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Choriocarcinoma is a rare and rapidly growing malignant cancer that occurs in the female uterus after getting pregnant. It falls into the category of gestational trophoblastic disease.
It can arise in women who have had a miscarriage, or an ectopic pregnancy. It can also occur in normal pregnancies. However, a hydatidiform mole is the main cause of the disease.
What is Choriocarcinoma?
Choriocarcinoma is a malignant tumour. It mostly occurs in the placenta of pregnant women. The cancerous cells develop first in the tissue of a developing placenta.
However, in some rare cases, it affects the testicles of men and uterus of a post-menopausal woman.
How Common is it during Pregnancy?
Choriocarcinoma is relatively rare with an incidence of one case per 40,000 pregnancies and for it to occur during pregnancy is even rarer.
What Causes Choriocarcinoma?
- Choriocarcinoma after a normal pregnancy may occur but it is more prevalent during pregnancy. The disease comes into being when big lumps called hydatidiform moles form in the uterine tissue at the beginning of a pregnancy. These moles then become cancerous and the cells start multiplying. Then they start spreading out.
- Choriocarcinoma may also affect people who have had a miscarriage or an ectopic pregnancy (which occurs outside the womb).
- Testicular Choriocarcinoma may occur in men as a result of genetic reasons and undescended testes.
Who is Most at Risk of Getting Choriocarcinoma?
The risk factors for Choriocarcinoma include:
- Women who get pregnant before 20 or after 40 are at a greater risk of acquiring the disease.
- Any prior incident of molar pregnancy.
- A person with low levels of carotene and Vitamin A in her diet is at risk of molar pregnancy which in turn could trigger Choriocarcinoma.
- People who belong to blood groups of A or AB.
- Rarely there have been few incidences of more than one woman from the same family suffering from a molar pregnancy.
What are the Symptoms?
The signs in a Choriocarcinoma patient are:
- Lumps in the uterus
- Continuous vaginal bleeding
- Cysts present in the ovary
- High HCG levels during and after the first trimester,Hypogastric pain
- If in case the cancer cells have spread to the lungs, then the person may experience shortness of breath, chest pain, and may cough up blood.
- Increase in Thyroid Stimulating Hormone (TSH)
- Men with Choriocarcinoma may suffer from hyperpigmentation, loss of weight and abnormal growth of breasts in men(Gynaecomastia)
In some people, the signs of the disease may be apparent, but some people may be asymptomatic (showing no signs).
Stages of Choriocarcinoma
The stages of Choriocarcinoma which usually refers to uterine choriocarcinoma, is the FIGO staging system and it is as follows:
The disease is limited to the uterus.
It then starts spreading and now is limited to the female genital tract only.
It then starts spreading upwards towards the lungs.
In this stage, all the metastases spread to the other parts of the body. Being hematogenous in nature, the metastases spread in other parts of the body through blood circulation.
How is the Diagnosis done?
Choriocarcinoma can be diagnosed and detected firstly through lumps in the uterus. However, lumps or oedema may not be detected in all cases.The HCG level is tested and in this disease, it is noticed that it becomes very high. Apart from this, the doctor may recommend a kidney test, a liver test and a complete blood count test. A CAT scan, a CT scan or an MRI are more specific tests in locating internal abnormalities.
To detect any attack on the lungs, the doctor will ask for a chest x-ray.
The doctor also does a thorough examination of the pelvis to check the condition of the uterus.
The Complications of Choriocarcinoma include:
- A rise in HCG level (Serum)
- Uterine enlargement
- Intermenstrual PV Bleed
Treatment for Choriocarcinoma
Treatment for Choriocarcinoma is according to the stage of cancer. If a tumour is small and has not spread to other parts of the body, it is low-risk. Such tumours can be cured by chemotherapy alone. In case the tumour is big and has spread to other parts of the body, then it will be considered high-risk and will require surgery and chemotherapy or surgery, chemotherapy and radiation.
Except for a tumour in the testicles, chemotherapy reacts well to chemotherapy.
Surgery in Choriocarcinoma includes removal of uterus or hysterectomy. This is usually done for women above 40 years.
3. Radiation Therapy
Radiation treatment is for people who are at high risk. It is given at a time when the cancer cells have spread to other parts of the body.
Choriocarcinoma is usually treated with chemotherapy. In case the tumour is chemoresistant i.e, it cannot be cured by chemotherapy, then the womb is removed to get rid of the disease.
Can you Get Pregnant?
The high levels of HCG may stop your periods. Then may again start and the cycles may become normal. However, after Chemotherapy, it will again stop. Your cycles will again get back to normal after 3-6 months after your chemo stops.
However, it is to be understood that if hysterectomy (removal of the womb) is done in women with Choriocarcinoma, then she will never be able to get pregnant again.
- In case of cancer not having spread to other parts of the body then the woman has every chance of conceiving again.
- The cancer is hard to cure if it has spread to the liver or the brain.
- In case cancer recurs again despite the person being given chemotherapy earlier, it is hard to cure it.
- If the person gets affected after she delivers, then it can have chances of not getting cured.
- About 70% of women after treatment get cured and go into remission (disease free).
- Early detection of Choriocarcinoma can lead to positive outcomes and maximize the chances of cure with chemotherapy.
- The HCG levels should be regularly monitored for 1 year after undergoing chemotherapy.
- Early adequate treatment can increase the chances of full cure of the disease.
- Pregnancy should be avoided during chemotherapy and also the first year after chemotherapy stops.
- Having nutritional food goes a long way in preventing the disease.
The association of cancer with pregnancy is on the increase. Although chemotherapy is considered to be the best treatment for Choriocarcinoma, it can pose a danger to the foetus. Also, in cases where the women have to undergo hysterectomy, it can be emotionally challenging for her since conceiving after that will not be possible. Also, too much delay in treatment could result in the disease spreading to the other parts of the body. Therefore, the most viable thing would be to have an early delivery.