HemeOnc

Choriocarcinoma

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Choriocarcinoma, Chorioblastoma, Trophoblastic Tumor, Chorioepithelioma, Gestational Trophoblastic Neoplasia, Invasive Mole, Malignant Mole

  • See Also
  1. Trophoblastic Neoplasia
  • Pathophysiology
  1. Malignant transformation of trophoblast
  2. Villus formation absent
  3. Trophoblast cells invade myometrium and blood vessels
  • Etiology
  • Origin of neoplasm
  1. Molar Pregnancy (50%)
  2. Spontaneous or Elective Abortion (25%)
  3. Postpartum delivery of viable fetus (20%)
  4. Ectopic Pregnancy (5%)
    1. Represents 5x the risk of intrauterine pregnancy
  • Labs
  1. See Hydatidiform Mole
  • Radiology
  1. See Hydatidiform Mole
  • Management
  1. Surgery (risk of metastases)
    1. Suction Curettage while Oxytocin administered
    2. Hysterectomy if >40 years old
  2. Chemotherapy
    1. Methotrexate 15-30 mg IV x5 days every 2weeks
    2. Actinomycin D 10 ug/kg x5 days every 2weeks
    3. Combination therapy for metastases
  3. Radiation Therapy
    1. Indicated for Liver or CNS metastases
  1. bHCG every 2 weeks for 2 months then
  2. bHCG every month for 3 months then
  3. bHCG every 2 months for 6 months then
  4. bHCG every 6 months
  • Course
  • Dissemination
  1. Local Spread
    1. Vagina
    2. Pelvic organs
  2. Distant Metastases
    1. Liver
    2. Lungs
  • Prognosis
  1. Low Risk Patients: 100% five year survival
    1. Under 4 month history suggesting metastatic disease
    2. Serum HCG <50 mIU/ml
    3. No signs of Liver or CNS metastases
  2. High Risk Patients: 50% five year survival
    1. Over 4 month history of metastatic disease
    2. Serum HCG >50 mIU/ml
    3. Liver or CNS metastases
    4. Tumor development follows term pregnancy
    5. Chemotherapy failure