What Is Choriocarcinoma?

Choriocarcinoma is a type of cancerous tumor that originates in the uterus. During fertilization, when a sperm fertilizes an egg, the tumor forms from abnormal cells found in the tissues that make up the uterine wall. In a healthy pregnancy, the cells and tissues in the uterus would eventually become the placenta, an organ that provides nutrients to an unborn fetus. 

This article will cover the symptoms, causes, diagnosis, and treatment of choriocarcinoma.

Types of Choriocarcinoma

Choriocarcinoma is classified as a gestational trophoblastic disease (GTD). GTD includes several tumors that occur at the beginning of pregnancy.

GTD consists of two categories:

• Hydatidiform mole (molar pregnancy): A noncancerous mass that grows in the womb during pregnancy. It is an egg that forms into a tumor instead of a fetus. There can be partial or complete molar pregnancies.
• Gestational trophoblastic neoplasia (GTN): These are usually cancerous and often grow and spread to other parts of the body. They include choriocarcinoma, invasive mole, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor.

Choriocarcinomas are rare and fast-growing tumors that can occur even after miscarriage or ectopic pregnancy (when the fertilized egg implants outside the uterus).

Choriocarcinoma Symptoms

Different symptoms during pregnancy may have a link to choriocarcinoma. Some of the most common ones include:

• Abnormal or irregular bleeding (not related to a menstrual cycle)
• Pelvic pain (from bleeding or overgrowth of the ovaries)
• Enlarged uterus
• Cysts or nodules in the ovaries

Some of the associated symptoms of choriocarcinoma can be normal variations of pregnancy. It is important to get regular prenatal care and contact your obstetrician, midwife, or other healthcare provider to discuss concerning symptoms or if something seems abnormal.

Causes

Choriocarcinoma is a tumor linked to the conception of a fetus. It can originate after an abortion, miscarriage, or a healthy full-term pregnancy.

However, choriocarcinomas are most commonly caused by complications that arise from a molar pregnancy, like the overproduction of abnormal cells that can develop into tumors.

There are no known ways to prevent choriocarcinoma. However, there are risk factors that can make a pregnant person more susceptible to developing a choriocarcinoma, including:

• History of molar pregnancy, miscarriage, or ectopic pregnancy
• Pregnancies in women under the age of 21 and over the age of 35
• Smoking
• High levels of human chorionic gonadotropin (HCG, a hormone produced during pregnancy)

Diagnosis

In addition to a complete medical history and physical exam, physicians will use the following tests and procedures to diagnose choriocarcinoma:

• Pelvic exam: An exam that includes a visual and physical exam of the vagina, cervix, rectum, and surrounding areas. The exam can help to reveal an enlarged uterus, which is common with choriocarcinoma. 
• Pap smear: Involves the insertion of a speculum into the vagina to look at the inner vaginal area and cervix. During the exam, a physician will also collect a small tissue sample that will be sent to a lab and examined for cancerous or abnormal cells.
• Blood tests: Blood is collected to obtain a complete blood count (CBC), check HCG levels, or for any substances typically seen in people with a cancer diagnosis. It is important to note that HCG levels will be on the high side, even in people who aren’t pregnant, at the time of diagnosis. 
• Pelvic ultrasound: Provides a picture of the inside of the pelvis. Ultrasounds can reveal abnormalities of the uterine lining, the surrounding organs, and tissues.
• Imaging tests: Can detect the presence of choriocarcinomas. Some of them include a magnetic resonance imaging (MRI) scan, an X-ray, or a computerized tomography (CT) scan. These tests allow the healthcare provider to get a closer look at the inside of the body to determine if any tumors exist and how advanced they are.

Treatment

The treatment plan may vary depending on the individual's current state of health and how far along the cancer is at diagnosis.

Other factors include the size of the tumor, the person’s age at the time of diagnosis, and if the cancer is contained to one area of the body or has begun to spread.

Various treatments can include:

• Chemotherapy: Chemotherapy is the most common treatment for choriocarcinomas. An oncologist will develop a drug regimen based on your diagnosis to help kill or limit the spread of cancer-containing cells. 
• Hysterectomy: Depending on the progression of the cancer, the surgical removal of the uterus may be necessary. In some cases, surrounding organs like the ovaries or fallopian tubes require removal too.
• Other surgery: To allow the removal of cancerous tumors or diseased organs.

Prognosis

Early detection of choriocarcinoma makes for the best prognosis. Regular preventive care and prenatal screenings can help your healthcare provider with early detection of any abnormalities.

Those who are diagnosed with choriocarcinoma have an 87.5% chance of achieving remission. Many will be able to successfully conceive after a full recovery from treatment. However, in some people, choriocarcinoma may return within a few months to three years of treatment.

Potential complications that may impact the prognosis include:

• Spreading of the cancer to other parts of the body (metastasis), especially to the liver or the brain.
• Early symptoms of pregnancy occurring four months or more before treatment was started.
• Choriocarcinoma recurs after chemotherapy.
• When the diagnosis is made after someone has previously given birth.
• When HCG hormone levels are higher than 40,000 milli-international units per milliliter at the beginning of treatment.

A Word From Verywell 

Planning for the birth of a child is a joyous occasion for many. However, it can be stressful and overwhelming when complications arise. If you are diagnosed with choriocarcinoma, your healthcare provider and oncologist will develop the right treatment plan for you. Shared decision-making with your providers can help lessen some of the helplessness that you may feel.