Choriocarcinoma: Definition, Causes, Symptoms, Diagnosis and Treatment

It is a type of gestational trophoblastic disease (GTD for its acronym in English).

What is it? It is a rare type of tumor that most often affects pregnant women and is called Gestational Choriocarcinoma.

Choriocarcinoma is the most aggressive form of ETG (gestational trophoblastic disease) due to its rapid growth and metastatic potential.

They usually develop after a CM (Medical classification or medical coding); It has been reported that the incidence in patients with a history of CM is 29-83% according to various studies throughout the world.

Partial moles and PSTT (placental bed trophoblastic tumor) rarely lead to choriocarcinoma. Choriocarcinomas can occur after any type of pregnancy, usually in the first year, although there have been cases of choriocarcinoma after an interval of 35 years after pregnancy.

The incidence of choriocarcinoma after term labor with no history of CM is approximately 1: 50,000. The true incidence may actually be much higher, but curiously, choriocarcinoma after a full-term pregnancy is more often associated with aggressive disease.

Patients present symptoms similar to those of the hydatidiform moles, but gynecological symptoms may be absent in up to a third of the cases in those with metastases. The disease can metastasize to any place: lungs, brain, liver, skin, heart, etc.

 Pulmonary metastases may be parenchymal, pleural or the result of tumor emboli in the pulmonary arteries. This produces symptoms of dyspnea , hemoptysis or pulmonary arterial hypertension .

 Brain metastases present with seizures, focal neurological signs, intracerebral hemorrhage or signs of elevated intracranial pressure.

 Liver metastases may cause local pain or referred pain in the tip of the right shoulder.

Although these symptoms or characteristics are not exclusive of ETG, it is an important differential diagnosis that should be considered in women of childbearing age who have metastases of unknown primary origin and that can be easily confirmed by serum hCG and tumor biopsy.

The high level of hCG can also cause thyrotoxicosis and ovarian lute teak cysts.

What causes it?

Choriocarcinoma is formed when the cells that were part of the placenta in a normal pregnancy become cancerous. It can occur after a spontaneous abortion, abortion, ectopic pregnancy or molar pregnancy, when an egg is fertilized, but the placenta develops into a mass of cysts instead of a fetus.

What are the symptoms?

If the choriocarcinoma is in the vagina, it could cause bleeding. If it has spread to the abdomen, you may also feel pain or pressure there. If it has spread to other parts of your body such as the lungs or the brain, you can see:

  • Tos
  • Difficulty breathing
  • Chest pain
  • Headache
  • Dizziness

How is it diagnosed?

If the doctor thinks he has choriocarcinoma, he will do some tests on the patient:

  • A pelvic exam to detect unusual lumps or changes
  • A test to look for levels of a hormone called hCG. These will be high if you have an ETG.
  • Blood and urine tests
  • An exam to see if the cancer has spread to other parts of your body
  • Imaging tests such as CT, MRI, ultrasound or X-ray

Location

It usually arises in association with the reproductive organs:

  • Uterus
  • Ovary
  • Testicles

The primary occurrence outside the reproductive system has been reported but is extremely rare. These sites include:

  • Brain
  • Lung
  • Pulmonary arteries
  • Stomach
  • Small intestine
  • Pancreas
  • Skin
  • Heart
  • Liver

Which is the treatment?

The doctor will discover the status of choriocarcinoma. He will give the patient a score based on a test to determine how big the tumor is and if it has spread to other parts of the body, among other things. If the tumor is low risk, which means it is small and has not spread, chemotherapy is the main treatment.

You will have to undergo it until there are no signs of cancer in the body depending on the levels of hCG. If the cancer is high risk, surgery and chemotherapy, or surgery, chemotherapy and radiation may be needed.

Almost all women diagnosed with the disease are cured with the treatment, although it is less likely if the disease has spread to your liver or your liver and brain. But each case is different, and your doctor will discuss the option that is right for you.