Choriocarcinoma
Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by "early hematogenous spread" to the lungs. It is the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.
Symptoms, signs, and labs
- increased quantitative chorionic gonadotropin (the "pregnancy hormone") levels
- vaginal bleeding
- shortness of breath
- hemoptysis (coughing up blood)
- chest pain
- Chest X-ray shows multiple infiltrates of various shapes in both lungs
- presents in males as testicular cancer, sometimes with skin hyperpigmentation (from excess chorionic gonadotropin cross-reacting with the alpha MSH receptor), gynecomastia, and weight loss (from excess chorionic gonadotropin cross-reacting with the LH, FSH, and TSH receptor) in males
- can present with decreased thyroid-stimulating hormone (TSH) due to hyperthyroidism.
Treatment
Since gestational choriocarcinoma (which arises from a hydatidiform mole) contains paternal DNA (and thus paternal antigens), it is exquisitely sensitive to chemotherapy. Even for metastatic gestational choriocarcinoma, the cure rate is around 90–95%.
At present, treatment with single-agent methotrexate is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and vincristine (Oncovin) are recommended for intermediate or high-risk disease.
Hysterectomy (surgical removal of the uterus) can also be offered to patients > 40 years of age or those for whom sterilization is not an obstacle. It may be required for those with severe infection and uncontrolled bleeding.
Choriocarcinoma arising in the testicle is rare, malignant, and highly resistant to chemotherapy. The same is true of choriocarcinoma arising in the ovary. Testicular choriocarcinoma has the worst prognosis of all germ-cell cancers.
- More information is available at [ Wikipedia:Choriocarcinoma ]
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