Choriocarcinoma may present with the following symptomatology in patients:
The following diagnostic workups are performed in patients with choriocarcinoma and other gestational trophoblastic diseases:
The following treatment modalities are available in the treatment of choriocarcinoma:
Patient diagnosed with metastatic choriocarcinoma is considered high risk and has a grim prognostic outlook . Other parameters seen in choriocarcinoma which is considered high risk include: brain and liver metastasis, serum human Chorionic Gonadotropin (hCG) level of more than 40,000 mlU/ml, disease duration of more than 4 months, previous history of unsuccessful chemotherapy, and malignant choriocarcinoma following a term pregnancy.
Chemotherapy has a success rate of 75% in the treatment of high risk malignant gestational trophoblastic neoplasia with metastasis . The probability of late recurrence in choriocarcinoma approaches 1% after a year of remission from chometherapy .
The following complications are commonly seen in cases of Choriocarcinoma:
Choriocarcinoma and the other gestational trophoblastic diseases are caused by an abnormally fertilized egg. In a complete molar pregnancy, all of the fertilized egg chromosomes are derived from the father. The mother’s chromosomes in the egg are lost shortly after fertilization and the father’s chromosome is duplicated resulting to an egg an inactive nucleus or no nucleus at all. In cases of partial and incomplete molar pregnancies, the father provides a duplicate set of chromosomes while the chromosome set from the mother remains. This will result in an embryo with 69 chromosomes instead of 46. Such etiology usually happens when two sperms fertilize a single egg in the uterus.
In the United States, gestational trophoblastic neoplasia (GTN) occurs in 15-20% of patients with a complete hydatidiform mole and only 2% from incomplete hydatidiform mole. The relative incidence of choriocarcinoma is 1 out of 40 hydatidiform molar pregnancies .
The pregnancy prevalence of choriocarcinoma is about 1 in 20,000 to 40,000 pregnancies . However, choriocarcinoma incidence plunges to 1 out of 160,000 after a successful term pregnancy .
The relative prevalence of choriocarcinoma with any molar pregnancy and other GTD’s vary in every region of the globe. An increased prevalence rate of 1 in 500-600 pregnancies are observed in India  while a 1 in 50,000 pregnancy ratio is seen in Mexico, Paraguay and Sweden .
Choriocarcinoma starts as an aneuploidy of the chromosome set which can be heterozygous depending on the type pregnancy origin. Chromosomes may appear exclusively paternal in origin if the choriocarcinoma is preceded by a molar pregnancy. Majority of choriocarcinoma is virtually preceded by a hydatidiform mole pregnancy in up to 50% of the cases. However, both paternal and maternal sets of chromosomes are present in the choriocarcinoma if it follows a term pregnancy.
The incidence of choriocarcinoma increases significantly when the woman reaches the age of 40 years old; thus, it is prudent to avoid conceiving during this age to prevent this gestational tumor.
Women with previous history of a molar pregnancy should wait for six to twelve months before planning another conception to lower the risk given that choriocarcinoma stems out from molar pregnancies in 50% of the time. Careful monthly ultrasound monitoring of the fetus may be advised for those mothers with prior GTD histories.
Choriocarcinoma is a clinical disease described as the most aggressive form of gestational trophoblastic disease (GTD) characterized by rapid growth and a high metastatic potential. Choriocarcinoma is a cancer that originates from the trophoblast which surrounds the blastocyst. This aggressive tumor may occur during and after intrauterine pregnancy and ectopic pregnancy. When choriocarcinoma occurs during pregnancy, spontaneous abortions, preeclampsia and fetal death usually ensues with a very rare instance of fetal survival. Some forms of GTD are discovered malignant while others are benign although they may behave aggressively.
When choriocarcinoma develops in the absence of preceding gestation, it is referred to as non-gestational choriocarcinoma. These occur most often in the ovary or testes, but are very rare. It is important to distinguish the different forms because of the poor prognosis of non-gestational choriocarcinoma.
Choriocarcinoma is an aggressive form of gestational trophoblastic disease (GTD) characterized by rapid tumor growth and a high metastatic potential.
Chromosomal mutation and aneuploidy, and history of previous molar pregnancy
Blood tests and abdominal and transvaginal ultrasound are done to diagnose choriocarcinoma.
Treatment and follow-up
Dilatation and Curettage, hysterectomy and chemotherapy are the most common treatment options.