Malignant trophoblastic tumour arising from gestation
Gestational choriocarcinoma is a form of gestational trophoblastic neoplasia, which is a type of gestational trophoblastic disease (GTD), that can occur during pregnancy. It is a rare disease where the trophoblast, a layer of cells surrounding the blastocyst, undergoes abnormal developments, leading to trophoblastic tumors. The choriocarcinoma can metastasize to other organs, including the lungs, kidney, and liver.[1] The amount and degree of choriocarcinoma spread to other parts of the body can vary greatly from person to person.[2]
Gestational choriocarcinoma can happen during and after any type of pregnancy event, though risk of the disease is higher in and after complete or partial molar pregnancies.[3] Risk of disease may also be higher in those experiencing pregnancy at younger or older ages that average, such as below 15 years old or above 45 years old.[4] Those with gestational choriocarcinoma may experience abnormal vaginal bleeding, abdominal pain, and have high levels of human chorionic gonadotropin (hCG), in addition to history of molar pregnancy or other metastatic cancer. A combination of history, symptoms, human chorionic gonadotropin levels, and imaging can be used in the diagnosis process, with ultrasonography being commonly used to image.[5] Approximately 50% of those with gestational choriocarcinoma have experienced molar pregnancy, approximately 25% developed the disease after a regular, term pregnancy, and other situations have included history of ectopic pregnancy, where the pregnancy does not occur in the uterus.[6]
Guidelines from the Federation of Gynecologists and Obstetricians (FIGO), Royal College of Obstetricians and Gynaecologists (RCOG), European Society for Medical Oncology (ESMO), and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) exist to evaluate risk and treatment of the disease. There are generally three levels of risk: low risk, high risk, and ultrahigh risk.[6] The primary form of treatment is chemotherapy with one or more agents. Duration can go upwards of six weeks following the return of human chorionic gonadotropin levels to the normal range. Depending on the risk of gestational trophoblastic disease (GTD) development, such as in certain people with mole pregnancies, chemotherapy has been used in a preventative manner in the past. However, this type of use is now advised against due to risk of toxicity and resistance to agents that may be needed in future treatment of the disease, on top of medical costs.[2] Guidelines also detail options for salvage therapies in the situation of resistance to preferred choice of chemotherapy and surgical procedures possible in the situation of drug-resistant tumors.[6]
^Sharami SR, Saffarieh E (March 2020). "A review on management of gestational trophoblastic neoplasia". Journal of Family Medicine and Primary Care. 9 (3): 1287–1295. doi:10.4103/jfmpc.jfmpc_876_19. PMC 7266251. PMID 32509606.
^ abBraga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, Seckl MJ (February 2019). "Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide". World Journal of Clinical Oncology. 10 (2): 28–37. doi:10.5306/wjco.v10.i2.28. PMC 6390119. PMID 30815369.
^Cite error: The named reference Hui_2019 was invoked but never defined (see the help page).
^Cite error: The named reference Ngan_2018 was invoked but never defined (see the help page).
^Shaaban AM, Rezvani M, Haroun RR, Kennedy AM, Elsayes KM, Olpin JD, et al. (2017). "Gestational Trophoblastic Disease: Clinical and Imaging Features". Radiographics. 37 (2): 681–700. doi:10.1148/rg.2017160140. PMID 28287945.
^ abcCite error: The named reference Diagnosis_2020 was invoked but never defined (see the help page).
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