Choriocarcinoma Explained: Detailed Insights into Symptoms, Causes, Diagnosis, and Treatment

Choriocarcinoma

Understanding Choriocarcinoma

Choriocarcinoma is an uncommon and highly aggressive cancer that mainly affects the uterus or ovaries. It originates from tissue that would usually form the placenta during pregnancy, categorizing it under gestational trophoblastic disease (GTD). GTD refers to a set of rare conditions emerging during pregnancy when tumors develop from placental tissue, which supplies oxygen and nutrients to the fetus.

This type of cancer often follows a molar pregnancy, where abnormal fertilization results in a hydatidiform mole. However, it can also arise after an ectopic pregnancy, miscarriage, or even a full-term pregnancy. While choriocarcinoma is mostly seen in women, it can occasionally occur in men as a component of a mixed germ cell tumor.

Choriocarcinoma is notorious for its rapid growth and tendency to metastasize quickly to various parts of the body, such as the lungs, uterine muscle, lymph nodes, liver, kidneys, brain, and blood vessels. Despite its aggressive behavior, choriocarcinoma is generally treatable with chemotherapy.

In essence, choriocarcinoma is a swiftly growing malignant tumor originating from trophoblastic cells involved in early pregnancy development. Although it primarily affects the uterus, it can spread to other organs via the bloodstream, particularly the lungs. With prompt medical treatment, including chemotherapy, the outlook for choriocarcinoma patients is generally favorable.

Types of Choriocarcinoma

Choriocarcinoma is classified into two types: gestational and non-gestational.

Gestational choriocarcinoma, the more prevalent form, occurs during or shortly after pregnancy, originating from placental tissue. This type predominantly affects women and typically arises from complications in pregnancy, such as a molar pregnancy.

Non-gestational choriocarcinoma, on the other hand, can occur in individuals of any sex. It is a germ cell tumor that can develop in the ovaries or the lining of the uterus in women, but it is not associated with pregnancy or the placenta. In men, this type can develop in the testicles. Although rare, non-gestational choriocarcinoma is important because it affects both males and females.

How Common is Choriocarcinoma?

Choriocarcinoma is a rare but serious cancer. Gestational choriocarcinoma accounts for about 5% of all gestational trophoblastic disease (GTD) cases. GTD itself is uncommon, occurring in approximately 0.1% of all pregnancies in the United States. To put this in context, gestational choriocarcinoma affects fewer than 7 in 100,000 pregnancies in the U.S. This indicates that while gestational choriocarcinoma is relatively more common within the subset of GTD, it remains quite rare overall. Non-gestational choriocarcinoma, which can affect both women and men, is even rarer.

Symptoms of Choriocarcinoma

Individuals with choriocarcinoma, particularly those who have recently been pregnant, may exhibit the following symptoms:

Irregular vaginal bleeding
Pelvic pain

If choriocarcinoma metastasis to other areas of the body, additional symptoms may arise, including:

Lungs: Cough, difficulty breathing, chest pain
Vagina: Heavy bleeding, abnormal discharge, lumps
Brain: Headaches, dizziness, seizures
Liver or kidneys: Abdominal pain or pressure

Other possible signs include:

Elevated levels of the pregnancy hormone (hCG)
Shortness of breath
Coughing up blood
In men, testicular cancer, which may be accompanied by weight loss, breast enlargement, and skin changes due to hormone imbalances

Causes of Choriocarcinoma

Several key factors contribute to the development of choriocarcinoma:

Choriocarcinoma arises when trophoblasts, the cells that typically form the placenta during pregnancy, become cancerous. These cells are essential for supporting the growth of the placenta and fetus.
Approximately 50% of choriocarcinoma cases are linked to molar pregnancies. In a molar pregnancy, abnormal sacs or tumors form in the uterus instead of a normal placenta. Even after removal attempts, this tissue can continue to grow abnormally and turn cancerous.
Non-gestational choriocarcinoma can develop in tissues such as the ovaries, testicles, or uterus. In these instances, the cancerous cells begin producing human chorionic gonadotropin (hCG), a hormone typically produced by the placenta during pregnancy.
The cancer can develop rapidly, sometimes months or even years after a pregnancy. It is known for its aggressive nature and ability to spread quickly to other parts of the body.
Risk factors for choriocarcinoma include having a molar pregnancy, being younger than 20 or older than 40 during pregnancy, or experiencing complications such as an ectopic pregnancy.
In rare instances, choriocarcinoma can originate in primary locations other than the placenta, such as the testicles or ovaries. These cases often occur as part of mixed germ cell tumors and tend to have a poor prognosis due to early metastasis and resistance to treatment.

How Quickly Does Gestational Choriocarcinoma Develop?

The timeline for the development of gestational choriocarcinoma is variable; it can occur months or even years after a pregnancy. This type of cancer is known for its rapid growth and aggressive nature.

Risk Factors for Choriocarcinoma: Choriocarcinoma can develop in anyone who has been pregnant, whether the pregnancy ended in miscarriage, ectopic pregnancy, termination, or went to full term. However, the highest risk is associated with having had a molar pregnancy.

Other risk factors include: Being younger than 20 or older than 40 during pregnancy.

Diagnosis and Tests for Choriocarcinoma

1. Diagnostic Tests for Choriocarcinoma:

Pelvic or physical exam: To check for lumps or masses.

Blood tests:

Measure hCG (human chorionic gonadotropin) levels, which are elevated in choriocarcinoma.
Assess liver and kidney function.
Complete blood count (CBC).

Imaging tests:

Pelvic ultrasound.
Computed tomography (CT) scan.
Magnetic resonance imaging (MRI).
Chest X-ray.

These tests help determine if the cancer has spread.

