Choriocarcinoma is a rare form of cancer in the tissues of the reproductive system. This type of cancer most often affects women. But it can also include a rare type of testicular cancer in men.
Choriocarcinoma in women usually follows a pregnancy. It is more common after a molar pregnancy. A molar pregnancy is one in which a fetus does not develop. A tumor made up of abnormal cells develops instead of a baby. The tumor of the molar pregnancy is usually benign, which means it is not cancer. Molar pregnancies are more common in less developed parts of the world where nutrition is poor. Choriocarcinoma is also more common in those areas.
Choriocarcinoma develops from reproductive tissue cells, which are very active. When these cells undergo cancerous changes, they grow and multiply very rapidly. A tumor forms and sheds cancer cells into the bloodstream at an early stage. The cancer cells in the bloodstream develop new cancers in other parts of the body, a process known as metastasis. If choriocarcinoma is not treated successfully, these tumors throughout the body can result in damage. And that can quickly lead to death.
The exact cause of choriocarcinoma is unknown. A woman whose diet is low in protein and other nutrients is known to be at higher risk for molar pregnancies. A woman who has had a molar pregnancy is also at high risk for choriocarcinoma.
Choriocarcinoma generally causes no symptoms until the cancer is widespread. Then the symptoms will be related to the major organs that are involved.
After a molar pregnancy is diagnosed and removed, blood samples will be taken. Beta-HCG, a tumor marker, will be measured. If the levels do not drop over time, CT scans are used. These scans help the doctor to look for a tumor remaining in the uterus or one that has spread elsewhere. If a tumor is found, a biopsy is done to confirm the presence and type of cancer. In men, a piece of tissue removed from a tumor, usually in the testicle, may show this form of testicular cancer.
Improving the nutrition of all pregnant women may prevent some cases of choriocarcinoma. Any woman who has had a molar pregnancy should be monitored carefully. Treating the cancer early is much more successful than treating late-stage disease.
Choriocarcinoma can kill quickly if it is not successfully treated.
Choriocarcinoma is not contagious and poses no risk to others.
Treatment of choriocarcinoma can be very effective, particularly in its early stages. Chemotherapy is given because the cancer is usually widespread by the time it is diagnosed. The chemotherapy medicines are introduced into the bloodstream and are delivered throughout the body. The treatment requires large doses of medicine to be effective.
When the cancer has spread to the brain, radiation therapy may be given to the brain. Unfortunately, choriocarcinoma that has spread to the brain or the liver is very hard to treat.
The side effects of chemotherapy depend on the medicines used. Most side effects can be managed and go away when treatment ends. A woman who has been successfully treated for choriocarcinoma after a molar pregnancy may be able to have a normal pregnancy later.
The person will be closely followed to make sure the cancer does not recur. If the cancer does not respond to therapy, the person will be closely followed for responses while other therapies are tried.
Blood samples are taken on a regular basis to measure the level of beta-HCG. An increase in the level could indicate the cancer has come back. CT scans may also be done to measure the response of the tumor to treatment or to check for recurrence.
If the treatment is successful, monitoring can be done less often. Many women are successfully cured of this cancer. Men with this form of testicular cancer do not respond as well to treatment.
Author:Miriam P. Rogers, EdD, RN, AOCN, CNS
Editor:Crist, Gayle P., MS, BA
Reviewer:Gail Hendrickson, RN, BS
"Gynecologic Cancers," FM Muggia et al., In Cancer: Principles and Practice of Oncology, VT Devita, 1997, pp. 1499-1502