Definition

Choriocarcinoma is a rare and rapidly developing cancer that originates in the uterus and can spread to other parts of the body, particularly the lungs. Choriocarcinoma is classified under gestational trophoblastic disease (GTD), a group of diseases that occur during pregnancy and originate in the uterus.

GTD is a condition that starts with a tumor in the uterus, specifically in cells called trophoblasts, which typically develop into the placenta. The placenta is an organ that connects the fetus to the pregnant mother, providing essential nutrients and oxygen for fetal development.

In GTD, trophoblast cells do not develop into a healthy placenta but rather into abnormal growths. Choriocarcinoma is the malignant form of GTD. This cancer usually begins in the uterus but can spread to other areas such as the vagina, lungs (most commonly), kidneys, liver, and brain.

Choriocarcinoma may appear months or even years after pregnancy. Its unpredictable nature makes it difficult to diagnose. It can grow quickly and cause symptoms in a short period.

Men can also experience choriocarcinoma in their testicles, a condition referred to as non-gestational choriocarcinoma. It is an extremely rare type of testicular cancer.

Causes

In women with choriocarcinoma, an abnormal pregnancy occurs due to this rare cancer. In this condition, the fetus in the uterus may or may not continue to develop. This cancer can occur in a normal pregnancy, in cases of molar pregnancy (also known as hydatidiform mole), where fertilization of the egg by the sperm does not proceed as it should, leading to abnormal cell growth or fluid-filled sacs in the uterus.

Additionally, molar pregnancy means that the fertilized egg develops into large cysts instead of a fetus. Choriocarcinoma can also occur after an early pregnancy that does not continue, such as a miscarriage, abortion, or ectopic pregnancy.

You can read this article to learn more about molar pregnancy: Molar Pregnancy - Understanding, Causes, Symptoms, and Treatment.

Risk Factor

Risk factors for choriocarcinoma include:

• History of molar pregnancy or family history of molar pregnancy
• History of miscarriage
• History of ectopic pregnancy
• Pregnancy under the age of 20 or over 35
• High levels of human chorionic gonadotropin (hCG) hormone in the body
• Low levels of vitamin A and carotene in the body
• Blood type A
• Smoking

Symptoms

Symptoms of choriocarcinoma vary depending on its spread. According to the American Cancer Society, choriocarcinoma does not always show symptoms. Some potential symptoms include:

• Abnormal vaginal bleeding
• Infections caused by vaginal bleeding
• Cramping in the lower abdomen
• Fever
• Pain possibly related to bleeding or ovarian enlargement If choriocarcinoma has spread to other parts of the body, such as the brain or lungs, symptoms may include:
• Coughing up blood
• Dry cough
• Chest pain
• Difficulty breathing
• Headaches
• Dizziness

Diagnosis

Doctors will perform a physical examination and ask about your medical history, including your pregnancy history. Next, they may recommend several tests, such as:

• Pelvic examination to check for lumps or abnormalities
• Blood or urine tests to check for hCG hormone levels. Trophoblast cells produce hCG, which is typically only present in pregnant women. If you are not pregnant but have hCG in your system, it may indicate choriocarcinoma.
• Organ function tests, such as liver and kidney function tests
• Imaging tests like ultrasound, X-rays, or MRI to see if the tumor has spread. If you test positive for pregnancy but no fetus is seen on the imaging test, choriocarcinoma may be suspected.
• Spinal fluid examination Based on these tests, doctors can assess the stage of choriocarcinoma and assign a score based on tumor size and spread.

Management

Chemotherapy

Treatment for choriocarcinoma usually involves chemotherapy. If the tumor is small and has not spread, chemotherapy is the primary treatment and is continued until there are no signs of cancer in the body. This can be monitored by checking hCG levels in the body. Chemotherapy works by killing cancer cells or stopping the tumor from growing. Some patients may require more than one type of chemotherapy. If the tumor has spread and poses a high risk, radiation therapy and surgery may also be necessary.

Surgery

In some cases, surgery may be used to remove the tumor and abnormal tissue. For older women who do not plan to have children in the future, doctors may recommend a hysterectomy, a procedure that removes the uterus, to ensure that the cancer does not return.

Regular Blood Tests

Patients with choriocarcinoma are advised to undergo regular blood tests for 1-2 years after treatment. Most women diagnosed with choriocarcinoma can recover after treatment. However, the chances of recovery decrease if the tumor has spread to the liver or brain. It's important to note that each case is unique, so it's essential to discuss all treatment options with your doctor.

Complications

Without proper treatment, choriocarcinoma can be fatal. Side effects of chemotherapy should be discussed with your doctor, including:

• The possibility of cancer progression during therapy (indicating unsuccessful treatment)
• Nausea
• Vomiting
• Hair loss
• Diarrhea
• Fever
• Infection
• Need for blood products 

Your menstrual cycle may be affected, such as stopping due to high hCG levels in your body. Your cycle may return to normal and stop again during chemotherapy. Your cycle should resume and normalize within 3 to 6 months after chemotherapy ends.

It's important to note that if you undergo a hysterectomy to remove the tumor, you will no longer be able to conceive. This procedure is rarely used for treating GTD. Discuss with your doctor how long you should wait before attempting to conceive again after treatment.

Prevention

There is no effective prevention for choriocarcinoma, but you can reduce your risk by avoiding known risk factors.

When to See a Doctor?

You should see a doctor immediately if you suspect any symptoms of choriocarcinoma. Contact your doctor if you experience these symptoms within a year.

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