Choriocarcinoma is a rare and rapidly growing malignant cancer that occurs in the female uterus after getting pregnant. It falls into the category of gestational trophoblastic disease.
It can arise in women who have had a miscarriage, or an ectopic pregnancy. It can also occur in normal pregnancies. However, a hydatidiform mole is the main cause of the disease.
Choriocarcinoma is a malignant tumour. It mostly occurs in the placenta of pregnant women. The cancerous cells develop first in the tissue of a developing placenta.
However, in some rare cases, it affects the testicles of men and uterus of a post-menopausal woman.
Choriocarcinoma is relatively rare with an incidence of one case per 40,000 pregnancies and for it to occur during pregnancy is even rarer.
The risk factors for Choriocarcinoma include:
The signs in a Choriocarcinoma patient are:
The stages of Choriocarcinoma which usually refers to uterine choriocarcinoma, is the FIGO staging system and it is as follows:
STAGE I
The disease is limited to the uterus.
STAGE II
It then starts spreading and now is limited to the female genital tract only.
STAGE III
It then starts spreading upwards towards the lungs.
STAGE IV
In this stage, all the metastases spread to the other parts of the body. Being hematogenous in nature, the metastases spread in other parts of the body through blood circulation.
Choriocarcinoma can be diagnosed and detected firstly through lumps in the uterus. However, lumps or oedema may not be detected in all cases.The HCG level is tested and in this disease, it is noticed that it becomes very high. Apart from this, the doctor may recommend a kidney test, a liver test and a complete blood count test. A CAT scan, a CT scan or an MRI are more specific tests in locating internal abnormalities.
To detect any attack on the lungs, the doctor will ask for a chest x-ray.
The doctor also does a thorough examination of the pelvis to check the condition of the uterus.
The Complications of Choriocarcinoma include:
Treatment for Choriocarcinoma is according to the stage of cancer. If a tumour is small and has not spread to other parts of the body, it is low-risk. Such tumours can be cured by chemotherapy alone. In case the tumour is big and has spread to other parts of the body, then it will be considered high-risk and will require surgery and chemotherapy or surgery, chemotherapy and radiation.
Except for a tumour in the testicles, chemotherapy reacts well to chemotherapy.
Surgery in Choriocarcinoma includes removal of uterus or hysterectomy. This is usually done for women above 40 years.
Radiation treatment is for people who are at high risk. It is given at a time when the cancer cells have spread to other parts of the body.
Choriocarcinoma is usually treated with chemotherapy. In case the tumour is chemoresistant i.e, it cannot be cured by chemotherapy, then the womb is removed to get rid of the disease.
The high levels of HCG may stop your periods. Then may again start and the cycles may become normal. However, after Chemotherapy, it will again stop. Your cycles will again get back to normal after 3-6 months after your chemo stops.
However, it is to be understood that if hysterectomy (removal of the womb) is done in women with Choriocarcinoma, then she will never be able to get pregnant again.
The association of cancer with pregnancy is on the increase. Although chemotherapy is considered to be the best treatment for Choriocarcinoma, it can pose a danger to the foetus. Also, in cases where the women have to undergo hysterectomy, it can be emotionally challenging for her since conceiving after that will not be possible. Also, too much delay in treatment could result in the disease spreading to the other parts of the body. Therefore, the most viable thing would be to have an early delivery.