Choriocarcinoma: Treatment, Cost and Side Effects

Choriocarcinoma is a type of cancer occurring in a woman’s uterus and is a type of gestational trophoblastic disease. What is gestational trophoblastic disease? It is basically a group of tumors occurring in a woman’s uterus. A tumor is an abnormal growth of cells in any part of the body and might contain cancer cells (malignant) or not (benign). A GTD normally begins in the layer of trophoblast (tropho means nutrition and blast means bud or early development) cells that surrounds an embryo. This layer of trophoblast cells eventually grows into the placenta, the organ that protects and nourishes the growing fetus. In GTD, the tumor grows from the placenta and can be cancerous or non-cancerous. Therefore, choriocarcinoma is basically a malignant form of gestational trophoblastic disease.

The causes of choriocarcinoma varies widely and in most cases starts from molar pregnancy or hydatidiform mole. Hydatidiform mole is also a type of gestational trophoblastic disease. The thin layer of trophoblast has small finger like projections called villi which became swollen with fluid and subsequently they start to grow in clusters, making you seem pregnant. However, it should be noted that a normal pregnancy is not possible in case of hydatidiform mole but in rare cases a fetus can develop alongside the tumor. Also hydatidiform mole is not cancerous butcan turn into malignant GTD. Other causes of GTD include miscarriage, abortion, ectopia pregnancy. It can also occur after a normal pregnancy or delivery.

For proper diagnosis of choriocarcinoma, you need to consult a doctor who may be a oncologist or a gynecologist. More often, patients are monitored by a multidisciplinary team that includes an oncologist, a gyneacologist, physiotherapists and psychologists. Your treatment will depend on the stage of GTD (gestational trophoblastic disease), your general health, your age and whether you have other medical conditions. Patients having choriocarcinoma tests positive after pregnancy test. Other test may include quantitive serum HCG (human chronic gonadotropin levels which is hormone produced during prgenancy), blood test, kidney function test and liver function test. Based on this tests, your treatment will begin.

The treatment will generally include chemotherapy. Chemotherapy uses anti-cancer (cytotoxix) drugs to destroy tumour cells. If you are in Stage 1 of choriocarcinoma, then your treatment will include methotrexate. The drug will either be injected into the muscle every other day or in your buttock area. A total of 4 injections are given, after which there is a gap of 7 days and the next cycle begins. This is a low risk chemotherapy which usually works for early stage choriocarcinoma. If your tumor does not respond and your HCG level is still high or has not decreased, then your drug will be changed. A combination of EMA-CO (etoposide, methotrexate/leucovorin, and actinomycin-D, followed a week later with cyclophosphamide and vincristine) is given along with cistaplin and etoposide (before EMA-CO). These drugs are generally given in high risk chemotherapy and are administered through an injection or channel. Therefore, you may require staying at a hospital for a few weeks depending on your stage and response to treatment.

People having choriocarcinoma have various symptoms that include heavy vaginal bleeding, abdominal swelling and anemia. This symptom makes a person eligible for treatment of choriocarcinoma. However, if the tumour spreads to the lungs or abdomen or brain, you may experience cough, chest pain, stomach pain, headaches and lightheadedness.

People suffering from benign GTD (gestational trophoblastic disease) are not eligible for the treatment. Also, people having other types of GTD like hydatifiform mole, invasive mole, placenta-site trophoblastic tumour and epithelioid trophoblastic tumour are not eligible for the treatment.

Because the treatment of choriocarcinoma involves chemotherapy as beginning treatment, the side effects experienced by patients are common to chemotherapy. They include- feeling sick, loss of appetite, sudden weight loss, feeling tired and weak, low immunity (prone to developing other diseases like infection, common cold, etc), bleeding and bruising, diarrhea and constipation and hair loss. You can also experience fevers of higher temperature. It is important to note that the side effects of the patient depends upon the drugs used in chemotherapy, how much dosage is given to you and your body reactions and responses to the treatment. You should consult your doctor immediately in case of any discomfort.

As with most cancer care and post-treatment guideline, palliative care is an important part for the overall healing of a patient. The whole treatment of choriocarcinoma from chemotherapy to hospitalization to diagnosis can drain a person physically and mentally as well. Therefore, it is recommended by doctors and specialists to start palliative care as early as possible to help the patient and his or her family to cope. Palliative care generally includes nutritional changes, emotional support, psychological counseling, yoga and meditation and other therapies. It is usually seen that a patient under palliative care along with treatment have a better quality of life.

Recovery from choriocarcinoma treatment usually takes 6 months to 1 year because treatement does not get over with chemotherapy but also include a follow-up of blood and urine test showing HCG levels in the blood and body.

The price for choriocarcinoma treatment can range from Rs. 5,000 and go upto Rs.2,00,000.

The results of the treatment are semi-permanent. However, if the tumour does not respond to chemotherapy, then other treatments are given. Compared to other cancers, choriocarcinoma has a high cure rate.

Other alternative treatment for choriocarcinoma include radiation and surgery like hysterectomy. This treatments are only advised if chemotherapy does not work.