Choriocarcinoma

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

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II. Pathophysiology

  1. Malignant transformation of trophoblast
  2. Villus formation absent
  3. Trophoblast cells invade myometrium and blood vessels

III. 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

IV. Labs

  1. See Hydatidiform Mole

V. Radiology

  1. See Hydatidiform Mole

VI. 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

VII. Monitoring: Serum Quantitative bhCG

  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

VIII. Course: Dissemination

  1. Local Spread
    1. Vagina
    2. Pelvic organs
  2. Distant Metastases
    1. Liver
    2. Lungs

IX. 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

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