Gestational trophoblastic disease, or choriocarcinoma, is an aggressive, malignant, often metastatic (spreading) cancer in the uterus that begins following a pregnancy, a miscarriage, or an abortion.

Choriocarciona is among the most sensitive cancers to chemotherapy. As such, even when choriocarcinoma is metastatic, the cure rate is between 90 - 95%.

Hydatidiform mole is a condition which develops when a pregnancy has many complications. Conception takes place, but placental tissue grows very fast, rather than supporting the growth of a fetus.

The result is a tumor, rather than a baby. This is known as a molar pregnancy. There are only about 3,000 molar preganancies per year in the United States.

Choriocarcinoma is a similar type of growth. In approximately one-half of cases of choriocarcinoma, the preceding factor is hydatidiform mole. However, only 5 - 10% of molar pregnancies are associated with later choriocarcinoma. Therefore, choriocarcinoma remains an uncommon, yet almost always curable, cancer that can be associated with pregnancy.

Nearly one-fourth of choriocarcinomas follow a term pregnancy from which a normal child has been delivered. The remainder follow an abortion (spontaneous, elective, or therapeutic), ectopic pregnancy, or genital tumor.

A possible symptom is continued vaginal bleeding in a woman with a recent history of hydatidiform mole, abortion, or term pregnancy.

Additional symptoms that may be associated with this disease include:

• Irregular vaginal bleeding
• Theca lutein cysts on the ovaries
• Uneven enlargement of the uterus
• Persistently elevated HCG (pregnancy hormone) levels
• Pain
• Symptoms related to the disease spreading to other organs such as lungs, liver, and brain

• Quantitative serum HCG (blood test to confirm pregnancy)
• CT scan to detect potential metastatic tumor in any organ
• Chest x-ray

After an initial diagnosis, a careful history and examination are done to rule out metastasis (spread to other organs). Chemotherapy is the treatment of choice.

A hysterectomy is rarely required, due to choriocarcinoma's extreme sensitivity to chemotherapy. More than 90% of women with malignant, nonmetastatic disease are able to maintain reproductive capabilities.

Nearly all women with malignant, nonmetastatic disease are cured, with more than 90% preserving reproductive function.

Some women with malignant, metastatic disease may have a poor prognosis if they meet one of the following conditions:

• Disease has spread to the liver or brain.
• Serum HCG measurement is greater than 40,000 mIU/ml at the time treatment is started.
• Having received prior chemotherapy.
• Having symptoms (or the preceding pregnancy) for more than 4 months before treatment.
• Term pregnancy is associated with diagnosis.

About 66% of women having a poor prognosis experience remission (a disease-free state).

Almost all women who receive a good prognosis with malignant, metastatic disease that does not meet one of these conditions experience remission.

Choriocarcinoma may recur, usually within several months but possibly as late as 3 years after treatment ends. Complications associated with chemotherapy or surgery can also occur.

If a hysterectomy is performed, infertility will result. Menopause will begin if the ovaries are also removed.