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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.

Alternative Names:

Chorioblastoma; Trophoblastic tumor; Chorioepithelioma; Gestational trophoblastic neoplasia

Causes, incidence, and risk factors:

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

The cancer may occur after a normal pregnancy. However, it most often occurs 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 early pregnancy that doesn't continue (miscarriage), ectopic pregnancy, or genital tumor.

Symptoms:

A possible symptom is vaginal bleeding in a woman who recently had a hydatidiform mole or pregnancy.

Other symptoms may include:

  • Irregular vaginal bleeding
  • Pain
Signs and tests:

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

A pelvic exam may show uterine swelling or a tumor.

Blood tests that may be done include:

Imaging tests that may be done include:

  • CT scan
  • MRI

You should be carefully monitored after a hydatidiform mole or at the end of a pregnancy. Getting diagnosed with choriocarcinoma early can improve the outcome.

Treatment:

After you are diagnosed, a careful history and exam will be 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 still be able to have children. A choriocarcinoma may come back within a few months to 3 years after treatment.

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

  • Disease spreads to the liver or brain
  • Pregnancy hormone (HCG) level is greater than 40,000 mIU/mL when treatment begins
  • Cancer returns after having chemotherapy
  • 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 have a poor outlook at first go into remission (a disease-free state).

Calling your health care provider:

Call for an appointment with your health care provider if you develop symptoms within 1 year after a hydatidiform mole or pregnancy.

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.

McGee J, Covens A. Gestational trophoblastic disease: hydatidiform mole, nonmetastatic and metastatic gestational trophoblastic tumor: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 35.

Braunstein GD. Endocrine changes in pregnancy. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.


Review Date: 5/31/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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