Choriocarcinoma

Definition

Choriocarcinoma is a quick-growing form of cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta, the organ that develops during pregnancy to feed the fetus.

Choriocarcinoma is a type of gestational trophoblastic disease.

See also:

• Gestational trophoblastic disease
• Hydatiform mole

Alternative Names

Chorioblastoma; Trophoblastic tumor; Chorioepithelioma; Gestational trophoblastic neoplasia

Causes, incidence, and risk factors

Choriocarcinoma is an uncommon, but very often curable cancer associated with pregnancy. A baby may or may not develop in these types of pregnancy.

The cancer may develop after a normal pregnancy; however, it is most often associated with a complete hydatidiform mole. The abnormal tissue from the mole can continue to grow even after it is removed and can turn into cancer. About half of all women with a choriocarcinoma had a hydatidiform mole, or molar pregnancy.

Choriocarcinomas may also occur after an abortion, ectopic pregnancy, or genital tumor.

Symptoms

A possible symptom is continued vaginal bleeding in a woman with a recent history of hydatidiform mole, abortion, or pregnancy.

Additional symptoms may include:

• Irregular vaginal bleeding
• Ovarian cysts
• Uneven swelling of the uterus
• Pain

Signs and tests

A pregnancy test will be positive even when you are not pregnant. Pregnancy hormone (HCG) levels will be persistently high.

A pelvic examination may reveal continued uterine swelling or a tumor.

Blood tests that may be done include:

• Quantitative serum HCG
• Complete blood count
• Kidney function tests
• Liver function tests

Imaging tests that may be done include:

• CT scan
• MRI

Treatment

After an initial diagnosis, a careful history and examination are done to make sure the cancer has not spread to other organs. Chemotherapy is the main type of treatment.

A hysterectomy and radiation therapy are rarely needed.

Support Groups

For additional information, see cancer resources.

Expectations (prognosis)

Most women whose cancer has not spread can be cured and will maintain reproductive function.

The condition is harder to cure if the cancer has spread and one of more of the following events occur:

• Disease has spread to the liver or brain
• Pregnancy hormone (HCG) level is greater than 40,000 mIU/mL at the time treatment begins
• Cancer returns after having chemotherapy in the past
• Symptoms or pregnancy occurred for more than 4 months before treatment began
• Choriocarcinoma occurred after a pregnancy that resulted in the birth of a child

Many women (about 70%) who initially have a poor outlook go into remission (a disease-free state).

Complications

A choriocarcinoma may come back after treatment, usually within several months but possibly as late as 3 years. Complications associated with chemotherapy can also occur.

Calling your health care provider

Call for an appointment with your health care provider if symptoms arise within 1 year after hydatidiform mole, abortion (including miscarriage), or term pregnancy.

Prevention

Careful monitoring after the removal of hydatidiform mole or termination of pregnancy can lead to early diagnosis of a choriocarcinoma, which improves outcome.

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References

Goldstein DP, Berkowitz RS. Gestational trophoblastic disease. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 94.

Kavanagh JJ, Gershenson DM. Gestational trophoblastic disease: hydatidiform mole, nonmetastatic and metastatic gestational trophoblastic tumor: diagnosis and management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 35.

Soper J, Creasman JT. Gestational trophoblastic disease. In: Disaia PJ, Creasman WT, eds. Clinical Gynecologic Oncology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 7.