Presentation and management of choriocarcinoma after nonmolar pregnancy.
OBJECTIVE
To ascertain the mode of presentation and treatment outcome for women with choriocarcinoma after a nonmolar pregnancy.


METHODS
Retrospective analysis of case records between 1985 and 1994.


METHODS
A referral centre for trophoblastic disease.


METHODS
One hundred women with choriocarcinoma: 62 after a live birth, six after a live birth preceded by a molar pregnancy and 32 after a nonmolar abortion.


RESULTS
Choriocarcinoma after nonmolar pregnancies represent 17% of the total gestational trophoblastic tumours requiring treatment. Vaginal bleeding was the commonest symptom in all groups, but symptoms from metastatic disease were important in the group presenting after a live birth. Metastatic disease was present in 31% of cases after live birth and 43% post-abortion. The median interval between the antecedent pregnancy and choriocarcinoma was five and six months, respectively. High risk multi-agent chemotherapy was required in 82% and 60% of cases, respectively. The mortality rate was significantly higher after a live birth than a nonmolar abortion (21% vs 6%).


CONCLUSIONS
Treatment of choriocarcinoma after a live birth is associated with an unacceptably high mortality rate. Vaginal bleeding is an important early symptom and a pregnancy test should be performed if it persists after usual medical treatment.
Tidy
J A
JA
Department of Medical Oncology, Charing Cross Hospital, London, UK.
Rustin
G J
GJ
Newlands
E S
ES
Foskett
M
M
Fuller
S
S
Short
D
D
Rowden
P
P
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000032:analysis; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin