What should have been the beginning of a dream turned out to be a painful process for 25-year-old Brazilian Mariana Freitas. The young woman discovered, in sequence, a pregnancy, a molar pregnancy and placental cancer.
In mid-May 2021, through a blood test, she received the news that she was pregnant. Although pregnancy was not in the plans, as she had just changed jobs, the news was well received.
However, after the transvaginal examination failed to locate the fetus, suspicions began. She waited around three days to do a new blood test (also called beta, as it measures the HCG hormone and indicates pregnancy).
“I was a little anxious. I went to the hospital again, collected a second beta and, like, my beta tripled, it increased a lot. And then the doctor immediately said to me, ‘you’re super pregnant'”, recalls Mariana.
And she adds: “I went home with that information that I was pregnant. But I was still feeling very ill. I started working from home and waited for about ten days to do my [segundo] transvaginally, to know the gestational age.”
The nausea continued to increase, to the point that, according to Mariana, she lived “on Vonau [medicamento utilizado para prevenir e tratar náuseas e enjoos]”. At that moment, the parents and people close to the couple already knew about the pregnancy.
On the day of the transvaginal, however, she ended up being surprised.
“My mum accompanied me but she had to stay outside and as soon as the doctor started checking me she asked ‘are you alone?’ and I said ‘no, my mum is outside’ . And the doctor continued, ‘ah, so let’s call her because she doesn’t have a heartbeat'”, says Mariana.
The news, said in a cold and “brutal” way, as it characterizes it, was just the beginning of what would become a long process.
“It was a very early pregnancy, but even though it was only ten days, I always wanted to be a mother, so I was very happy with that. I really believed I was pregnant, my husband was super happy”, she recalls.
The two options left to her at that moment, according to the doctor, were to wait for the bleeding to start and the body to expel the fetus or to perform a curettage.
“That same day I went home and threw up a lot, it wasn’t for me to be like that, because, if I was in an abortive process, my beta was supposed to be decreasing and, automatically, reducing nausea. And mine didn’t go away, in fact, it only got worse”, says Mariana.
That same day, she decided to look for another hospital network to investigate the nausea. There, she had another beta test and an ultrasound.
“I discovered [em junho] that my beta kept going up and in the ultrasound they saw that it was a molar pregnancy. I had lots of little bumps in my uterus,” she recalls.
According to Antônio Rodrigues Braga Neto, professor at UFRJ (Federal University of Rio de Janeiro) and UFF (Fluminense Federal University), who followed Mariana’s case, “molar pregnancy [também conhecida como doença trofoblástica gestacional] It is an anomaly of pregnancy in which there is a mistake in fertilization at the moment when the sperm meets the egg”.
There are two types: the complete mole, in which there is no baby formation (Mariana’s case), and the partial mole, in which a baby is formed. Both cases involve genetic alterations, which prevent the fetus from surviving.
“That same day I was admitted to the hospital. I went into absolute fasting, because I was going to do an aspiration. The procedure was: I do it, this material is taken from the uterus, taken for analysis and, in the meantime, the beta has to drop until zero”, explains Mariana.
However, Mariana’s beta decreased and rose again. This occurred because the mole had become invasive, a condition called placental cancer or gestational trophoblastic neoplasia. According to the MSD manual, trophoblastic tumors located in the placenta are very rare.
Private hospitals do not treat this type of condition, so she was referred to a SUS (Sistema Único de Saúde) research center — the UFRJ maternity hospital.
“I was very welcomed. The first thing I had to do was talk to the psychologist and the nurse. And, in the first consultation [no mesmo dia], I stayed there for hours, because I already went with a pre-diagnosis. I was already referred, I had already been treated, and I had already done the first uterine evacuation”, says Mariana.
After several examinations, conversations and an analysis of the case, she was invited to participate in a researchguided by the physician and doctoral student of Neto, Marcio Barcellos.
“It was a survey by a Harvard research center and the maternity school, and the survey said that 50% of women who have a second aspiration do not need to go for chemotherapy. I already had the chemo referral in my hand, from from the moment I was diagnosed with cancer,” she says.
Mariana then accepted to be part of the research and was referred for a second aspiration, this time at SUS, on July 16th. If the beta did not decrease after the procedure, she would proceed with chemotherapy.
“Both treatment strategies [aspiração e quimioterapia] are acceptable, because it is not known which is the most effective. The objective of the study is to evaluate which is the best strategy for each patient”, explains Neto.
The professor adds that the woman signs a free consent form, agreeing to participate in the study, and is randomized to one of the treatment groups. It remains in uninterrupted and free monitoring.
“I had the aspiration done. I was treated superhumanly, I was careful, zealous with the person there, so much so that after I left the aspiration they put me in a shared room, but in which there were no women who had just had a baby In the first aspiration I did, they put me on the floor of the maternity ward, so I spent the whole morning listening to the baby’s cry after having done an aspiration”, recalls Mariana.
After the process, she returned weekly to the hospital to collect the beta and observed its gradual decrease, until it finally reached zero.
After zeroing, she waited a year to see if the cancer remission was going to happen and to get the long-awaited absolute high.
“At the end of September 2022, I was officially discharged”, he celebrates.
Before that victory, however, she faced a feeling that had been repressed throughout the process: grief.
“I only went through grief in March of last year, almost a year after I found out about all this, because I stopped thinking ‘wow, I lost a pregnancy’. It hit me so hard that I became a little inert”, account.
And he adds: “It’s a funny situation, because I never heard the baby’s heartbeat, my molar pregnancy was complete, so I wouldn’t even have a heartbeat. I didn’t see anything, but I felt that I had, that he lived in me, there’s this feeling of empty, and I only experienced it almost a year later”.
Mariana advises all women, even those who had a common pregnancy, to have a blood sample taken during and after pregnancy, to avoid a situation similar to the one she experienced.
“My pregnancy turned into cancer, but this can happen even to a person who had a normal pregnancy; then, the person who had a 100% healthy baby, they can have an invasive mole even when the baby is already born, because it is cancer placenta,” he warns.
It is worth noting that the sooner the disease is discovered, the better for treatment and specialized referral.
“The condition [câncer de placenta] it is completely curable, and even more special: without having to remove the uterus, in the vast majority of cases! But, for this standard of excellence, it is crucial that patients are treated in reference centers”, says Neto.
As it is still uncertain whether patients can benefit from the second aspiration, the search for centers is essential. In Rio de Janeiro, they are the Maternity-School of UFRJ and the Hospital Universitário Antônio Pedro, of UFF.
Patients diagnosed with gestational trophoblastic neoplasia can seek guidance in the Facebook group Brazilian Association of Gestational Trophoblastic Disease.
* Intern at R7under the supervision of Giovanna Borielo
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