L3: Choriocarcinoma

Question 1

Def of Choriocarcinoma

Answer 1

it is malignant gestational trophoblastic tumor

Question 2

Incidence of Choriocarcinoma

Answer 2

In Far-east 1/5000 while in USA and Europe 1/20000.

Question 3

Predisposing Factors of Choriocarcinoma

Answer 3

Question 4

Predisposing Factors of Choriocarcinoma

• Age

Answer 4

• Common in middle age group “age of pregnancy”.
• Increased incidence with age >35 years.

Question 5

Predisposing Factors of Choriocarcinoma

• Race

Answer 5

Southeast Asia (Philippines).

Question 7

Predisposing Factors of Choriocarcinoma

• SES

Answer 7

Low

Question 8

Predisposing Factors of Choriocarcinoma

• Parity

Answer 8

• Vesicular mole is common in low parity.
• Choriocarcinoma is common in multipara.

Question 9

Predisposing Factors of Choriocarcinoma

• Special

Answer 9

• Rice eating & spicy cooking.
• Trisomy 16 is common association

Question 10

Predisposing Factors of Choriocarcinoma

• Familial Predisposition

Answer 10

Previous molar pregnancy as the disease is found:
- 50% following vesicular mole.
- 25% following abortion or ectopic pregnancy.
- 20% following normal pregnancy.

Question 11

Pathology of Choriocarcinoma

Answer 11

Question 12

Pathology of Choriocarcinoma

• NE

Answer 12

Question 13

Desc. of Non-Metastatic Choriocarcinoma

Answer 13

Question 14

TTT of Non-Metastatic Choriocarcinoma

Answer 14

It is always by hysterectomy as the tumor is chemo-resistant.

Question 15

Non-Metastatic Choriocarcinoma

• name
• HCG

Answer 15

• Called placental site tumor.
• Produces little amount of HCG and HPL.

Question 16

Desc. of Metastatic Choriocarcinoma

Answer 16

Question 17

TTT of Metastatic Choriocarcinoma

Answer 17

It is usually chemo-sensitive

Question 18

Types of Metastatic Choriocarcinoma

• Acc to Risk

Answer 18

The disease is subdivided into:
* Low risk (è good prognosis)
* High risk (è poor prognosis)

Question 19

ME of Choriocarcinoma

Answer 19

Question 20

Spread of Choriocarcinoma

Answer 20

Question 21

Spread of Choriocarcinoma

• Local

Answer 21

To surrounding structures

Question 22

Spread of Choriocarcinoma

• Lymphatic

Answer 22

…

Question 23

Spread of Choriocarcinoma

• Blood

Answer 23

The main route (commonest site is the lung).

Question 24

Staging of Choriocarcinoma

Answer 24

Question 25

Staging of Choriocarcinoma

• e Risk Factors

Answer 25

Question 26

Complications of **Choriocarcinoma**

Question 27

Dx of **Choriocarcinoma**

Answer 27

Question 28

Symptoms of **Choriocarcinoma**

Answer 28

Question 29

Symptoms of **Choriocarcinoma** - Asymptomatic

Answer 29

In early stages

Question 30

Symptoms of **Choriocarcinoma** - Bleeding

Answer 30

**Bleeding "vaginal"** → Commonest symptom - Excessive irregular vaginal bleeding.

Question 31

Symptoms of **Choriocarcinoma** - Cachexia & symptoms of distant metastasis

Answer 31

Question 32

Symptoms of **Choriocarcinoma** - Discharge

Answer 32

Serous then serosanguineous then offensive (due to infection) & ass. with fever.

Question 32

Symptoms of **Choriocarcinoma** - Enlargement of abdomen (pelviabdominal mass)

Answer 32

Due to vaginal or abdominal mass.

Question 33

Symptoms of **Choriocarcinoma** - Pain

Answer 33

Due to uterine distension or perforation

Question 34

Symptoms of **Choriocarcinoma** - Pressure Symptoms

Answer 34

....

Question 35

Symptoms of **Choriocarcinoma** - Endocrinal Manifestations

Answer 35

Thyrotoxicosis (due to thyrotropic activity of HCG).

Question 36

Signs of **Choriocarcinoma**

Answer 36

Question 37

Signs of **Choriocarcinoma** - General

Answer 37

As scheme + - hypertension - thyrotoxicosis - pleural rub.

Question 38

Signs of **Choriocarcinoma** - Abdominal

Answer 38

- Uterus may be enlarged. - Hepatomegaly & Ascites. - Adnexal swelling [cystic ovaries].

Question 39

Signs of **Choriocarcinoma** - Local

Answer 39

Question 40

INVx for **Choriocarcinoma**

Answer 40

Question 41

INVx for **Choriocarcinoma** - For Dx

Answer 41

Question 42

INVx for Dx of **Choriocarcinoma** - Labs

Answer 42

Serum HCG & CSF level of HCG.

Question 43

INVx for Dx of **Choriocarcinoma** - Radiology

Answer 43

As scheme + ... * Chest X-ray give → (Canon ball appearance). * US to diagnose any uterine mass and ovarian cysts.

Question 44

INVx for Dx of **Choriocarcinoma** - Endoscopy

Answer 44

scheme

Question 45

INVx for Dx of **Choriocarcinoma** - Biopsy

Answer 45

By endometrial curettage (D&C).

Question 46

INVx for **Choriocarcinoma** - Detect Mets

Answer 46

scheme

Question 47

INVx for **Choriocarcinoma** - Pre-Operative

Answer 47

scheme

Question 48

TTT of **Choriocarcinoma**

Answer 48

Question 49

TTT of **Choriocarcinoma** - Prophylactic

Answer 49

Question 50

TTT of **Choriocarcinoma** - Active

Answer 50

Question 50

Active TTT of **Choriocarcinoma** - Correction of general condition

Answer 50

- Correction of general condition and ttt complications especially HTN & Thyrotoxicosis.

Question 51

Active TTT of **Choriocarcinoma** - Plan of TTT

Answer 51

Question 52

Plan of TTT of **Choriocarcinoma** - Stage I

Answer 52

Question 53

Plan of TTT of **Choriocarcinoma** - Stage II & III

Answer 53

Question 54

Plan of TTT of **Choriocarcinoma** - Stage II & III (1ry)

Answer 54

Question 55

Plan of TTT of **Choriocarcinoma** - Stage II & III (2ry)

Answer 55

Question 56

Plan of TTT of **Choriocarcinoma** - Stage IV

Answer 56

Question 57

Plan of TTT of **Choriocarcinoma** - Stage IV (1ry)

Answer 57

Question 58

Plan of TTT of **Choriocarcinoma** - Stage IV (2ry)

Answer 58

Question 59

Chemotherapy in **Choriocarcinoma** - Single Agent Chemo

Answer 59

Methotrexate or Actinomycin D

Question 60

Chemotherapy in **Choriocarcinoma** - Combination Chemo

Answer 60

Question 61

Other Types of Uterine Malignancies

Answer 61