Description
1. Choriocarcinoma is a cancer that originates in trophoblastic cells of the placenta (afterbirth). The technical term given to the abnormal growth of trophoblastic cells is gestational trophoblastic neoplasia. Gestational trophoblastic neoplasia is classified into three types (1) hydatiform mole, that stays in the uterus, (2) invasive hydatiform mole, that invades locally, and the gravest (3) choriocarcinoma, that may spread throughout the body.
2. Cure rates are high for choriocarcinoma, if treated aggressively.
3. Gestational trophoblastic neoplasia usually begins early in pregnancy when the embryo or fetus does not develop but the placental tissue continues to grow.
4. The villi of the placenta are made up these trophoblastic cells. As these trophoblasts grow, the villi swell and multiply becoming visible to the naked eye.
5. Half of the cases of choriocarcinoma have a history of recent hydatidiform mole.
6. The trophoblastic cells produce the pregnancy hormone, human chorionic gonadotropin, HCG. HCG levels are used to track the effectiveness of treatment for all types of gestational trophoblastic neoplasia.
7. In the United States, choriocarcinoma occurs in 1 out of 40,000 pregnancies.
Causes
1. Genetic, more common in Asians than Blacks, and least common in Caucasians
2. Older women, particularly those older than 40 years
3. Multiple pregnancies
4. Hydatidiform mole
5. Pregnancy
6. Abortion
7. Ectopic pregnancy
8. History of other tumors of the female reproductive tract
Symptoms
1. Vaginal spotting, bleeding
2. Abnormal discharge, e.g., passage of villi (cystic grape-like clusters)
3. Lower abdominal pain
4. Nausea and/or vomiting
5. Abnormal nipple discharge
6. Swelling of the lower abdomen due to enlarged uterus
7. Uterus that does not decrease in size after pregnancy
8. Absent fetal heart tones
Diagnosis
1. Ultrasound
2. Chest x-ray
3. HCG hormone level
4. MRI
Treatment
1. Dilation of the cervical opening followed by removal of uterine contents with suction and curettage (see section on Dilation and Curettage)
2. Serial blood tests to determine HCG hormone levels
3. Chemotherapy
4. Radiation therapy
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