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Gestational trophoblastic disease
Definition:

Gestational trophoblastic disease is an aggressive, malignant, often metastatic (spreading to other organs) cancer in the womb which begins following a pregnancy (particularly one with hydatidiform mole), a miscarriage, or an abortion.

Choriocarciona is among the most sensitive cancers to chemotherapy. As such, even when choriocarcinoma is metastatic, the cure rate is between 90 and 95%.
Alternative Names:
Chorioblastoma; Choriocarcinoma; Trophoblastic tumor; Chorioepithelioma; Invasive/malignant mole; Gestational trophoblastic neoplasia

Causes, incidence, and risk factors:

Hydatiform mole is a condition which develops when a pregnancy has many complications. Conception takes place, but placental tissue grows very fast, rather than supporting the growth of a fetus.

The result is a tumor, rather than a baby. This is known as a "molar pregnancy." There are only approximately 3,000 molar preganancies per year in the United States.

Choriocarcinoma is a similar type of growth. In approximately one-half of cases of choriocarcinoma, the preceding factor is hydatidiform mole. However, only 5 to 10% of molar pregnancies are associated with later choriocarcinoma. Therefore, choriocarcinoma remains an uncommon, yet almost always curable, cancer that can be associated with pregnancy.

Nearly one-fourth of choriocarcinomas follow a term pregnancy, from which a normal child has been delivered. The remainder follow an abortion (spontaneous, elective, or therapeutic), ectopic pregnancy, or genital tumor.
Symptoms:

A possible symptom is continued vaginal bleeding in a woman with a recent history of hydatidiform mole, abortion, or term pregnancy.

Additional symptoms that may be associated with this disease include:

  • Irregular vaginal bleeding
  • Theca lutein cysts on the ovaries
  • Uneven enlargement of the uterus
  • Persistently elevated HCG (pregnancy hormone) levels
  • Pain
  • Symptoms related to the disease spreading to other organs (e.g., lungs, liver, brain)
Signs and tests:
A pelvic examination may reveal continued uterine enlargement or a tumor. These conditions may be felt within the genito-urinary tract.

Tests include:
  • Quantitative serum HCG (blood test to confirm pregnancy)
  • CT scan to detect potential metastatic tumor in any organ
  • Chest X-ray
Note: These signs and tests apply to women with a recent history of hydatidiform mole, abortion, or term pregnancy.
Treatment:

After an initial diagnosis, a careful history and examination are done to rule out metastasis (spread to other organs). Chemotherapy is the treatment of choice.

A hysterectomy is rarely indicated, and over 90% of women with malignant, but non-metastatic disease are able to maintain reproductive capabilities. The lack of need for surgery (hysterectomy) is due to the extreme sensitiveness of choriocarcinoma to chemotherapy.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.
Expectations (prognosis):

Nearly all women with malignant, non-metastatic disease are cured, with over 90% preserving reproductive function.

Some women with malignant, metastatic disease (spreading to other organs) may have a poor prognosis if they meet one of the following conditions:

  1. Spread to the liver or brain.
  2. Serum HCG measurement greater than 40,000 mIU/ml at the time that treatment is started.
  3. Having received prior chemotherapy.
  4. Having symptoms (or the preceding pregnancy) for more than 4 months before treatment.
  5. Term pregnancy associated with diagnosis. However, about 66% of women having a poor prognosis experience remission (a disease-free state).

Almost all women who receive a good prognosis with malignant, metastatic disease (that does not meet one of the previously conditions) experience remission.
Complications:
Choriocarcinoma may recur, usually within several months, but possibly as late as 3 years after therapy ends. Complications associated with chemotherapy or surgery can also occur. If the uterus must be removed, there will be infertility and onset of menopause.
Calling your health care provider:
Call for an appointment with your health care provider if symptoms arise within 1 year after hydatidiform mole, abortion (including miscarriage), or term pregnancy.
Prevention:
Although careful monitoring of women after the removal of hydatidiform mole or termination of normal or ectopic pregnancy may not prevent the development of choriocarcinoma, it is essential in early identification, which improves outcome.
Review Date: 8/6/2002
Reviewed By: Kevin Knopf, M.D., M.P.H., Hematologist/Oncologist and Director of Clinical Research, Annapolis Oncology/Hematology Center, Annapolis, MD. Review provided by VeriMed Healthcare Network.
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