Gestational Trophoblastic Disease

Definition

Gestational trophoblastic disease is a quick growing form of cancer that occurs in a woman's uterus after a pregnancy, miscarriage, or abortion. It is usually metastatic, which means it spreads to other places in the body.

Gestational trophoblastic disease is also called a choriocarcinoma.

Alternative Names

Chorioblastoma; Choriocarcinoma; Trophoblastic tumor; Chorioepithelioma; Invasive/malignant mole; Gestational trophoblastic neoplasia

Causes, incidence, and risk factors

Choriocarcinoma remains an uncommon, yet almost always curable, cancer that can be associated with pregnancy.

The cancer forms in the tissues that develop after a baby is conceived. A choriocarcinoma looks like the cells that normally surround a developing baby (embryo).

In approximately 50% of cases of choriocarcinoma, the woman had a hydatidiform mole (molar pregnancy).

Nearly one-fourth of choriocarcinomas occur after pregnancy has resulted in the delivery of a normal child. The remainder of cases occurs after any type of abortion, 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 pregnancy.

Additional symptoms may include:

• Irregular vaginal bleeding
• Certain types of cysts on the ovaries
• Uneven swelling of the uterus
• Persistently high HCG (pregnancy hormone) levels (positive pregnancy test)
• Pain

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
• Chest x-ray

These signs and tests apply to women with a recent history of hydatidiform mole, abortion, or 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 required.

Support Groups

For additional information, see cancer resources.

Expectations (prognosis)

Nearly all women whose choriocarcinoma did not spread are cured, and more than 90% maintain reproductive function.

The outlook may not be as good if the cancer has spread and one of more of the following conditions occur:

• Disease has spread to the liver or brain
• Serum HCG level is greater than 40,000 mIU/ml at the time treatment is started
• Having received prior chemotherapy
• Symptoms or pregnancy occurred for more than 4 months before treatment
• Choriocarcinoma occurred after a pregnancy that resulted in the birth of a child

However, about 66% of women who initially have a poor outlook go into remission (a disease-free state).

Complications

Choriocarcinoma may recur, usually within several months but possibly as late as 3 years after treatment ends. Complications associated with chemotherapy or surgery can also occur.

If a hysterectomy is performed, infertility will result. Menopause will begin if the ovaries are also removed.

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 after the removal of hydatidiform mole or termination of pregnancy may not prevent the development of choriocarcinoma, it is essential in early identification of the condition, which improves outcome.

•	Hydatidiform mole
•	Abortion
•	Ectopic pregnancy
•	Tumor
•	Menopause