Choriocarcinoma: Not a Death Sentence Renee Oliver-Evers COM/156 March 25, 2012 Raymond Gentry Choriocarcinoma: Not a Death Sentence Choriocarcinoma, or also known as Gestational Trophoblastic Disease (GTD), is a very rare and malignant type of tumor. According to Spickler and Oberleitner (2011), Choriocarcinoma develops from genetically deformed germ cells which usually produce sperm or eggs (pp.1012-1014). Research shows no exact causes for the development of Choriocarcinoma (GTD). Early research shows that Choriocarcinoma was almost always found to be a fatal disease. There are no known means of prevention for this disease. According to Spickler and Oberleitner (2011), although Choriocarcinoma has the capability to metastasize extremely fast, there is a high possibility of a complete cure or remission even if the disease has been diagnosed in later stages of development even with metastases (pp.1012-1014). My research will show that it is not a dismal death sentence for those diagnosed with it. Choriocarcinoma (GTD) is primarily found in women during their childbearing years however it has been diagnosed in men as well. This paper will concentrate on the causes, risk factors, and forms of treatment in women. Doctors have no exact explanation for the development of Choriocarcinoma (GTD), though there are many risk factors. Some of the leading causes are an ectopic pregnancy where the fetus starts development in the fallopian tube. According to Goldstein and Berkowitz (2004b) the development of Choriocarcinoma in the beginning stages of a pregnancy where the fetus develops only partially or not at all happens in about 50 percent of women who have been diagnosed with this cancer (pp. 2347-2367). In these cases there can be a history of what is called a hydatiform mole (a noncancerous growth), or a molar pregnancy. A molar pregnancy is a pregnancy where there may be a fetal sac, and possibly fetal heart tones, but the fetus or fetal tissue is consumed by a mass of abnormal or partially developed tissue. Because of the many abnormalities the fetus grows improperly, and soon dies. In either of these situations the uterus grows abnormally large, in a short amount of time. Vaginal bleeding is usually presented in either case. Another leading cause of Choriocarcinoma is abortion. It can develop from tissue retained after the body’s natural expulsion of a fetus or a miscarriage. Women at risk of developing Choriocarcinoma are women under the age of 20 and those older than age 40, according to Goldstein and Berkowitz (2004b, pp. 2347-2367). According to Rastegari and Odle (2006) the development in older women stems from deciding to have babies later in life when the occurrences of certain types of cancers can happen (pp. 1008-1012). According to “Http://www.mskcc.org/cancer-Cancer-Care/adult/gestational-Trophoblastic-Disease/aboutGestational-Trophoblastic-Disease” (2012) another contributing risk factor is a woman’s blood type. There are no explained reasons, but women with B or AB have an elevated risk for Choriocarcinoma (GTD), says the center. The center also states that a woman who has low levels of beta carotene or vitamin A may be at a slightly higher risk. According Spickler and Oberleitner (2011) the symptoms of Choriocarcinoma can depend on where the cancer begins and if it should metastasize. The most common symptom usually involves vaginal bleeding unassociated with a regular menstrual cycle (pp.1012-1014). There also can be abdominal pain and abdominal swelling. Choriocarcinoma can be associated with ovarian cysts which can be a source of the abdominal pain. The cancer can spread quickly through the bloodstream. It is stated by Goldstein and Berkowitz (2011a), if the cancer spreads outside of the uterus it can show up in the genital area in the form of purple or blue/black nodules or lumps (pp.1012-1014). Jaundice develops when the cancer spreads to the liver. Another symptom that a patient may have with metastases to the lung is frequent coughing. They may even cough up blood and have chest pain. If the cancer reaches the brain it can cause a hemorrhage, which could result in a stroke. To diagnose Choriocarcinoma (GTD), there are many examinations and tests performed. The first would be an internal pelvic examination to access for possible bumps or unusual shape or size of the uterus according to Goldstein and Berkowitz (2004b, pp. 2347-2367). If a woman is pregnant, her uterus is measured regularly throughout the term of the pregnancy to determine if the growth rate is within normal range for the specific period of time. If it is determined during the examination that the uterus is larger than normal for the gestational period the thought of thought of multiple births, hydatiform mole, Choriocarcinoma, or other possible complications are considered. If a woman is not pregnant, a pregnancy test or human chorionic gonadotropin (HCG) blood test is performed according to Goldstein and Berkowitz (2004b, pp. 2347-2367). If there is advanced levels of HCG found in the blood further evaluation needs to be performed. A complete blood test (CBC) will also be completed at this time. A series of diagnostic tests are next completed. These tests include a kidney function test to see if there is any evidence of metastases in the kidneys, and liver function test to check for metastases in the liver. An ultrasound of the uterus will follow the routine blood tests to check for any masses or tumors. A CT scan may also be ordered to check further for any other metastases in the