Chorionic carcinoma is the name given to a malignant tumor in trophoblast tissue. This leads to rapidly progressing metastases.
What is chorionic carcinoma?
In medicine, chorionic carcinoma also goes by the names.
Chorionic epithelioma, trophoblastic tumor, or villous cancer. This refers to an infiltrative malignant tumor of the placenta consisting of anaplastic trophoblast cells. It occurs predominantly in women of childbearing age and is often the result of a bladder mole (mola hydatiosa). The Latin term mole stands for the maldevelopment of an embryo. In some cases, the tumor also occurs after ectopic pregnancies, normal pregnancies or miscarriages. Because chorionic carcinoma is considered an extremely aggressive tumor, rapidly growing daughter tumors (metastases) soon develop. A rare variant is the non-gestational chorionic carcinoma of the ovary. This germ cell tumor often presents in childhood or adolescence. In Europe and the U.S., the ratio of births to chorionic carcinoma is approximately 1:45,000. It is not uncommon for chorionic epithelioma to present after the first pregnancy in women older than 30 years. Occasionally, chorionic carcinoma is also seen in the male sex, where it occurs in the testis.
Causes
Often, chorionic carcinoma is the result of a bladder mole. For example, a bladder mole occurred in about 50 percent of all affected women prior to the tumor. Another 25 percent suffered a miscarriage. In the remaining 25 percent, the pregnancy proceeded normally. A bladder mole rarely presents. In most cases, it is caused by defective egg fertilization, after which there is no longer any genetic material. This results in the degeneration of the placental villi into hundreds of vesicles, which explains the name bladder mole. Because the small amniotic sac can no longer be adequately nourished, it dies. Bladder mole is a benign trophoblastic disease caused by pregnancy. It involves fertilization of a DNA-less oocyte by two spermatozoa, which, however, does not result in embryonic tissue, but only trophoblast tissue. Likewise, development from embryonic tissue and trophoblast tissue is possible, which is called incomplete bladder mole. Approximately two to three percent of all bladder moles result in a malignant proliferation from which chorionic carcinoma develops. The probability of degeneration varies between 2 and 17 percent. Another conceivable cause of villous carcinoma is increased immune tolerance to antigens from the father. A typical feature of chorionic carcinoma is excessive production of the peptide hormone beta-hCG (human chorionic gonadotropin). For this reason, after successful treatment of the tumor, the beta-hCG levels present in the blood are checked regularly.
Symptoms, complaints, and signs
In the case of a bladder mole, the abdomen grows rapidly. Thus, in more than two-thirds of all affected women, the uterus turns out larger than it corresponds to the gestational age. Bleeding also occurs from the 11th week of pregnancy. Furthermore, labor-like pains as well as the discharge of frothy, bubbly fluid are noted. The main symptoms of chorionic carcinoma are vaginal bleeding, which occurs independently of the menstrual cycle. If metastases already occur, this also results in various complaints. Depending on the degree of tumor growth as well as the occurrence of daughter tumors, it is necessary to differentiate between several stages. These include non-metastatic chorionic carcinoma, destructive bladder mole, metastatic chorionic epithelioma with low risk and metastatic chorionic epithelioma with high risk. High Risk is when metastases occur in the central nervous system, liver, lungs, or pelvis.
Diagnosis and progression
If a bladder mole is suspected, a medical examination must be performed. During this examination, the doctor palpates the uterus of the pregnant woman. A typical feature is that the organ turns out to be too large for the particular stage of pregnancy. During sonography (ultrasound examination), instead of the heartbeat of the embryo, a snowy image appears. Laboratory tests are also important for the diagnosis of chorionic carcinoma.They can be used to detect elevated beta-hCG levels. Another possible indication of the tumor is an increased concentration of alpha-1-fetoprotein (AFP), which is a glycoprotein formed exclusively during pregnancy. The combination of an overly large uterus, ultrasound snowflakes, and greatly elevated beta-hCG levels in the woman’s urine or blood are sure indicators of the presence of a trophoblastic tumor. Chorionic carcinoma is one of the most aggressive tumors. Without prompt treatment, there is a risk of hemorrhage and hematogenous metastases to the vagina, liver, kidney, lung, and brain. However, in general, the prognosis of chorionic epithelioma is considered favorable, even if metastasis already exists.
Complications
Chorionic carcinoma can cause a number of serious complications. First, there is a risk that the tumor will metastasize to the vagina, kidney, liver, lungs, and brain. This can lead to life-threatening bleeding, nerve disorders, pressure pain and other complications as it progresses. If a blood vessel is compressed, tissue death, blockage, a bile back-up or jaundice may occur. Corresponding symptoms are accompanied by various secondary symptoms and can sometimes lead to permanent organ damage and death of the patient. If the chorionic carcinoma spreads to the brain, irreversible brain damage may occur. In general, a malignant tumor in trophoblastic tissue increases the risk of circulatory problems and thrombosis. If the tumor spreads to the gastrointestinal tract, other local complications may also occur. For example, there is a risk that a metastasis will break through the intestinal wall or cause inflammation of the peritoneum. A typical complication is also fistulas, which occur mainly in the area of the urinary bladder and uterus and can lead to infection and inflammation. During the treatment itself, serious complications are unlikely. Risks arise here, for example, from the chemotherapy itself as well as from the side effects of the drugs used.
