no need to bisopy because pretty obvios from history and examination
GTN is one tumour that can be diagnosed by a blood test.... no need clinical, radiological or histologyical evidence.
no need to bispy the metstates ...metastates with elevated b hcg is diagnostic.
After the procedure tero tonics can be used to stop bleeding but not during the precedure (check out molar pregnancy page)
USg is done in below case because the bleeding can be due to incomplete removal too...to check whether everything has been removed.
sub involution is when the uetrus doesnt return to its normal size
chest x ray also for tb because insitituiong chemotherapy like emthotraxtate
LFT and KFT is needed because to have a baseline becase the drugs can affects the kidney and liver so we need to monitor the changes.
also some drugs care hepato or reno taxic so cant be used if dreanged profiles.
the above staging dont have any clinical relevance
EMA-EP e is a repeat dose of etoposide
must be a weekly thing until bhcg levels fall.
but gtn is very responsive to chemptherapy so thats good.
but only the rare cases PSTT and ETT dont respond that good. so hysterectomy...but overall gtn responds well to chemotherapy.
hysterectomy dont excuse the need for chemotherapy. chemotherapy has to be done if beta hcg levels are high even if hysterectimy
because gtn is a disease where there could be micro metastates.
primary tx is always chemotherapy