Gestational Trophoblastic Disease: Choriocarcinoma Diagnosis, Prognostic Factors, and Treatment Strategies

Introduction

Choriocarcinoma is a highly malignant gestational trophoblastic neoplasia (GTN) that arises from placental trophoblastic tissue. Early detection and effective treatment are crucial for improved patient outcomes.

Diagnosis

Clinical Presentation

• Abnormal uterine bleeding postpartum or post-miscarriage
• Elevated serum β-hCG levels
• Metastatic symptoms such as hemoptysis and neurological deficits

Imaging and Laboratory Tests

• Transvaginal ultrasound to assess intrauterine mass
• Chest X-ray and MRI for metastasis detection
• β-hCG quantification for monitoring disease progression

Prognostic Factors

Prognostic scoring systems evaluate risk based on patient age, disease duration, β-hCG levels, metastatic spread, and prior chemotherapy response.

Treatment Strategies

Low-Risk GTN

• Single-agent chemotherapy (Methotrexate or Actinomycin-D)
• Regular β-hCG monitoring

High-Risk GTN

• Multi-agent chemotherapy (EMA-CO regimen)
• Surgical intervention for localized tumor
• Radiotherapy for brain metastases

Conclusion

Choriocarcinoma requires prompt diagnosis, accurate prognostic assessment, and tailored treatment strategies to ensure optimal patient recovery and survival.