When should you go to the doctor?
Since chorionic carcinoma usually leads to the formation of metastases relatively quickly, this tumor should be diagnosed and treated at a very early stage. This can significantly increase the life expectancy of the affected person. As a rule, the doctor should be consulted when the patient’s abdominal volume increases significantly without any particular changes in everyday life. Bleeding during pregnancy can also be an indication of chorionic carcinoma and should be investigated in any case. These also occur outside the menstrual cycle. If the chorionic carcinoma is detected late, it can also cause symptoms in other regions of the body if the metastases have spread. For this reason, regular examinations during pregnancy are enormously important. Diagnosis and treatment of this disease is usually performed by a gynecologist. However, the removal of the tumor and chemotherapy requires an inpatient stay in a hospital. Whether this will result in a complete cure cannot be universally predicted.
Treatment and therapy
Chorionic carcinoma is initially treated surgically by scraping out the uterus. Sometimes, another scraping (curettage) may be required after four to six weeks to ensure that no diseased tissue remnants remain. The next therapeutic step is chemotherapy, during which methotrexate is administered. In the case of a bladder mole, methotrexate has the ability to repel the contents of the uterus. In the case of chorionic epithelioma, the tumor responds well to the drug. A cure is possible even in the early stages of metastasis. In later pregnancies, the risk of further bladder moles developing is considered low. Follow-up care also plays an important role in therapy. Thus, regular monitoring of the hCG level is required.
Outlook and prognosis
If diagnosed early and treatment is started quickly, chorionic carcinoma has a good chance of cure. Treatment is via curettage of the uterus in women and surgery in men. Depending on the type and severity of the chorionic carcinoma, as well as subsequent follow-up care, the patient is usually symptom-free and completely cured within a few weeks.However, chorionic carcinoma has a very rapid course of disease in both men and women due to its rapid growth. Without medical treatment, further metastases develop in the organism within a short time. These can lead to an infestation of the kidneys, liver, lungs or brain. In these cases, the chance of recovery decreases significantly and the prognosis deteriorates considerably. If left untreated, chorionic carcinoma therefore poses a risk to the life of the affected person and the disease takes a fatal course. In existing pregnancies, miscarriage occurs in 25% of cases due to chorionic carcinoma. The risk of chorionic carcinoma recurring in another pregnancy is very low. Nevertheless, there is an increased risk for the appearance of secondary diseases due to an experienced miscarriage. Psychological disorders are possible due to the loss of the unborn child. Vulnerability to depression, anxiety or sexual disorder is therefore increased by the condition.
Prevention
Preventive measures against chorionic carcinoma are not known. In the case of a bladder mole, it is essential to have a medical checkup.
Follow-up care
After successful therapy of chorionic carcinoma, the affected person must strictly comply with the scheduled follow-up examinations. In any case, attention must be paid to contraception, as there is a risk of placental perforation during the first year and, at the same time, an increased risk of miscarriage. In metastatic tumors, HCG checks are performed monthly during the first year. In addition, vaginal examinations should be performed every four months, as well as a CT scan of the thorax after about six months. The latter serves to exclude any lung metastases that may be present. If the HCG value remains negative after this year, further HCG checks are only required as part of the vaginal examination and thus every four months for the next two years. Similarly, the patient may consider pregnancy in consultation with the attending physician. If no elevated HCG values occur after this time, semi-annual checks are sufficient for a further two years to rule out a recurrence. Patients whose values remain stable 5 years after the onset of the disease are recommended to have annual checks for a further 5 years. If a non-metastatic tumor was present, its location determines further follow-up. Generally, however, imaging is not required in this case and HCG checks are performed at longer intervals. Patients may also be allowed to consider pregnancy as early as six months.
Here’s what you can do yourself
Chorionic carcinoma is first treated surgically. After the procedure, the patient must take it easy for several days to weeks. If symptoms continue to occur, a visit to the doctor is indicated. The physician must perform a comprehensive physical examination after four to six weeks at the latest to ensure a complication-free healing process. If metastases have already formed, chemotherapy is indicated. It is advisable for those affected to consult a specialist, as chemotherapy is always associated with certain risks. Accompanying precautionary measures must be taken for the start of treatment. Often the diet has to be changed, and a further medical examination is also necessary. During therapy, the body and especially the immune system should not be subjected to additional stress. Those affected may engage in moderate sports, but should also incorporate sufficient rest phases into their daily routine. After treatment, there is often a lack of appetite. Therefore, the diet must be changed and possibly supplemented with dietary supplements. Often essential oils help to stimulate the appetite. After the chorionic carcinoma has been removed, the patient should talk to the gynecologist again. A comprehensive examination must be performed to determine whether the disease has caused infertility or other health problems that need to be treated.
