Treatment of Choriocarcinoma
Best hospitals and doctors for choriocarcinoma treatment abroad
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Choriocarcinoma is one of the types of trophoblastic diseases. This is a malignant tumor originating from the outer layer of the trophoblast germ. The neoplasm can develop both during and after pregnancy. Although choriocarcinoma mostly occurs in women, the disease can also develop in men as a variant of testicular cancer. As a rule, in such cases, choriocarcinoma is only one of the elements of a mixed tumor, and the greater the proportion of choriocarcinoma, the worse the prognosis, since it is very aggressive: it is prone to metastasis and rapid growth.
Doctors in developed countries successfully cure most cases of the disease. In women, the disease can be treated with chemotherapy. Occasionally, there may be a need for surgery, uterine artery embolization, or radiation therapy. You are welcome to visit the Booking Health website to undergo your treatment of choriocarcinoma abroad. On the website, you can select a hospital, compare the cost of treatment, and make an appointment at the best price.
Content
- Treatment of choriocarcinoma by risk groups
- Chemotherapy for choriocarcinoma
- Treatment for therapy-resistant choriocarcinoma
- Surgical treatment of choriocarcinoma
- Treatment of non-gestational choriocarcinoma
- Treatment of choriocarcinoma in men
Treatment of choriocarcinoma by risk groups
To understand how best to treat choriocarcinoma, doctors divide patients into two risk groups. Women from a low-risk group receive only chemotherapy, while high-risk patients are treated with chemotherapy, surgery, and radiation therapy.
Several factors are considered to determine the risk and points are calculated:
- age: up to 40 years or older;
- how the pregnancy ended;
- how much time has passed from pregnancy to the start of treatment;
- hCG levels in the blood;
- tumor size;
- metastases are present;
- previous experience with chemotherapy.
For some items, a patient can get only 1-2 points, and for others, up to 4 points. If a woman scores seven or more points, the risk is considered high.
In developed countries, even severe forms of the disease can be successfully treated. Women from a low-risk group are cured with a probability close to 100%. Patients with high risk have a five-year survival rate of over 93%.
Unfavorable prognosis factors are as follows:
- non-gestational choriocarcinoma (in a woman who is not pregnant);
- total score over 12 points;
- stage 4 of the disease (development of distant metastases).
Chemotherapy for choriocarcinoma
Chemotherapy is the main treatment for choriocarcinoma. In most women, recovery can be achieved without the use of additional therapeutic techniques and without surgery.
No surgical interventions are performed before the start of chemotherapy. Even if a patient has tumor bleeding, it is eliminated with hemostatic drugs. Uterine artery embolization can be performed to manage severe bleeding. This is a minimally invasive vascular procedure under X-ray guidance. Doctors deliver emboli to uterine blood vessels through a small incision in the leg, which block them and stop bleeding.
The first-line chemotherapy regimen is selected based on the risk group. Regular monitoring of hCG blood levels is required to assess the results. Tests are performed every 2 weeks if a woman is from a low-risk group, and every week if she is undergoing treatment for high-risk choriocarcinoma. Should treatment be a success, hCG levels are constantly decreasing.
Chemotherapy is carried out until the hCG levels are less than 5 mIU/mL. After that, three more courses are carried out, but if the disease is detected at stage 4, four more courses are required. This stage of treatment is called consolidation.
Treatment for therapy-resistant choriocarcinoma
If hCG levels have reached the norm and stabilized, the disease is highly likely to be cured and it will not recur. However, chemotherapy can be ineffective for some women.
Choriocarcinoma is considered resistant in the following cases:
- hCG levels rise during or following chemotherapy;
- hCG levels remain at the same level or decrease by no more than 10% in three measurements within 10 days.
Such women are referred to specialized hospitals with vast experience. Their risk group is repeatedly assessed, considering the failure of the treatment provided. This is followed by second-line chemotherapy. Women from a low-risk group take only one drug. High-risk patients are prescribed the EMA-EP regimen.
Surgical treatment of choriocarcinoma
Surgical treatment for choriocarcinoma is not a common option. The operation may be required in the following cases:
- uterine bleeding that cannot be stopped with drugs, and embolization has failed or there are no technical possibilities for it;
- uterine perforation (the tumor has invaded through the uterine wall);
- unsuccessful first- and second-line chemotherapy in the absence of distant metastases or in the presence of conditions for the simultaneous removal of all tumors.
