Presentation and management of choriocarcinoma after nonmolar pregnancy

Abstract

Objective To ascertain the mode of presentation and treatment outcome for women with choriocarcinoma after a nonmolar pregnancy. Design Retrospective analysis of case records between 1985 and 1994. Setting A referral centre for trophoblastic disease. Subjects One hundred women with choriocarcinoma: 62 after a live birth, six after a live birth preceded by a molar pregnancy and 32 after a nonmolar abortion. Results Choriocarcinoma after nonmolar pregnancies represent 17% of the total gestational trophoblastic tumours requiring treatment. Vaginal bleeding was the commonest symptom in all groups, but symptoms from metastatic disease were important in the group presenting after a live birth. Metastatic disease was present in 31% of cases after live birth and 43% post‐abortion. The median interval between the antecedent pregnancy and choriocarcinoma was five and six months, respectively. High risk multi‐agent chemotherapy was required in 82% and 60% of cases, respectively. The mortality rate was significantly higher after a live birth than a nonmolar abortion (21%vs 6%). Conclusions Treatment of choriocarcinoma after a live birth is associated with an unacceptably high mortality rate. Vaginal bleeding is an important early symptom and a pregnancy test should be performed if it persists after usual medical treatment.

Intraplacental Choriocarcinoma Associated with Viable Pregnancy: Pathologic Features and Implications for the Mother and Infant

“…Choriocarcinoma with metastases may present during pregnancy, but more commonly the diagnosis is made several months after delivery [2]. The median interval between pregnancy and the diagnosis of maternal choriocarcinoma is 5 months, with the most common presenting symptom being vaginal bleeding, although many women also present with symptoms of extrauterine metastatic disease [3]. Maternal choriocarcinoma following live birth frequently requires multi-agent chemotherapy, and it is associated with a mortality rate of 21%, a mortality rate significantly higher than that of choriocarcinoma following other gestational events [3].…”

Unexplained anaemia and failure to thrive as initial symptoms of infantile choriocarcinoma: a review

“…In women developing gestational trophoblastic disease following apparently normal non-molar term pregnancy, the median interval between delivery and diagnosis is 5 to 6 months from delivery to diagnosis [34]. In women developing gestational trophoblastic disease following molar pregnancy, a median interval of 45 months between pregnancy and first maternal symptoms is reported [17].…”

Elevated hCG and a high proportion of hCGβ in serum preceding the diagnosis of trophoblastic disease by seven months

“…The prognosis of choriocarcinoma has improved with combination chemotherapy 7 , but the mortality of choriocarcinoma after a live birth is still high (21%) 5 . hCG in serum is a very reliable marker of trophoblastic tumours 8 and an elevated ratio of hCGb to hCG indicates that the tumour is malignant 3,4 .…”

“…Choriocarcinoma after normal pregnancy usually causes abnormal vaginal bleeding 5 . In our case the presenting symptom was galactorrhoea, which is surprising considering the inhibitory effect of choriocarcinoma on the release of prolactin 6 .…”