Uterine chorionepithelioma is an oncological disease that affects the reproductive organs of the female body. It accounts for no more than 2% of the total number of malignant neoplasms of the gynecological sphere. Most often, the disease affects women of childbearing age. With the onset of menopause, it is extremely rare.
Chorionepithelioma of the uterus - what is it?
This is a malignant oncological disease, which is characterized by the degeneration of the epithelial elements of the chorion into a tumor. It occurs during pregnancy or after childbirth. The appearance of a tumor is possible not only in the uterine cavity. Often it affects the cervix, fallopian tubes, ovaries.
The birth of a neoplasm begins with a small nodule. It is localized initially in the area of the placenta, then grows into the area of the muscle layer or directly into the cavity of the organ.
The main danger of the disease lies in the destruction of blood vessels by the tumor, through which metastasesspread throughout the body. Such a process is developing very actively. In this case, the vagina, pelvic organs, lungs and liver are affected. Gradually, elements of the tumor approach the brain. Under their action, the walls of blood vessels die and rupture, which leads to hemorrhage and thrombosis.
Prevalence of pathology
Chorioepithelioma of the uterus and hydatidiform mole, with which some identify what is wrong, the first disease is a unique pathology. They develop from embryonic tissues. And it is precisely the cystic drift that can cause the development of chorionepithelioma.
It is often diagnosed during pregnancy, but it can also appear after the baby is born. Among all oncological pathologies, it occurs in 1 case per 50 thousand normal births.
The average age of patients is 27-38 years. The older the patient, the more severe the stage of the disease she is diagnosed with.
Main reasons
The exact causes of pathology are poorly understood. It is assumed that spontaneous abortion or hydatidiform drift is most often preceded by chorionepithelioma of the uterus. What kind of disease this is, most women find out by chance due to its low prevalence.
Among the factors that increase the likelihood of its occurrence, doctors identify the following:
- age over 35;
- previous trophoblastic disease;
- blood type II (A);
- belonging to an Asian racial group;
- problems withconception;
- use of oral contraceptives;
- deficiency in the diet of carotene.
The neoplasm is usually localized at the place where the egg was introduced into the uterine mucosa. On the micropreparation of chorionepithelioma of the uterus, the presence of nodes with a wide base is determined. Mostly they are located singly, less often they are placed in small groups of 2-3 units. The size of the tumor also varies from the size of a cherry to a hen's egg.
According to the WHO classification, there are 4 stages in the development of the pathological process:
- At the first stage, the neoplasm is localized within the uterus.
- The second stage is characterized by the spread of the tumor beyond the genital organ.
- The third stage is accompanied by the release of metastases to the lungs.
- The fourth stage is characterized by the spread of tumor elements to other organs.
Determining the stage of development of the disease helps to choose the most effective treatment tactics and make the correct prognosis for recovery.
Clinical picture
Symptoms of chorionepithelioma of the uterus (cystic drift caused its development or something else - it doesn't matter)) are not detected immediately. Pathology is usually manifested by profuse vaginal bleeding. They can start at any time in the menstrual cycle and are similar to menstruation. Therefore, especially if the woman is not pregnant, the disease is difficult to detect at an early stage.
As the disease progresses, the clinical picture becomes more pronounced. Bleeding may occur between periods. Allocations become more abundant and longer. The blood becomes dark. After the end of the discharge, the woman begins to lose weight, she develops anemia. There is a chill, general weakness, the temperature rises. Also, the woman is haunted by pain in the lower abdomen and cramps, reminiscent of contractions.
Metastases located in the lungs are detected during X-ray examination. The process itself is accompanied by cough, shortness of breath and hemoptysis. Malignant formations in the vagina outwardly represent nodes of a cyanotic hue, their size varies. They are located near the entrance or side walls of the vagina.
Diagnostic Methods
Diagnosis of the pathological process begins with the collection of anamnesis. Typically, patients complain of symptoms that characterize chorionepithelioma of the uterus and cystic mole. Then they proceed to a gynecological examination, during which cyanosis is detected. The structure of the uterus has an uneven consistency. It becomes bumpy and mobile, but there is no painful discomfort.
A mandatory step in the diagnosis is a blood test for hCG. This is an informative method of examination. However, in the case of low biological activity of the tumor, its implementation is considered ineffective. Pneumogynecography is also performed to determine the degree of displacement of the uterus, its possible deformation, protrusion of the contours.
