Obstetrics and Gynecology - A.M. Gromova 2000
Malignant neoplasms of the female reproductive organs
Trophoblastic diseases
Choriocarcinoma
Choriocarcinoma is one of the most malignant and clinically aggressive hormone-active human tumors.
The primary lesion of choriocarcinoma most commonly develops in the Uterus, and occasionally in the fallopian tube or Ovary. When the tumor originates outside the reproductive Organs—such as in lung tissue or the retroperitoneal space—it is termed ectopic.
The malignant process develops either during Pregnancy or following a Hydatidiform Mole (except for cases originating from germ Cells of the female or male Gonads, or from teratoid tumors). Women complain of abnormal vaginal bleeding, fatigue, and lower abdominal pain. In cases of pulmonary involvement, patients develop a cough, dyspnea, and possible low-grade fever. Metastasis to the Kidneys presents as Hematuria accompanied by signs of Renal Colic. Intestinal involvement leads to clinical manifestations of bowel obstruction and gastrointestinal bleeding.
Gynecological examination reveals cyanosis of the Vagina and the vaginal portion of the cervix, metastatic nodules in the vagina, an enlarged uterus (exhibiting accelerated growth during pregnancy), and cystic degeneration of the Ovaries.
The Diagnosis is confirmed by hysterography, chest radiography, angiography, radionuclide scanning of the Liver, Lungs, and kidneys, as well as by assessing human chorionic gonadotropin (hCG) levels in the Blood or urine (in choriocarcinoma, hCG becomes thermostable and is detected in high concentrations). Immunological tests for trophoblastic Proteins (ß-glycoprotein, protein-5) are of diagnostic value, helping to differentiate between benign and malignant trophoblastic tumors. Histological examination of Tissues obtained from uterine curettage, cytological analysis of uterine aspirates, imprint smears from vaginal metastases, and sputum Cytology further confirm the diagnosis of choriocarcinoma.
Treatment for patients with choriocarcinoma begins with Chemotherapy. Methotrexate, mercaptopurine, dactinomycin, actinomycin D, cisplatin, and rubomycin are prescribed. These agents are used either as monotherapy or in combination regimens tailored to individual patient protocols. In some cases, this approach can achieve a cure and even preserve reproductive function.
Surgical treatment is indicated in the event of profuse intraperitoneal or external bleeding, rupture or torsion of an ovarian cyst, or when the uterine size exceeds that of a twelve-week pregnancy. Surgery is also performed in women over 45 years of age, in cases of chemoresistant tumors, when the disease duration exceeds 6 months, or upon the appearance of intoxication signs due to infection of the affected organ. The Scope of the surgical intervention depends on the patient's age and the extent of the disease. In young women with involvement confined to the uterus, simple Hysterectomy without adnexa is performed; in older patients, total hysterectomy with adnexa is indicated. If the tumor metastasizes to the vagina, the nodules are excised, followed by infiltration of the vaginal wall with chemotherapeutic agents.
Dispanser (follow-up) observation following treatment for choriocarcinoma is indicated for ten years. During the first year, clinical and hormonal evaluations, along with fluorography, are performed every two months; in subsequent years, follow-up visits are scheduled every three months.
1. Describe the clinical manifestations of Vulvar Cancer.
2. Outline the treatment Methods for vulvar cancer.
3. Diagnostic methods for Cervical cancer.
4. List the Clinical symptoms of cervical cancer.
5. Treatment methods for cervical cancer.
6. What pathogenetic variants of endometrial (uterine body) cancer exist?
7. Describe the symptoms of endometrial cancer.
8. Treatment methods for Uterine Sarcoma.
9. Provide Examples of primary malignant ovarian tumors.
10. Describe the clinical manifestations of Ovarian cancer.
11. Diagnostic and treatment methods for malignant ovarian tumors.
12. Name the types of malignant neoplasms of the fallopian tubes.
13. What is "trophoblastic disease"?
14. Describe the Clinical presentation of a hydatidiform mole.
15. On The basis of what findings is choriocarcinoma diagnosed?
Last update: 08/08/2026
Editorial and Educational Adaptation: This material has been compiled based on the primary/original source text. The project team performed an editorial review, corrected technical inaccuracies, structured sections, and adapted the content for an educational format.
What was processed:
- elimination of formatting defects (OCR errors, structural breaks, corrupted characters);
- editorial organization of content;
- standardization of terminology in accordance with academic sources;
- verification of factual statements against the original source text.
All mentions of the author, publication year, and origin of the primary text have been preserved in accordance with the source.