Chorioblastoma; Gestational trophoblastic disease; Trophoblastic tumor; Chorioepithelioma; Invasive/malignant mole; Gestational trophoblastic neoplasia
Gestational trophoblastic disease, or choriocarcinoma, is an aggressive, malignant, often metastatic (spreading) cancer in the uterus that begins following a pregnancy, a miscarriage, or an abortion.
Choriocarciona is among the most sensitive cancers to chemotherapy. As such, even when choriocarcinoma is metastatic, the cure rate is between 90 - 95%.
Causes, incidence, and risk factors
Hydatidiform mole is a condition which develops when a pregnancy has many complications. Conception takes place, but placental tissue grows very fast, rather than supporting the growth of a fetus.
The result is a tumor, rather than a baby. This is known as a molar pregnancy. There are only about 3,000 molar preganancies per year in the United States.
Choriocarcinoma is a similar type of growth. In approximately one-half of cases of choriocarcinoma, the preceding factor is hydatidiform mole. However, only 5 - 10% of molar pregnancies are associated with later choriocarcinoma. Therefore, choriocarcinoma remains an uncommon, yet almost always curable, cancer that can be associated with pregnancy.
Nearly one-fourth of choriocarcinomas follow a term pregnancy from which a normal child has been delivered. The remainder follow an abortion (spontaneous, elective, or therapeutic), ectopic pregnancy, or genital tumor.
A possible symptom is continued vaginal bleeding in a woman with a recent history of hydatidiform mole, abortion, or term pregnancy.
Additional symptoms that may be associated with this disease include:
- Irregular vaginal bleeding
- Theca lutein cysts on the ovaries
- Uneven enlargement of the uterus
- Persistently elevated HCG (pregnancy hormone) levels
- Symptoms related to the disease spreading to other organs such as lungs, liver, and brain
Signs and tests
A pelvic examination may reveal continued uterine enlargement or a tumor. These conditions may be felt within the genito-urinary tract.
- Quantitative serum HCG (blood test to confirm pregnancy)
- CT scan to detect potential metastatic tumor in any organ
- Chest x-ray
These signs and tests apply to women with a recent history of hydatidiform mole, abortion, or term pregnancy.
After an initial diagnosis, a careful history and examination are done to rule out metastasis (spread to other organs). Chemotherapy is the treatment of choice.
A hysterectomy is rarely required, due to choriocarcinoma’s extreme sensitivity to chemotherapy. More than 90% of women with malignant, nonmetastatic disease are able to maintain reproductive capabilities.
For additional information, see cancer resources.
Nearly all women with malignant, nonmetastatic disease are cured, with more than 90% preserving reproductive function.
Some women with malignant, metastatic disease may have a poor prognosis if they meet one of the following conditions:
- Disease has spread to the liver or brain.
- Serum HCG measurement is greater than 40,000 mIU/ml at the time treatment is started.
- Having received prior chemotherapy.
- Having symptoms (or the preceding pregnancy) for more than 4 months before treatment.
- Term pregnancy is associated with diagnosis.
About 66% of women having a poor prognosis experience remission (a disease-free state).
Almost all women who receive a good prognosis with malignant, metastatic disease that does not meet one of these conditions experience remission.
Choriocarcinoma may recur, usually within several months but possibly as late as 3 years after treatment ends. Complications associated with chemotherapy or surgery can also occur.
If a hysterectomy is performed, infertility will result. Menopause will begin if the ovaries are also removed.
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.
Although careful monitoring after the removal of hydatidiform mole or termination of pregnancy may not prevent the development of choriocarcinoma, it is essential in early identification of the condition, which improves outcome.
by Mamikon Bozoyan, M.D.