In the first place, a high percentage of women have bleeding in the first trimester of their pregnancy, with threatened abortions or with ectopic pregnancies are at risk of developing symptoms of choriocarcinoma.
For one thing, the physician will find this setting highly suspicious and check the blood for increased titers of the beta-subunit of human chorionic gonadotropin (HCG level or beta-HCG). It is important to realize that this blood test is a very specific marker for gestational trophoblastic disease.
To emphasize, there can be passing of grape-like structures, called “villi”, which are part of the trophoblastic disease that is shed by the uterus. To put it another way, patients with molar pregnancies tend to have a uterus size, which is much larger than expected for a normal pregnancy. There also are many more complications. Specifically, there is more vomiting and severe nausea, there may be intrauterine infections and blood poisoning.
Toxemia
Also, a condition called toxemia, which is characterized by high blood pressure and protein leakage into the urine and is normally found only towards the end stage, is often present right from the beginning of the pregnancy. As long as the trophoblastic disease is in place, there is the danger of developing kidney disease when toxemia is present.
When distant metastases are present from a choriocarcinoma, which is the case in about 5% of patients with molar pregnancies, they are found in the majority of cases in the lungs and the local tissues like the vagina and the pelvis. Other sites for distant metastases are the liver, spleen, the bowel, the kidneys and the brain. Liver metastases and brain metastases are most feared as there are only very few survivors in these conditions even after combination chemotherapy and there are no other treatment alternatives yet.
References
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Vol. 1. Chapter on gynecological tumors.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on gynecological tumors.
3. EI Kohorn Int J Gynecol Cancer 2001 Jan;11(1):73-77.
4. MS Cha et al. Biochem Biophys Res Commun 2001 Apr 13;282(4):1061-1066.
5. IK El-Lamie et al. Int J Gynecol Cancer 2000 Nov;10(6):488-496.
6. AM Case et al. Hum Reprod 2001 Feb;16(2):360-364.
