Alternate Names: Chorioblastoma; Trophoblastic tumor; Chorioepithelioma; Invasive/malignant mole; Gestational trophoblastic disease; Gestational trophoblastic neoplasia

Causes and Risks: In approximately one-half of cases of choriocarcinoma, the preceding factor is hydatidiform mole. Nearly one-fourth follow a term pregnancy. The remainder follow an abortion (spontaneous or elective and/or therapeutic), ectopic pregnancy, or genital tumor.

Prevention: Although careful monitoring of women after removal of hydatidiform mole or termination of normal or ectopic pregnancy may not prevent the development of choriocarcinoma, it is essential in early identification, which improves outcome.

Symptoms:

• continued vaginal bleeding in a woman with recent history of hydatidiform mole, abortion, or term pregnancy

• irregular vaginal bleeding
• theca lutein cysts on the ovaries
• uneven enlargement of the uterus
• persistently elevated HCG (pregnancy hormone) levels
• pain

Signs and Tests: Pelvic examination may reveal continued uterine enlargement or a tumor may be able to be felt within the genito-urinary tract.

Tests include:

• quantitative serum HCG (blood test to confirm pregnancy)
• CT scan to detect potential metastatic tumor in any organ
• chest x-ray

Treatment: After an initial diagnosis, a careful history and examination are done to rule out metastasis (spread to other organs). Chemotherapy is the treatment of choice. A hysterectomy is rarely indicated: over 90% of women with malignant but non-metastatic disease are able to maintain reproductive capabilities.

Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Prognosis:

Nearly all women with malignant, non-metastatic disease are cured, with over 90% preserving reproductive function.

Some women with malignant, metastatic disease (disease spread to other organs) are designated as having a poor prognosis if they meet one of the following conditions:

1. Spread to the liver or brain.
2. Serum HCG measurement greater than 40,000 mIU/ml at the time that treatment is started.
3. Having received prior chemotherapy.
4. Having symptoms (or the preceeding pregnancy) for more than 4 months before treatment.
5. Term pregnancy associated with diagnosis. About 66% of patients in this poor prognosis category achieve remission (a disease-free state).

Almost all women with malignant, metastatic disease of good prognosis (that does not meet one of the conditions) achieve remission.

Complications: Choriocarcinoma may recur, usually within several months but possibly as late as 3 years after therapy ends.

Call for an appointment with your health care provider if symptoms arise within 1 year after hydatidiform mole, abortion, or normal-term pregnancy.