Treatment of choriocarcinoma abroad
Choriocarcinoma (chorionic epithelioma or placentoma) is a rare malignant female tumor occuring in the uterus of the chorion villi. The tumor is associated with the pregnancy as it develops from the tissues surrounding the fetus.
China and Indonesia have highest incidence of this tumor. Choriocarcinoma is diagnosed 30-40 times more often in Asian countries than in the European.
Causes of choriocarcinoma
Choriocarcinoma occurs during or after pregnancy. Risk factors are:
- Age over 35 years
The highest incidence of this tumor is observed in the developing countries where women get pregnant and give birth very often.
It’s being assumed that there are certain contributing factors to choriocarcinoma occurrence:
- A large number of childbirths and short intervals between them
- Immunodeficiency conditions
- Low level of estrogens in the body
- Malnutrition with a deficit of proteins in the diet
- Viral infections in the medical history
According to WHO, choriocarcinoma develops 1000 times more often after a pathological pregnancy than after a normal one.
Symptoms of choriocarcinoma
Key symptom that appears in almost 100% of patients isbloody vaginal discharge. 25% of patients experience discharges right after the childbirth, abortion or miscarriage. 50% observe this symptom as menstruation delay. 25% of sick women notice more discharges in between the periods. Purulent discharge from the vagina can appear after the tumor nodes disintegration.
The risk of metastasizing to different organs is:
- Lungs – 60%
- Brain – 17%
- Vagina – 40%
- Liver – 16%
- Kidneys – 12%
Metastases in different organs give corresponding symptoms: affected lungs - hemoptysis, presence of metastases in the brain - neurological symptoms.
Diagnostics of choriocarcinoma
There are four ways to diagnose choriocarcinoma:
- Clinical examination
- Histological examination
- Laboratory diagnostics
Objective exam and woman’s answers help to suspect the illness. A reliable clinical sign of choriocarcinoma is the appearance of dark red nodes on the mucous membrane of the cervix or vagina.
Indirect signs are also taken into account such as:
- Cyanosis (blue tint) of the genital tract mucous membrane
- Enlargement of the uterus with softening sites on it
- Intrauterine fetal death
- Irregular menstrual cycle (if a woman is not pregnant)
- Discharge from the genital tract
- Anemia (low hemoglobin level in the blood)
- Cramping pain in the lower abdomen
- Signs of pregnancy in the absence of a fetus according to ultrasound
- Rupture of the uterus
- Hemoptysis (consequence of tumor metastasis to the lungs)
To confirm the diagnosis laboratory and instrumental diagnostics techniques are used. A reliable biochemical marker of choriocarcinoma is an increased level of the hormone of pregnancy in the blood and urine called chorionic gonadotropin.
The final diagnosis is established on the basis of the histological examination of the biological material obtained during scraping of the uterus.
Choriocarcinoma treatment abroad
Chemotherapy is the basis of treatment. Indication of high-quality medicines helps to completely destroy the tumor in the majority of cases.
It is noteworthy, that surgery is still required in the certain cases. Specialists try not to indicate it to young women and their wish to preserve the reproductive function. Even young patients must still undergo extirpation of the uterus in certain cases.
Indications for a surgery for women of reproductive age:
- Chemotherapy resistance
- Frequent bleedings that threaten life
- Threat of the uterusperforation
- Internal bleeding
- The size of uterus exceeds 13 weeks of pregnancy
Radiation therapy is only applied as an additive and is usually used if a patient is resistant to chemotherapy or if there are metastases present.
Innovative treatments of choriocarcinoma
Taking into account that chemotherapy is the treatment cornerstone, they keep on looking for the most effective combinations of the drugs that will give a chance to:
- Ensure the maximum possible patients’ survival
- Overcome the resistance to the conventional chemotherapy
- Lengthen life of the patients with the advanced stages of choriocarcinoma
Specialists also implement new medicines not used for choriocarcinoma treatment previously, including those below:
The possibility of using increased doses of drugs with subsequent stem cell transplantation is being investigated as an option for those who are resistant to chemotherapy. Preliminary studies show encouraging results.
Prognosis for choriocarcinoma
Life prognosis is comparatively favorable for choriocarcinoma if we talk about all the rest of malignant tumors. Complete cure can be reached with the help of chemotherapy only.
5-years-survival due to the tumor stages:
- Stage 1 – 97%
- Stage 2 – 86%
- Stages 3 – 53%
- Stage 4 – 7%
Unfavorable prognosis is peculiar if metastases into the lungs (lethal outcome is 50%) and into the brain (lethal outcome reaches 90%) have already occurred.
Reproductive function can be preserved in the majority of cases. But, a woman is allowed to get pregnant no less than in a year or two after treatment. Exact terms are determined by the doctor depending on the exact clinical case.