What Is Choriocarcinoma?

Choriocarcinoma is a highly malignant tumor secondary to hydatidiform mole, abortion, or term delivery. A few can occur after ectopic pregnancy, and most are women of reproductive age. The ovaries that occasionally occur in unmarried women are called primary choriocarcinoma. The use of chemical drugs has significantly improved the prognosis of choriocarcinoma.

Basic Information

nickname

Choriocarcinoma

English name

choriocarcinoma

Visiting department

Obstetrics and Gynecology

Multiple groups

Women of childbearing age

Common symptoms

Hydatidiform mole, irregular vaginal bleeding after delivery, abortion, uterus cannot be restored as scheduled

Causes of choriocarcinoma

It is thought that it can occur directly from pregnant eggs, and even very few from the nourishing leaf components of the eggs contained in teratomas. Occurred in tubal pregnancy or abdominal pregnancy are rare.

Clinical manifestations of choriocarcinoma

For hydatidiform moles, irregular vaginal bleeding after delivery or abortion, the uterus cannot be restored as scheduled, larger and softer, and the possibility of choriocarcinoma should be considered.

Choriocarcinoma test

1. Blood or urine (human chorionic gonadotropin) HCG measurement

Those with elevated titers or negative HCG in blood and urine appear positive again.

2.X-ray inspection

Pulmonary shadows are visible in the lungs and are distributed on both sides of the lung field, sometimes as a single metastatic lesion. Or several nodules fused into cotton balls, mass-like lesions.

3. Pathological diagnosis

In the myometrium of the uterus or other resected organs, large areas of necrotic tissue and blood clots can be seen, and a large number of active trophoblasts can be seen around them. There is no villi structure.

Diagnosis of choriocarcinoma

1. For histological examination, the histological diagnosis shall prevail. In histological examination of choriocarcinoma, only a large number of trophoblasts and hemorrhage and necrosis are seen. If villi are seen, the diagnosis of choriocarcinoma can be ruled out.

2. Patients without histological examination, who have symptoms or metastases after abortion, childbirth, ectopic pregnancy, and elevated HCG, can be diagnosed as choriocarcinoma. Hydatidiform mole, which occurs more than one year after the palace clearance, is also diagnosed with choriocarcinoma.

3. When suspected of brain metastases, CT and B ultrasound can be used to show metastases, but the diagnosis is not necessarily clear when the lesions are small. Cerebrospinal fluid and plasma HCG measurement: Cerebrospinal fluid HCG level: plasma HCG level> 1: 60, it is shown that HCG is directly secreted into the cerebrospinal fluid, which can be diagnosed as brain metastasis.

According to clinical characteristics, combined with HCG measurement, auxiliary diagnostic methods and available lesion tissue examinations, more correct diagnosis can be obtained.

Choriocarcinoma Treatment

Treatment principle

Chemotherapy is the main method and surgery is the auxiliary method. Young infertiles do not remove the uterus as much as possible to preserve fertility. If the uterus is removed, the ovaries can still be retained.

2. Chemotherapy

Drug selection: In general early cases, a single drug can be used, and 5-fluorouracil (5-Fu) is preferred. If the condition is urgent or has reached the advanced stage, two or more drugs should be used in combination. Commonly used is 5-Fu plus dactinomycin. 5-Fu and ksm have the best curative effect, have small side effects, and are effective for metastasis of lung, digestive tract, urinary tract and reproductive tract. It can be used for intravenous administration, arterial infusion, intracavitary or intratumoral injection, or oral administration.

3. Surgical treatment

After proving that chemotherapy has more effects, surgical treatment is not as important as in the past, but in some cases, such as those with large lesions, it is estimated that those who cannot be completely conquered by chemotherapy or whose HCG declines slowly during treatment; uterine perforation, intrahepatic metastasis Focal bleeding and so on, in order to save patients' lives, surgery is still an important method for treating choriocarcinoma. General extensive hysterectomy and bilateral accessory omentum and parauterine venous plexus and ovarian venous plexus resection.

4. Radiation therapy

Choriocarcinoma and malignant moles are sensitive to radiotherapy. If the isolated lesions of the lungs, pelvis, abdomen, etc. are difficult, or the chemotherapy does not resolve after multiple courses of chemotherapy, radiotherapy can be considered. ⁶⁰ cobalt or deep x-rays can be used for irradiation. Brain metastases can be treated with whole brain irradiation and cannot be removed. Vaginal metastatic nodules can also be treated topically with radium.

5. Treatment of metastases

(1) Treatment of vulvar and vaginal bleeding Metastases are not ulcerated. In addition to 5-Fu intravenous drip, 5-Fu metastasis injection can be added. If the metastatic tumor has ulcerated and bleeding, gauze strips can be used to stop bleeding, or gauze strips can be coated with sterile bleeding drugs, such as Yunnan Baiyao. If hemostasis cannot be achieved through the above methods, surgical resection or suture can be considered.

(2) Management of intra-abdominal hemorrhage If there is acute and obvious intra-abdominal hemorrhage, laparotomy should be performed immediately to remove the uterus. Postoperative systemic chemotherapy was continued.

(3) Management of brain metastases Systemic chemotherapy. The preferred drug is the commonly used 5-Fu combined with ksm chemotherapy; symptomatic treatment to make chemotherapy work, reduce the intracranial pressure with mannitol or sorbitol, half an hour; sedative control convulsions can be stabilized, barbitur or du Drugs such as Lingding; Prevent complications such as coma, convulsions, bites, aspiration pneumonia, etc., it is necessary to do good nursing work, and at the same time to correct electrolyte disorders and acid-base balance imbalance.

(4) Treatment of hemoptysis Once massive hemoptysis occurs, it is difficult to handle, and there is no ideal treatment method at present. Intravenous infusion of 5% glucose solution with pituitary hormone; Hemostasis and p-carboxybenzylamine can be used for bleeding medicine; Surgery, if the bleeding site can be determined, conditions and time permit, consider emergency lobectomy. At the same time pay attention to anti-shock and correct anemia. Anti-infection and prevention of suffocation caused by hemoptysis.