of research.

The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peer-reviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on gestational trophoblastic tumors.

Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-of-charge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current.

In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process.

We must emphasize that no sourcebook on gestational trophoblastic tumors should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate options is always up to the patient in consultation with their physician and healthcare providers.

Organization

This sourcebook is organized into three parts. Part I explores basic techniques to researching gestational trophoblastic tumors (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to gestational trophoblastic tumors. It also gives you sources of information that can help you find a doctor in your local area specializing in treating gestational trophoblastic tumors. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with gestational trophoblastic tumors.

Part II moves on to advanced research dedicated to gestational trophoblastic tumors. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on gestational trophoblastic tumors. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options.

Part III provides appendices of useful background reading for all patients with gestational trophoblastic tumors or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with gestational trophoblastic tumors. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with gestational trophoblastic tumors.

Scope

While this sourcebook covers gestational trophoblastic tumors, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that gestational trophoblastic tumors is often considered a synonym or a condition closely related to the following:

• Chorioadenoma Destruens


• Chorioblastoma


• Choriocarcinoma


• Chorioepithelioma


• Gestational Trophoblastic Disease


• Gestational Trophoblastic Neoplasia


• Hydatidiform Mole


• Invasive/malignant Mole


• Trophoblastic Tumor

In addition to synonyms and related conditions, physicians may refer to gestational trophoblastic tumors using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for gestational trophoblastic tumors:

• 239.5 unspecified neoplasm of the placenta

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to gestational trophoblastic tumors. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward

Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.

As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.

Why “Internet age”? All too often, patients diagnosed with gestational trophoblastic tumors will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with gestational trophoblastic tumors is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion.

While we focus on the more scientific aspects of gestational trophoblastic tumors, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan.

The Editors