Uterine chorionepithelioma is an oncological disease affecting 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 detected extremely rarely.
Uterine chorionepithelioma - 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 neoplasm begins with a small nodule. It is localized initially in 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 the blood vessels by the tumor, through which metastases spread throughout the body. A similar process is developing very actively. In this case, the vagina, pelvic organs, lungs and liver are affected. Gradually, the elements of the tumor approach the brain. Under their action, the walls of blood vessels die and rupture, which leads to hemorrhage and thrombosis.
Pathology prevalence
Uterine chorionepithelioma and cystic skid, with which some identify what is wrong, the first disease is unique pathologies. They develop from germinal tissues. And it is precisely the cystic skid that can cause the development of chorionepithelioma.
It is often diagnosed during pregnancy, but can also appear after the baby is born. Among all oncological pathologies, it occurs in 1 cases 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 the pathology are poorly understood. It is assumed that most often precedes spontaneous abortion or cystic skidding of uterine chorionepithelioma. What kind of ailment is this, most women learn by chance because of its low prevalence.
Among the factors that increase the likelihood of its occurrence, doctors distinguish the following:
- age over 35 years;
- previous trophoblastic disease;
- blood group II (A);
- belonging to the Asian racial group;
- problems with conception;
- use of oral contraceptives;
- carotene deficiency.
The neoplasm is usually localized at the place where the egg was introduced into the uterine mucosa. On a micropreparation of uterine chorionepithelioma, the presence of nodes with a broad base is determined. Mostly they are located singly, less often placed in small groups of 2-3 units. Tumor size also varies from cherry size to chicken egg.
According to the WHO classification, there are 4 stages of 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 area.
- The third stage is accompanied by the release of metastases in the lungs.
- The fourth stage is characterized by the spread of tumor elements to other organs.
Determining the stage of the development of the disease helps to choose the most effective treatment tactics and make the correct prognosis for recovery.
Clinical picture
Symptoms of uterine chorionepithelioma (cystic drift caused its development or something else is not important) are not immediately apparent. Pathology is usually manifested by profuse vaginal bleeding. They can begin at any period of 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 appears brighter. Bleeding may occur between menstruation. Allocations become more plentiful and longer. Blood takes on a dark shade. After the discharge ends, the woman begins to lose weight, she develops anemia. There is a chill, general weakness, fever. Also, the woman is haunted by pain in the lower abdomen and cramps resembling contractions.
Metastases localized in the lungs are detected during an X-ray examination. The process itself is accompanied by cough, shortness of breath and hemoptysis. Malignant formations in the vagina externally represent nodes of a cyanotic shade, their size varies. They are located near the entrance or the side walls of the vagina.
Diagnostic Methods
Diagnosis of the pathological process begins with a medical history. Typically, patients complain of uterine chorionic epithelium and cystic skid symptoms. Then they go to a gynecological examination, during which cyanosis is detected. The structure of the uterus has an uneven consistency. It becomes tuberous and mobile, but there is no painful discomfort.
A mandatory diagnostic step is a blood test for hCG. This is an informative survey method. However, in the case of low biological activity of the tumor, its conduct 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 to control the tortuosity, asymmetry and expansion of the uterine arteries. With its help, the doctor usually monitors the effectiveness of the treatment, tumor regression. Another method of diagnosis is a histological examination. However, such an analysis can give erroneous results after an abortion or removal of cystic drift at an early stage.
Treatment options
Chemotherapy is used to relieve symptoms of uterine chorionepithelioma. They resort to her help regardless of the presence or absence of metastases. If taking anticancer drugs does not bring results, surgery is recommended.
Chemotherapy features
With limited damage to the uterine cavity or the penetration of metastases into the lungs, vaginal walls, chemotherapy is used. As a rule, the following drugs are used:
- Metatrexate It is administered intramuscularly or intravenously, sometimes taken orally. The standard course of treatment is 4-5 days, after which a break is made for a week. Dosage is determined individually. In this case, the therapeutic effect and the presence of toxic reactions are necessarily taken into account.
- "6-mercaptopurine." It is administered 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. It is administered exclusively intravenously.
Chemotherapy is a very painful procedure that can be accompanied by complications. We are talking about nausea, chills, burning sensation in the body. Such symptoms may persist for a sufficiently long time after the procedure.
To reduce the toxicity of chemotherapy, doctors recommend special training. 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;
- severe condition;
- decay of the neoplasm and a high risk of bleeding;
- active tuberculosis;
- a decrease in blood parameters of red blood cells, platelets and white blood cells;
- cachexia.
The treatment is constantly monitored by clinical observation, the study of the results of angiography. A decrease in hCG levels is a sure sign of the effectiveness of chemotherapy.
Extirpation of the uterus
In some cases, therapy is carried out surgically. The following cases are considered indications for the operation:
- external or intra-abdominal bleeding;
- age over 45 years;
- chemotherapy inefficiency;
- the presence of metastases that are insensitive to antitumor drugs.
If the neoplasm is small in size, only it is removed. Partial or complete resection of the uterus is recommended for large tumors, when there is a risk of organ rupture.
In addition to surgical intervention, hormone therapy is prescribed to all patients without exception. 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 to restore hormonal balance in the body after surgery.
Rehabilitation period
After completion of treatment of uterine chorionepithelioma, a woman should be observed by an oncogynecologist. In the first 6 months, a monthly examination with an ultrasound examination, monitoring of the level of hCG and menogram is mandatory.
If metastases in the lungs were detected during the pathological process, quarterly chest radiography is required during the year. According to the indications, brain and liver MRI, scintigraphy or PET-CT are additionally prescribed.
In the case of stage 1 or 2 of the disease, planning the conception of a child is allowed 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
Uterine chorionepithelioma is a dangerous disease, the treatment of which must be started immediately. Therefore, if you experience the first symptoms, you should consult a doctor. Otherwise, the risk of complications increases.
A favorable prognosis of the disease has in the following cases:
- Low hCG.
- Pregnancy, which provoked uterine chorionepithelium, was less than 4 months ago.
- There are no metastases in the liver and brain.
- Previously, chemotherapy has not been recorded in history.
Even after timely diagnosis and treatment, the symptoms of uterine chorionepithelioma can reappear. In this case, foci of pathology are detected not only in the uterine cavity, but also in other organs.
Prevention Methods
There are no specific measures for the prevention of chorionepithelioma. Every woman should undergo an examination by a gynecologist once a year. If necessary, and after childbirth, consultations with a specialist can be more often. It is also important to do an ultrasound of the pelvic organs.
Particular attention should be paid to weight. It is desirable that the body mass index is within normal limits. This will avoid not only chorionepithelioma, but also other oncological processes.
It is important to maintain a healthy lifestyle and try to eat right. It is recommended to abandon addictions, alcohol abuse. Compliance with fairly simple rules of prevention can prevent cancer and other equally dangerous ailments.