Gestational Choriocarcinoma Oranu
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GESTATIONAL CHORIOCARCINOMA By Dr. Oranu, E.O.
INTRODUCTION EPIDERMIOLOGY RISK FACTORS ETIOPATHOGENESIS CLINICAL FEATURES STAGING
INTRODUCTION
Gestational trophoblastic tumor of fetal origin GTD spectrum A rare condition Aetius 565 BC in Uteri Hydropil High curative rate/high confidence in modern medicine Success is based on – early diagnosis, availability of chemotherapy and good follow-up
EPIDEMIOLOGY
Generally, choriocarcinoma is a rare condition It represents 2-5% of all cases of GTD Incidence vary widely 1:30-40,000 in caucacians 1:11-15,000 in the orients Average for the negriods race Locally, 1:707 deliveries (UPTH) 1:344 deliveries (Ilorin) 1:1000 deliveries (Korlebu, Ghana) 50% of chronic case preceded by hydantidiform mole 25% by normal pregnancy 25% are preceded by abortion and ectopic pregnancy.
RISK FACTORS
Racial Age <20 and >40 years ABO blood grouping Antecedent pregnancies
Hydatidiform mole 50% Previous abortions 25% Normal pregnancy/ectopics, artificial insemination 25%
Multiparity Familial Diet I protein, vil A, and fat
AETIOPATHOGENESIS
Cause is unknown Pathological basis of this disease – genetic Generally, in all GTD tumors
Development of the inactivated ovum under influence of dispermic fertilization. Homogenous conceptus, abnormal growth. Choriocarcinoma to be precise is less well differentials.It is composed of cytotrophoblast and syncytotrophsblast but lacked the villi network.
ABO blood grouping
A and 0 – 10 fold disk against A andA AB – retative poor progrnosis.
CLINICAL FEATURES
Vaginal bleeding >90%, 30% (severe) Hyperemesis gravidarum 39%, 10% Amenorrhea 100% Chest symptoms chest pain (cough, hemophysis, dysnea) Disproportionate uterine size
50% fH >GA 30% fH
Pre-eclampsia.
STAGING
Staging system: International federation of gynaecology and obstetrician (FIGO) 2002 revised staging.
Disease confined to the uterus Disease extending outside of the uterus but limited to the genital structures (adnexia, vagina, broad ligaments) Disease extending to the lungs with or without other known genital tract involvement Disease at other metastatic sites
Sub staging:
A No risk factor B One risk factor C Two risk factors
Risk factors:
HCG > 100,000 iu/ml Duration of termination of antecedent pregnancy to diagnosis >6 months.
INTRODUCTION EPIDERMIOLOGY RISK FACTORS ETIOPATHOGENESIS CLINICAL FEATURES STAGING
INTRODUCTION
Gestational trophoblastic tumor of fetal origin GTD spectrum A rare condition Aetius 565 BC in Uteri Hydropil High curative rate/high confidence in modern medicine Success is based on – early diagnosis, availability of chemotherapy and good follow-up
EPIDEMIOLOGY
Generally, choriocarcinoma is a rare condition It represents 2-5% of all cases of GTD Incidence vary widely 1:30-40,000 in caucacians 1:11-15,000 in the orients Average for the negriods race Locally, 1:707 deliveries (UPTH) 1:344 deliveries (Ilorin) 1:1000 deliveries (Korlebu, Ghana) 50% of chronic case preceded by hydantidiform mole 25% by normal pregnancy 25% are preceded by abortion and ectopic pregnancy.
RISK FACTORS
Racial Age <20 and >40 years ABO blood grouping Antecedent pregnancies
Hydatidiform mole 50% Previous abortions 25% Normal pregnancy/ectopics, artificial insemination 25%
Multiparity Familial Diet I protein, vil A, and fat
AETIOPATHOGENESIS
Cause is unknown Pathological basis of this disease – genetic Generally, in all GTD tumors
Development of the inactivated ovum under influence of dispermic fertilization. Homogenous conceptus, abnormal growth. Choriocarcinoma to be precise is less well differentials.It is composed of cytotrophoblast and syncytotrophsblast but lacked the villi network.
ABO blood grouping
A and 0 – 10 fold disk against A andA AB – retative poor progrnosis.
CLINICAL FEATURES
Vaginal bleeding >90%, 30% (severe) Hyperemesis gravidarum 39%, 10% Amenorrhea 100% Chest symptoms chest pain (cough, hemophysis, dysnea) Disproportionate uterine size
50% fH >GA 30% fH
Pre-eclampsia.
STAGING
Staging system: International federation of gynaecology and obstetrician (FIGO) 2002 revised staging.
Disease confined to the uterus Disease extending outside of the uterus but limited to the genital structures (adnexia, vagina, broad ligaments) Disease extending to the lungs with or without other known genital tract involvement Disease at other metastatic sites
Sub staging:
A No risk factor B One risk factor C Two risk factors
Risk factors:
HCG > 100,000 iu/ml Duration of termination of antecedent pregnancy to diagnosis >6 months.
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