Summary about Disease
Choriocarcinoma is a rare, fast-growing cancerous tumor that develops in the uterus after pregnancy. It originates from trophoblastic cells, which normally form the placenta during gestation. While most often occurring after a molar pregnancy (gestational trophoblastic disease), it can also arise after a normal pregnancy, miscarriage, or ectopic pregnancy. It is a type of gestational trophoblastic neoplasia (GTN).
Symptoms
Symptoms can vary depending on whether the choriocarcinoma developed in the uterus or has spread to other parts of the body. Common symptoms include:
Uterine bleeding: Irregular or persistent vaginal bleeding after pregnancy (or molar pregnancy) is a key symptom.
Enlarged uterus: The uterus may be larger than expected.
Pelvic pain or pressure.
Symptoms related to metastasis: If the cancer has spread to other organs (lungs, brain, liver, vagina), symptoms may include cough, shortness of breath, hemoptysis (coughing up blood), headache, neurological problems, abdominal pain, vaginal nodules, etc.
Elevated hCG levels: High levels of human chorionic gonadotropin (hCG) in the blood or urine, even long after a pregnancy should have ended.
Hyperthyroidism: Rarely, choriocarcinoma can produce high levels of hCG, which can stimulate the thyroid gland, leading to hyperthyroidism symptoms such as rapid heartbeat, anxiety, and weight loss.
Causes
Choriocarcinoma is caused by abnormal growth of trophoblastic cells, which are cells that normally develop into the placenta during pregnancy. The exact trigger for this abnormal growth is not fully understood. It is strongly associated with the following:
Molar pregnancy (hydatidiform mole): This is the most common antecedent. In a molar pregnancy, abnormal tissue grows in the uterus instead of a normal fetus.
Normal pregnancy: Can occur after a live birth.
Miscarriage.
Ectopic pregnancy.
Medicine Used
Chemotherapy is the primary treatment for choriocarcinoma. Common chemotherapy drugs used include:
Methotrexate: Often used as a single agent for low-risk disease.
Actinomycin-D: Another single agent option for low-risk disease.
EMA/CO regimen: A combination chemotherapy regimen that includes Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, and Vincristine (Oncovin). This is used for high-risk disease.
Other Chemotherapy drugs such as platinum based medications may be used in resistant cases. Hysterectomy (surgical removal of the uterus) may be considered in some cases, particularly for patients who do not wish to preserve fertility or if chemotherapy is ineffective.
Is Communicable
No, choriocarcinoma is not a communicable or contagious disease. It is a type of cancer, and cancer is not spread from person to person through contact, air, or any other means.
Precautions
Since choriocarcinoma develops after pregnancy, there are no specific precautions that can be taken to prevent it in most cases. However, the following may be considered:
Monitoring hCG levels: After a molar pregnancy, it is crucial to closely monitor hCG levels until they return to normal and remain normal for a specified period (usually 6-12 months).
Avoiding pregnancy: Avoiding pregnancy during monitoring of hCG levels after a molar pregnancy is essential to avoid confusion in hCG level interpretation.
Prompt diagnosis and treatment: Early diagnosis and treatment of gestational trophoblastic disease, including molar pregnancies, can reduce the risk of choriocarcinoma development.
How long does an outbreak last?
Choriocarcinoma is not an "outbreak" like an infectious disease. It is a cancerous condition that can persist and worsen if left untreated. The "duration" of the disease depends on the time it takes to diagnose it, the effectiveness of treatment, and whether the cancer has spread. Treatment duration varies based on the risk stratification and treatment regimen used.
How is it diagnosed?
Diagnosis typically involves:
Physical examination: Includes a pelvic exam.
Blood tests: To measure hCG levels, which are usually very elevated.
Ultrasound: To visualize the uterus and surrounding tissues.
Chest X-ray or CT scan: To check for metastasis to the lungs.
CT scan or MRI of abdomen, pelvis, and brain: to assess for metastatic disease
Tissue biopsy: In some cases, a biopsy may be performed to confirm the diagnosis. However, biopsy is generally avoided if possible due to the risk of bleeding.
Timeline of Symptoms
The timeline of symptoms can vary, but a general progression might look like this:
Post-pregnancy (or molar pregnancy): Abnormal vaginal bleeding begins. This may be persistent or intermittent.
Weeks/Months: Elevated hCG levels are detected. If the cancer spreads:
Lungs: Cough, shortness of breath, chest pain develop.
Brain: Headaches, neurological symptoms (seizures, weakness) appear.
Vagina: Vaginal nodules with bleeding become present.
Untreated: Worsening of symptoms, potentially leading to life-threatening complications.
Important Considerations
Early detection is crucial: Choriocarcinoma is highly curable, especially when diagnosed and treated early.
hCG monitoring is essential: Consistent and accurate hCG monitoring is vital for detecting persistent disease and recurrence.
Fertility preservation: For women who wish to have children in the future, fertility-sparing treatment options (chemotherapy alone) are usually considered.
Treatment side effects: Chemotherapy can have side effects, and patients should be monitored closely and receive supportive care.
Follow-up: Long-term follow-up is necessary to monitor for recurrence.