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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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