title: Presentation and management of choriocarcinoma after nonmolar pregnancy.
abstract: 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.
authors.affiliation: Department of Medical Oncology, Charing Cross Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Tidy
authors.forename: G J
authors.initials: GJ
authors.lastname: Rustin
authors.forename: E S
authors.initials: ES
authors.lastname: Newlands
authors.forename: M
authors.initials: M
authors.lastname: Foskett
authors.forename: S
authors.initials: S
authors.lastname: Fuller
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.forename: P
authors.initials: P
authors.lastname: Rowden
mesh_terms: 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*
chemical_list: D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin