Choriocarcinoma

What is choriocarcinoma?

Choriocarcinoma is a rare and aggressive form of cancer that happens in your uterus or ovaries. The most common type, gestational choriocarcinoma is a type of gestational trophoblastic disease (GTD). GTD is a group of rare conditions that happens in pregnancy when tumors form from the placenta. The placenta provides oxygen and nutrients to a fetus through the umbilical cord.

Choriocarcinoma is most common in people who have a molar pregnancy (when the sperm and egg join incorrectly and make a hydatidiform mole). It can also happen after an ectopic pregnancy, a pregnancy that ends in miscarriage or even after a full-term pregnancy resulting in a birth.

Choriocarcinoma can spread quickly to other parts of your body, including your:

• Lungs.
• Uterine muscle layer.
• Lymph nodes.
• Liver or kidneys.
• Brain.
• Blood vessels.

Most cases of choriocarcinoma are cured by chemotherapy treatment.

Types of choriocarcinoma

There are two types of choriocarcinoma: gestational and non-gestational.

Gestational choriocarcinoma is more common. It refers to cancer developing while a person is pregnant or shortly after a person is pregnant.

Non-gestational choriocarcinoma affects all sexes. It’s a type of germ cell tumor that can affect the ovaries or uterine lining, but isn’t related to a placenta. In men and people assigned male at birth, it can develop in your testicles.

How common is choriocarcinoma?

Gestational choriocarcinoma accounts for about 5% of all cases of GTD. GTD occurs in about 0.1% of all pregnancies in the United States. Gestational choriocarcinoma is still very rare — it occurs in fewer than 7 in 100,000 pregnancies in the U.S.

What are the symptoms of choriocarcinoma?

People with choriocarcinoma, especially people who were recently pregnant, may have the following symptoms:

• Irregular vaginal bleeding.
• Pelvic pain.

You could develop other symptoms if choriocarcinoma spreads to other parts of your body. For example, once it spreads to your lungs, you may cough or have trouble breathing. Other symptoms could include:

• Heavy bleeding, abnormal discharge or lumps in your vagina (if it spreads to your vagina).
• Seizures or headaches if it spreads to your brain.
• Pain in your abdomen if it spreads to your kidneys or liver.

What causes choriocarcinoma?

Choriocarcinomas happen when cells that form the placenta (called trophoblasts) become cancerous. Choriocarcinoma can develop early in pregnancy or happen after a pregnancy. About 50% of people with choriocarcinoma had a molar pregnancy. A molar pregnancy is when fluid-filled sacs or tumors develop inside your uterus instead of a placenta.

In non-gestational choriocarcinoma, cells in your ovaries, testicles or uterus start making human chorionic gonadotropin (hCG) and resemble trophoblasts under a microscope.

How quickly does gestational choriocarcinoma develop?

There isn’t a set time for how long it takes to develop. It can occur months or years after a pregnancy. It spreads quickly and is considered an aggressive type of cancer.

What are the risk factors for this condition?

Anyone who’s been pregnant (miscarriage, ectopic, termination or full-term pregnancy) can get choriocarcinoma. But you’re most at risk if you’ve had a molar pregnancy.

Other risk factors include:

• Being younger than 20 or older than 40 during pregnancy.

What are the complications of this condition?

Because this type of cancer spreads quickly, not getting treatment for choriocarcinoma can be fatal. With treatment, many people can achieve remission or be cured. As with most cancers, treating it at its earliest stages has the most successful results.

How is choriocarcinoma diagnosed?

A healthcare provider diagnoses choriocarcinoma with the following tests:

• Pelvic exam or physical exam to check for lumps or masses.
• Blood test to look for hCG (human gonadotrophin), which is high in people with choriocarcinoma.
• Blood tests to check liver and kidney function.
• Complete blood count (CBC).
• Pelvic ultrasound.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Chest X-ray.

These tests can also tell your provider if the cancer has spread.

How is choriocarcinoma treated?

Healthcare providers treat choriocarcinoma differently depending on its stage. Staging is how your provider rates your cancer based on the size of the tumor, and if it’s spread to areas outside of your uterus, among other factors. Your overall health and personal preferences are also considered when deciding on a treatment plan.

The main treatment for choriocarcinoma is chemotherapy. Chemotherapy is a drug that kills cancer cells. Some people may also need surgery to remove their uterus (hysterectomy), radiation or a combination of treatments.

After treatment, your healthcare provider will schedule follow-up exams to make sure the cancer doesn’t return.

Is choriocarcinoma cancer curable?

Yes, choriocarcinoma is curable. Treatment with chemotherapy is usually successful in curing it. The prognosis is better when choriocarcinoma is caught early, before it spreads to other parts of your body.

It’s also harder to cure if:

• You’ve had chemotherapy and it was unsuccessful.
• You develop the disease after a full-term pregnancy or birth of a child.
• HCG levels are higher than 40,000 mIU/ml (milli-international units per milliliter) before treatment. HCG is a hormone the placenta creates during pregnancy.
• You’ve had symptoms or were pregnant more than four months before treatment.

Can I prevent choriocarcinoma?

No, you can’t prevent choriocarcinoma. If you’ve had a molar pregnancy, talk to your healthcare provider about your risk for choriocarcinoma.

How long can you live with choriocarcinoma?

The outlook for choriocarcinoma in its early stages is good. The survival rate for people with low-risk gestational choriocarcinoma is almost 100%. The survival rate for people with high-risk gestational choriocarcinoma is 94%.

Non-gestational choriocarcinoma (not related to a prior abnormal pregnancy/placental tissue) has a worse prognosis and is less chemosensitive, which means chemotherapy may not be as effective in killing the cancer cells.

Can Stage 4 choriocarcinoma be cured?

Stage 4 choriocarcinoma means the cancer has spread to other parts of your body like your brain and liver. Your healthcare providers will discuss your outlook with you, but it’s still possible to go into remission.

Can I still have a baby if I had choriocarcinoma?

Maybe. Many people are able to still have children after treatment for choriocarcinoma. It depends on your diagnosis. Discuss your desire for children with your healthcare provider so they know how to best treat you.

When should I see my healthcare provider?

You should contact your healthcare provider if you develop unusual vaginal bleeding or pelvic pain, especially if you’ve had a molar pregnancy.

A note from Cleveland Clinic

Choriocarcinoma is a rare but serious type of cancer. Receiving a diagnosis can be stressful. But the outlook for choriocarcinoma is generally very good. Discuss your concerns with your healthcare provider and ask them any questions you have about the disease. They’re there to answer your questions and give you the best possible care.