Individuals presented with the disease are mostly in their reproductive years.Similar to other non-gestational tumors, gestational choriocarcinoma can be reflected via an elevated level in serum hCG concentration. Besides the change in serum hCG levels, the diagnosis of gestational choriocarcinoma also focuses on the presence of metastases after any types of pregnancy events. Based on the International Federation of Gynecology and Obstetrics (FIGO)s updated guidelines on gestational trophoblastic disease management, the diagnostic criteria of a post-gestational trophoblastic neoplasia (GTN) is as follows:
Over a period of 3 weeks or longer (day 1, 7, 14, 21), there are 4 or more plateaued hCG levels. Over a period of 2 weeks or longer (day 1, 7, 14), there are 3 consecutive weekly measurements of rising hCG levels. A histological diagnosis of choriocarcinoma.There are currently different guidelines available in terms of diagnosing and recommending treatment options for gestational trophoblastic neoplasia (GTN). The 4 guidelines identified are: the Royal College of Obstetricians and Gynecologists (RCOG), the International Federation of Gynecology and Obstetrics (FIGO), the European Society for Medical Oncology (ESMO), and the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG). The differences in GTN diagnosis between the guidelines are as follows:
To differentiate gestational choriocarcinoma from other tumors such as lung or brain cancers, a genetic test is usually completed on top of a pathological diagnosis. DNA genotyping is a powerful tool that helps with the differentiation.
If this occurs, individuals usually undergo a more intensive medication regimen than what was originally given to them. Immune checkpoint inhibitors
New treatment options designed to reduce the risk of resistance are currently being researched, such as immune checkpoint inhibitors. Studies of gestational choriocarcinoma demonstrate an increased expression of the ligand PD-L1 and its corresponding receptor PD-1, leading to drug research and development into medications that can block the PD-1 receptor, such as Pembrolizumab. In individuals requiring more intensive chemotherapy options, using an immune checkpoint inhibitor may be preferable to long-term use of multi-agent chemotherapy to prevent prolonged toxicity to the body. Prognosis
The survival rate following treatment with chemotherapy is approximately at least 90%. If gestational choriocarcinoma has spread to the liver in an individual, survival rate may be lower. Overall survival rate is also higher when management of gestational choriocarcinoma occurs in a setting with physicians familiar with the condition. Earlier diagnosis and treatment intervention can lead to greater success in preserving potential of future pregnancy in those seeking it.Return of human chorionic gonadotropic levels to within the bounds of normal values lowers the chance of recurring gestational choriocarcinoma. These levels can be checked monthly as follow-up. If an individual is interested in pregnancy following chemotherapy treatment for gestational choriocarcinoma, it is recommended that they wait a minimum of one year following chemotherapy before they plan to have a child to minimize the chance of miscarriage. == References ==