There is no necessity to totally remove the uterus. Therefore, patients of reproductive age, subject to a well-performed surgical intervention, can maintain their fertility. Doctors perform an organ-preserving hysterotomy (uterine dissection) with tumor removal within healthy tissues. As a rule, this operation is performed using an open, but not a laparoscopic technique. This is necessary to prevent the dispersion of the cancer cells in the abdominal cavity so that metastases do not spread.
Treatment of non-gestational choriocarcinoma
Non-gestational choriocarcinoma develops in the ovary from pluripotent germ cells. This neoplasm belongs to germ cell tumors. This is a rare type of disease that accounts for up to 1% of all malignant ovarian germ cell tumors and up to 0.1% of all neoplasms.
This is an aggressive and often large tumor, which at the time of detection reaches a size of 10-20 cm. It invades the blood vessels, causing necrotic changes in the tissues and bleeding. The disease often develops in young women and adolescents. Since the tumor produces hormones, it may cause isosexual precocious puberty in children.
The disease is treated in the same way as ovarian cancer. The tumor is usually removed surgically. The standard operation is a hysterectomy. Doctors remove the uterus and its appendages.
Organ-preserving treatment can be performed for patients with reproductive plans with stage 1 cancer. Doctors remove the ovary and fallopian tube on one side, leaving the uterus and the other ovary. In the future, a patient will require accurate monitoring, as the risk of a malignant tumor in the second ovary remains.
If both ovaries are involved in the pathological process, organ-preserving surgery at an early stage is also possible. The operation is also performed for gonadal dysgenesis, since, in this case, the risk of a second tumor in the near future is very high. During the operation in women of reproductive age, doctors remove both ovaries, but preserve the uterus. In the future, a woman will be able to become pregnant with the help of in vitro fertilization with a donor egg.
At stage 2 and above, surgical treatment of oncology is performed using cytoreductive surgery. Doctors remove the uterus and its appendages, as well as all detected tumor nodes.
Chemotherapy is considered the second most important cancer treatment. In the case of choriocarcinoma, it is always carried out after surgery, even at stage 1. The VBP scheme is often used. If after the operation there are no tumor foci left, 3 cycles are enough. In the presence of a residual tumor, 4 cycles are carried out.
Treatment of choriocarcinoma in men
Among all testicular tumors in men, approximately 1% are pure choriocarcinomas, and another 15% contain choriocarcinoma components as part of mixed tumors. The greater the proportion of choriocarcinoma, the worse the prognosis, since this type of neoplasm is more aggressive than other tumors.
Treatment for these patients always begins with surgery. Doctors perform an inguinal orchiectomy: removal of the testicle through an incision in the pubis. Most patients also require a retroperitoneal lymphadenectomy. As a rule, this operation is performed simultaneously. This is a more traumatic surgical procedure, which is performed through a large abdominal incision. Lymph nodes are removed to check them for metastases and reduce the risk of a recurrence of the disease. If you are undergoing your treatment in a modern hospital abroad, a lymph node dissection can be performed using a minimally invasive laparoscopic technique. Such an operation reduces the rehabilitation period, although the cost of cancer treatment may be higher.
Some men also require chemotherapy after surgery. This treatment option may be used in the following cases:
- metastases in distant lymph nodes;
- tumor marker levels (primarily hCG) remain elevated.
In the early stages, if the tumor has not reached the blood vessels, a doctor may only remove the testicle without further chemotherapy and without a lymph node dissection. If hCG levels after the operation return to normal indicators, a patient will be monitored to detect a recurrence in time if it suddenly develops. If hCG levels remain elevated, a lymph node dissection and/or chemotherapy will be performed at the second stage of treatment.
Most cases of choriocarcinoma are completely cured in modern Oncology Hospitals abroad. You can use the services of foreign specialists to get the best therapeutic results with a minimal risk of complications. You are welcome to use the Booking Health service to find a hospital, see prices, compare the cost of treatment, and make your treatment appointment at the best price.
Our employees will advise you on all issues and help you to select a hospital and arrange your trip. When making your treatment appointment through the Booking Health service, the cost of treatment in a hospital abroad will be lower for you. The price will be reduced due to the lack of additional fees for foreign patients. You will also receive insurance that will protect you from additional medical expenses, so the initial cost of treatment will definitely not increase after the beginning of the medical care program. Treatment abroad will be easier, faster and cheaper for you with Booking Health.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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