abdomen. If there is reason to believe there are metastases to the brain, an MRI may be ordered to check for a mass. Choriocarcinoma can transfer to any place in the body. According to Goldstein and Berkowitz (2004b) the most common places to find metastasis are in the lungs, the genital tract, liver, kidneys, brain, and the gastrointestinal tract (pp. 2347-2367). Treatment for Choriocarcinoma (GTD) usually involves some combination of surgery, chemotherapy, and occasionally radiation, depending on the details of case-by- case scenarios. If the cancer has been diagnosed in the earliest stage before it metastasizes, it can usually be treated with chemotherapy in a woman who is still in her childbearing years. This method is used to retain the possibility for future pregnancies. The most common chemotherapeutic drug for treatments without metastasis is methotrexate. If the cancer is discovered during the first trimester of pregnancy there is greater concern because there are two patients to consider treatment for instead of just one. The first 12 weeks are crucial to the development of the growing fetus. Therefore, treatment with certain chemotherapeutic medications needs to be withheld until the second trimester of pregnancy when the fetus has a better chance for survival from the harsh effects of the drugs according to Spickler and Oberleitner (2011, pp.1012-1014). Oncology- gynecologists have to consider many factors when treating Choriocarcinoma (GTD) during a pregnancy: decisions of which medication will be most effective for treatment, with the least amount of harm to the developing fetus, stage of growth the fetus, length of the treatment, how often the patient will receive medication, and if the medication crosses safety thresholds of the development of a healthy fetus according to Rastegari and Odle (2006, pp. 1008-1012). Other factors considered during a pregnancy involve the concentration levels of the chemotherapy in the blood, sodium levels, and cardiac output in the blood. Weight can affect the balance of medication in the bloodstream. According to Spickler and Oberleitner (2011) if treatment of vaginal bleeding associated with Choriocarcinoma (GTD) is not controlled by medication, a hysterectomy is usually performed along with chemotherapy treatment (pp.1012-1014). Occasionally there is a combination of chemotherapy medications used to treat women considered to be high risk because of metastases. When there has been metastasis to the brain, patients will also be treated with radiation therapy. The prognosis of Choriocarcinoma (GTD) depends on what stage the cancer was diagnosed. If caught in the first stages without metastasis outside of the uterus the prognosis is usually very good. With treatment of chemotherapy there is a cure rate in 75 to 100 percent of cases as shown by Spickler and Oberleitner (2011, pp.1012-1014). The possibility of coming out of remission after have had continued normal HCG levels for at least a year is often less than one percent. The prognoses of remission for women who have had Choriocarcinoma spread to other areas outside of the uterus have a poorer outcome. Because the tumors can spread quickly, the prognosis is lower when there has been metastases in the liver or brain, or if the origination is outside of the uterus. There are no known measures to prevent Choriocarcinoma (GTD). The most important measures a woman can make are paying attention to her body and when something concerns her, to seek medical advice from her physician as soon as possible. Seeking early detection and treatment is the key to a positive outcome. This writer is a 31 year survivor of Choriocarcinoma (GTD). Cancer diagnosed during a pregnancy usually has no connection to the pregnancy. There is a single limitation to this, the diagnosis of Choriocarcinoma (GTD). This cancer is strictly found in pregnancy. Choriocarcinoma (GTD) is a very rare form of cancer. According to Encyclopedia Britannica Online in the early 1970s this cancer was considered to be fatal. It is now a very treatable disease and has a high rate of complete remission. The earlier it is detected and treated the better the prognosis. However, if caught in later stages of development there is still a high prognosis of a complete recovery. Having diagnosis of Choriocarcinoma does not mean that it is a death sentence. References Goldstein, D. P., & Berkowitz, R.S. (2008a). Gestational Trophoblastic Disease (4th ed.). Philadelphia, PA: Elsevier Churchill Livingstone Inc. Goldstein, D. P., & Berkowitz, R.S. (2004b). Gestational Trophoblastic Disease (3rd ed.). Philadelphia, PA: Elsevier Churchill Livingstone Inc. Rastegari, E. C. & Odle, T. G. (2006). The Gale Encyclopedia of Cancer [University of Phoenix Custom Edition eBook]. Detroit, MI: Gale Virtual Reference Library. Retrieved from University of Phoenix, COM/156 website. Spickler, A. R., & Oberleitner, M. G. (2011). The Gale Encyclopedia of Medicine [University of Phoenix Custom Edition eBook]. Detroit, MI: Gale Virtual Reference Library. Retrieved from University of Phoenix, COM/156 website. Choriocarcinoma. (2012). In Encyclopedia Britannica Online. Retrieved from http://www.britannica.com/EBchecked/topic/474704/pregnancy/76101/Trophoblastic-disease?anchor=ref607494 Health Issues.org. (2012). Retrieved from http://www.health-issues.org/rare-diseases/choriocarcinoma.htm Gestational Trophoblastic Disease. (2012). Retrieved from http://www.mskcc.org/cancer-care/adult/gestational-trophoblastic-disease/about-gestational-trophoblastic-disease