PREGNANCY RELATED CASE STUDY:

CHORIOCARCINOMA

Submitted by:
Cielo, Sunshine M.
BSN III-A1a

July 21, 2015

INTRODUCTION
Choriocarcinoma is an uncommon cancer that occurs during pregnancy. A baby may or
may not develop in this type of pregnancy. This cancer may occur after a normal pregnancy. But
it most often occurs with a complete hyatidiform mole. The abnormal tissue from the mole can
continue to grow even after it is removed and can turn into cancer. It may also occur after an
early pregnancy that does not continue (miscarriage) or after an ectopic pregnancy or genital
tumor. Choriocarcinoma is a fast growing form of cancer that occurs in a womans uterus
(womb). The abnormal cells start in the tissue that would normally become the placenta. This is
the organ that develops during pregnancy to feed the uterus. Choriocarcinoma is a type of
gestational trophoblastic disease. Choriocarcinoma is a highly malignant tumor that arises from
trophoblastic cells within the uterus. Choriocarcinoma tends to be invasive and to metastasize
early and widely through both the venous and lymphatic systems. Choriocarcinoma is one of the
two types of gestational trophoblastic tumor, the other being the hyatidiform mole.
Choriocarcinoma may follow any type of pregnancy. It is especially likely to occur with a
hyatidiform mole (molar pregnancy). About 2 to 3% of hyatidiform moles are complicated by the
development of choriocarcinoma. Overall, the cure rate for high risk patients is 60 to 80%.

SIGNS AND SYMPTOMS

A possible symptom is abnormal or irregular vaginal bleeding in a woman who recently
had a hyatidiform mole or pregnancy. Other symptoms may include irregular vaginal bleeding,
dyspnea, neurological symptoms and abdominal pain.

PATHOPHYSIOLOGY
Trophoblastic villi cells located in the outer ring of the blastocyst (the structure that develops via
cell division around 3 to 4 days after fertilization) rapidly increase in size, begin to deteriorate
and fill with fluid.

The cells become edematous, appearing a grapelike clusters of vesicles.

As a result, the embryo falls to develop past the early stages

LABORATORY EXAMS
A pregnancy test will be positive even if you are not pregnant. An internal (pelvic) exam is
usually the first of these tests. The pregnancy hormone HCG level will be high. Blood test that
may be done include quantitative serum HCG, complete blood count, kidney function test and
liver function test. Imaging test that may be done include CT scan and MRI. The patient should
be carefully monitored after a hyatidiform mole or at the end of the pregnancy. Early diagnosis
of choriocarcinoma can improve the outcome.

MEDICAL MANAGEMENT/TREATMENTS
After the patient is diagnosed, a careful history and exam will be done to make sure the
cancer has not spread to other organs. Chemotheraphy is the main type of treatment.
Hysterectomy and radiation therapy are rarely needed.

NURSING RESPONSIBILITIES AND MANAGEMENT

As for nursing care, remember to do the following:

Remember to assess the BP, check if the patient is bleeding profusely, and make sure

to notify the doctor immediately.

Teach deep breathing techniques to alleviate the pain. Use diversional activities if

possible.
Check for abdominal pain, assess the abdominal area for signs of internal

bleeding(e.g. Cullens)
If nausea and vomiting are present, make sure the patient would not aspirate it.
After D&C patient is at risk for infection. Make sure the patient has a good perineal

hygiene.
Administer all medications as ordered.
Remember that this might very hard for the patient to accept, make sure to provide

emotional support. Explain to the patient that it is not her fault this happened.
Discussed the family planning methods available for her. Remember to reiterate the

importance of
monitoring the hCG level and follow-ups.

PATIENT EDUCATION / DISCHARGE PLAN

Discharge planning is an important part of any hospital admission. It plays an important
role in ensuring a smooth move from hospital to home. This is achieved by making sure that
appropriate clinical and community based support services are in place if required.
There are a number of people that can help plan your discharge:

You and your family or carer(s) can alert us if your circumstances are such that you may
need additional support in the community

Your treating doctor can help identify any special requirements you may have

Nursing and Allied Health staff may help identify services that you may require

Care Coordinators can provide an assessment and arrange any services needed to support
you at home immediately after discharge

Hospitals are responsible for making sure all issues that may affect your care after
discharge are addressed before you leave the hospital