Angiography helps control tortuosity, asymmetry and dilation of the uterine arteries. With its help, the doctor usually monitors the effectiveness of the treatment,tumor regression. Another diagnostic method is histological examination. However, such an analysis may give erroneous results after an abortion or removal of a hydatidiform mole at an early stage.
Treatment options
Chemotherapy is used to relieve symptoms of uterine chorionepithelioma. Its help is resorted to regardless of the presence or absence of metastases. If anticancer drugs fail, surgery is recommended.
Features of chemotherapy
With limited damage to the uterine cavity or penetration of metastases into the lungs, the walls of the vagina, chemotherapy is used. Commonly used drugs are:
- "Metatrexate". It is administered intramuscularly or intravenously, sometimes taken orally. The standard course of treatment is 4-5 days, after which there is a break for a week. The dosage is determined individually. In this case, the therapeutic effect and the presence of toxic reactions are necessarily taken into account.
- "6-mercaptopurine". Used orally and daily. The total dosage is 300-400 mg and is divided into 2-3 doses. The course of treatment is 10 days, after which a break is made for 10 days.
- Chrysomallin. This is a domestic antibiotic that is used to eliminate tumors. Administered exclusively intravenously.
Chemotherapy is a very painful procedure that can be accompanied by complications. We are talking about nausea, chills, a burning sensation in the body. Similar symptoms may persistquite a long time after the procedure.
To reduce the toxicity of chemotherapy, doctors recommend special preparation. For example, follow a diet or take vitamin complexes.
Treatment of uterine chorionepithelioma with anticancer drugs is not always acceptable. Absolute contraindications to the procedure are the following situations:
- acute infectious processes;
- mental disorders;
- serious condition;
- disintegration of neoplasm and high risk of bleeding;
- tuberculosis in active stage;
- decrease in blood levels of erythrocytes, platelets and leukocytes;
- cachexia.
The ongoing treatment is constantly monitored through clinical observations, studying the results of angiography. A drop in hCG levels is a sure sign that chemotherapy is working.
Extirpation of the uterus
In some cases, therapy is carried out surgically. The following cases are considered indications for surgery:
- external or intra-abdominal bleeding;
- age over 45;
- failure of chemotherapy;
- presence of metastases that are insensitive to anticancer drugs.
If the neoplasm is small in size, only it is removed. Partial or complete resection of the uterus is recommended for a large tumor, when there is a threat of rupture of the organ.
As an addition to surgical intervention, all patients, without exception, are prescribedhormone therapy. Its main goal is to suppress the activity of gonadotropic hormones. For this, estrogens and androgens are used. Hormone therapy should be regarded as an auxiliary method of treatment. It helps restore hormonal balance in the body after surgery.
Rehabilitation period
After completing the treatment of uterine chorionepithelioma, a woman should be observed by an oncogynecologist. In the first 6 months, a monthly examination is mandatory with an ultrasound examination, control of the level of hCG and menogram.
If metastases in the lungs were detected during the pathological process, a quarterly chest x-ray is required during the year. According to indications, MRI of the brain and liver, scintigraphy or PET-CT are additionally prescribed.
In the case of stage 1 or 2 of the disease, it is allowed to plan the conception of a child only after a year. To prevent pregnancy during this period, it is necessary to use oral contraceptives. This choice is due to the risk of relapse.
Consequences and complications
Chorionepithelioma of the uterus is a dangerous disease, the treatment of which must be started immediately. Therefore, when the first symptoms occur, you should consult a doctor. Otherwise, the risk of complications increases.
The disease has a favorable prognosis in the following cases:
- Low HCG.
- Pregnancy causing uterine chorionepithelioma less than 4 months ago.
- No liver or brain metastases.
- No previous history of chemotherapy.
Even after timely diagnosis and treatment, the symptoms of uterine chorionepithelioma may reappear. At the same time, foci of pathology are detected not only in the uterine cavity, but also in other organs.
Prevention Methods
There are no specific measures to prevent chorionepithelioma. Every woman should be examined by a gynecologist once a year. If necessary, and after childbirth, consultations with a specialist may be more frequent. It is also important to do an ultrasound of the pelvic organs.
Special attention should be paid to weight. It is desirable that the body mass index is within the normal range. This will avoid not only chorionepithelioma, but also other oncological processes.
It is important to maintain a he althy lifestyle and try to eat right. It is recommended to give up addictions, alcohol abuse. Compliance with fairly simple prevention rules can prevent cancer and other equally dangerous ailments.