2. Additional Information:

A positive pregnancy test (even without being pregnant) due to high hCG levels.
Enlarged uterus and ovaries may be detected during a pelvic exam.
Further blood tests include quantitative serum hCG, CBC, kidney function tests, and liver function tests.
Imaging tests (CT scan, MRI, pelvic ultrasound, chest X-ray) help evaluate the extent of the disease.
Close monitoring after a hydatidiform mole or at the end of pregnancy can improve early diagnosis and outcomes.

3. Criteria for Starting Chemotherapy in Gestational Trophoblastic Disease (GTD):

Plateaued or rising hCG levels after uterine evacuation.
Heavy vaginal bleeding.
Gastrointestinal or intraperitoneal bleeding.
Histologic evidence of choriocarcinoma.
Evidence of metastases in the brain, liver, or gastrointestinal tract.
Lung opacities greater than 2 cm.
Serum hCG greater than 20,000 IU/L four weeks after evacuation.
Elevated hCG greater than six months after evacuation, even if decreasing.

4. Tests If Choriocarcinoma is Suspected:

Pelvic exam: To check for lumps or unusual changes.
Hormone level assessment: High hCG levels if GTD is suspected.
Blood and urine tests.
Examination to assess cancer spread to other body parts.
Imaging tests: CT, MRI, ultrasound, or X-ray.

Management and Treatment of Choriocarcinoma

How is choriocarcinoma treated?

The treatment approach for choriocarcinoma varies based on its stage. Staging considers the tumor size, spread beyond the uterus, and other factors. Your overall health and personal preferences also play a role in determining the treatment plan.

Chemotherapy: The primary treatment for choriocarcinoma involves chemotherapy, which uses drugs to kill cancer cells.
Surgery: Some patients may require surgery to remove the uterus (hysterectomy).
Radiation: In certain cases, radiation therapy or a combination of treatments may be necessary.

After completing treatment, healthcare providers will schedule follow-up exams to ensure the cancer does not recur.

Is choriocarcinoma curable?

Yes, choriocarcinoma is curable. Chemotherapy is typically effective in curing this cancer. The prognosis is more favorable when choriocarcinoma is detected early, before it spreads to other parts of the body.

However, the cancer is harder to cure if:

Previous chemotherapy was unsuccessful.
The disease develops after a full-term pregnancy or the birth of a child.
hCG levels are higher than 40,000 mIU/ml (milli-international units per milliliter) before treatment. hCG is a hormone produced by the placenta during pregnancy.
Symptoms or pregnancy occurred more than four months before treatment.

Can I prevent choriocarcinoma?

No, you can’t prevent choriocarcinoma.
However, if you’ve had a molar pregnancy, it’s crucial to talk to your healthcare provider about your risk for choriocarcinoma. Regular follow-up and monitoring can help detect any abnormal growths early, improving the chances of successful treatment. Understanding your risk factors and maintaining open communication with your healthcare provider can help manage and mitigate potential risks associated with choriocarcinoma.

Living With Choriocarcinoma

Can I still have a baby if I had choriocarcinoma?

Possibly. Many individuals can still have children after treatment for choriocarcinoma. The possibility depends on your specific diagnosis and treatment. It’s important to discuss your desire for future children with your healthcare provider to ensure your treatment plan aligns with your goals.

When should I see my healthcare provider?

Contact your healthcare provider if you experience unusual vaginal bleeding or pelvic pain, particularly if you have a history of molar pregnancy.

A Note from Cleveland Clinic

Choriocarcinoma is a rare but serious cancer, and receiving a diagnosis can be stressful. However, the outlook for choriocarcinoma is generally very positive. It’s important to communicate any concerns or questions you have with your healthcare provider. They are there to provide answers and offer the best possible care for your situation.

FAQs

Q: How long can you live with choriocarcinoma?

The prognosis for choriocarcinoma is generally favorable when diagnosed early. For individuals with low-risk gestational choriocarcinoma, the survival rate is nearly 100%. Those with high-risk gestational choriocarcinoma have a survival rate of around 94%.

In contrast, non-gestational choriocarcinoma, which is not associated with a prior abnormal pregnancy or placental tissue, has a poorer prognosis and is less responsive to chemotherapy, making treatment more challenging.

Q: Can Stage 4 choriocarcinoma be cured?

Stage 4 choriocarcinoma indicates that the cancer has metastasized to other parts of the body, such as the brain and liver. Although the prognosis is more guarded at this stage, remission is still possible. Your healthcare team will provide personalized information about your outlook and potential treatment options.

Q: How is choriocarcinoma monitored after treatment?

After treatment for choriocarcinoma, regular follow-up appointments are essential to ensure the cancer does not return. These follow-ups typically involve monitoring hCG levels, conducting physical exams, and performing imaging tests such as CT scans and MRIs to detect any signs of recurrence or metastasis.

Q: What are the risk factors for developing choriocarcinoma?

Key risk factors for choriocarcinoma include having experienced a molar pregnancy, being younger than 20 or older than 40 during pregnancy, and having complications like an ectopic pregnancy or miscarriage. A history of gestational trophoblastic disease also increases the risk.

Q: Can men develop choriocarcinoma?

Yes, although it is rare, men can develop choriocarcinoma. In men, this cancer often appears as part of a mixed germ cell tumor, typically in the testicles. It is known for its aggressive nature and poor prognosis due to early metastasis and resistance to treatment.

Q: What are the signs that choriocarcinoma has spread to other parts of the body?

Signs of choriocarcinoma spread vary depending on the affected organs. If it spreads to the lungs, symptoms may include coughing, chest pain, and difficulty breathing. Spread to the brain can cause headaches, dizziness, and seizures. Abdominal pain and pressure may indicate spread to the liver or kidneys.

Q: What should I do if I have a history of molar pregnancy?