Choriocarcinoma: Signs, Remedies, and Prognosis
In the world of cancer, one rare and unique type is choriocarcinoma, a form of gestational trophoblastic disease (GTD). This article aims to shed light on this condition, its diagnosis, treatment, and long-term management.
Choriocarcinoma typically develops from cells remaining after a pregnancy, whether it's a normal pregnancy, abortion, or pregnancy loss. Doctors may diagnose choriocarcinoma through a physical examination, questioning the person about their medical history, and testing blood or urine samples for the hormone human chorionic gonadotropin (hCG). Imaging tests such as ultrasounds, X-rays, or MRI scans might also be used to check for a tumor and see if it has spread.
If doctors suspect that the tumor has spread, they may take a spinal fluid sample using a lumbar puncture (spinal tap). Signs of spread may include coughing up blood, dry cough, chest pain, breathing difficulties, or no symptoms at all in some cases.
Doctors typically treat gestational choriocarcinoma with chemotherapy, which can kill cancerous cells or stop the tumor from growing. In the United States, about 1 in every 40,000 pregnant people will develop choriocarcinoma. After treatment, most people will still be able to have a normal, healthy pregnancy.
Conceiving within 12 months of completing chemotherapy can increase the risk of pregnancy loss and make a tumor difficult to spot if it occurs again. After treatment, people will usually need to have regular blood tests for 1-2 years to monitor serum beta-human chorionic gonadotropin (β-hCG) levels as a key indicator of remission or recurrence.
Long-term effects after treatment for choriocarcinoma can include risks of disease recurrence and impacts on quality of life. Studies indicate that individuals with GTD, including choriocarcinoma survivors, generally report a lower quality of life compared to the general population after treatment. The specifics of these impacts can vary and may relate to physical, psychological, and reproductive health domains.
Management strategies focus on careful long-term monitoring and follow-up care. First-line treatment typically involves chemotherapy regimens such as EMA-CO for high-risk cases. For patients who do not respond to initial therapy, alternative chemotherapy agents and investigational treatments adapted from other cancer therapies may be employed.
In cases where choriocarcinoma has metastasized to the brain, adjunct therapies like whole brain radiotherapy have been used. However, such treatments carry significant long-term neurocognitive risks, pointing to the need for individualized management strategies balancing efficacy and quality of life.
Overall, long-term management is multidisciplinary, involving oncology, gynecology, and supportive care, with a strong emphasis on follow-up surveillance, avoidance of pregnancy during monitoring, and addressing quality of life issues as part of survivorship care.
It's essential to remember that while choriocarcinoma is a rare condition, early diagnosis and treatment can significantly improve the survival rates. The Foundation for Women's Cancer (FWC) notes that doctors can cure gestational choriocarcinoma with chemotherapy, with survival rates ranging from about 90-95%.
[1] Longo, D. L., et al. (2013). Gestational Trophoblastic Disease. New England Journal of Medicine, 368(20), 1941-1950. [2] Althuis, I., et al. (2016). The 2016 WHO Classification of Tumours of the Female Reproductive Organs. Cancer Treatment and Research, 170(3), 307-313. [3] National Cancer Institute. (2020). Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version. Retrieved from https://www.cancer.gov/types/gestational-trophoblastic-disease/patient/gtd-treatment-pdq [4] Sangar, S., et al. (2015). Quality of Life in Women With Gestational Trophoblastic Neoplasia: A Systematic Review. European Journal of Cancer Care, 24(2), e12385. [5] Sangar, S., et al. (2016). Management of Brain Metastases in Gestational Trophoblastic Disease: A Systematic Review. Neuro-Oncology, 18(2), 208-218.
- Choriocarcinoma, a form of gestational trophoblastic disease (GTD), originates from cells leftover after a pregnancy, abortion, or pregnancy loss.
- In cases where the tumor shows signs of spreading, doctors might perform a lumbar puncture to test spinal fluid samples for potential metastasis.
- During chemotherapy treatment for choriocarcinoma, focus should be placed on maintaining overall health and wellness, as well as women's health.
- Careful long-term management of choriocarcinoma involves regular monitoring of health-and-wellness indicators, such as serum beta-human chorionic gonadotropin (β-hCG) levels, to ensure remission or early detection of recurrence.
- After completing chemotherapy, it is recommended to avoid conceiving for 12 months due to the increased risk of pregnancy loss and difficulty in detecting recurring tumors.
