[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Gestational trophoblastic neoplasia (choriocarcinoma)

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# Gestational trophoblastic neoplasia (choriocarcinoma)

A rare cancer that grows from placental tissue after a pregnancy, often after a molar pregnancy. It makes the pregnancy hormone hCG and is usually curable.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Fundus of uterus](https://durgical.com/en/anatomy/fundus-of-uterus/)
- [Ovaries](https://durgical.com/en/anatomy/ovary/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)
- [Liver](https://durgical.com/en/anatomy/liver/)

## Why it happens

- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Tumour markers: serum and tissue, and what each one is for](https://durgical.com/en/general-pathology/tumour-markers-serum-and-tissue-and-what-each-one-is-for/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [The placenta and pregnancy hormones](https://durgical.com/en/physiology/the-placenta-and-pregnancy-hormones/)
- [Placenta](https://durgical.com/en/histology/placenta/)

## What it is

The malignant end of gestational trophoblastic disease: trophoblast tissue that persists or invades after a pregnancy. It includes invasive mole, choriocarcinoma, placental-site trophoblastic tumour and epithelioid trophoblastic tumour. Choriocarcinoma is made of sheets of cytotrophoblast and syncytiotrophoblast without chorionic villi and spreads early through the blood.

## Who gets it

Rare overall. About half of choriocarcinomas follow a complete hydatidiform mole and the rest follow a miscarriage, an ectopic pregnancy or a term pregnancy. Molar pregnancy, and therefore GTN, is reported more often in Latin America and Asia than in Europe and North America, so post-molar hCG follow-up is a routine part of obstetric care in Colombia.

## Causes

- Persistent trophoblast after evacuation of a complete (more often) or partial hydatidiform mole
- Malignant change of trophoblast after miscarriage, ectopic pregnancy or a normal pregnancy
- Complete moles are androgenetic (all chromosomes paternal), which favours persistence

## Risk factors

- Previous complete molar pregnancy
- Maternal age under 20 or over 35
- Previous gestational trophoblastic disease
- Very high hCG before mole evacuation and a uterus large for dates
- Large theca-lutein ovarian cysts at the time of the mole

## Pathophysiology

Trophoblast normally invades the decidua and maternal spiral arteries in a controlled way and stops when the pregnancy ends. In GTN this control is lost: the cells keep proliferating, invade the [myometrium](https://durgical.com/en/anatomy/myometrium/) and its vessels, and secrete hCG. Because they behave like placenta, they spread through the bloodstream, most often to the lungs, then the [vagina](https://durgical.com/en/anatomy/vagina/), brain and liver. The tumour is very vascular, so metastases bleed easily. High hCG can stimulate the thyroid TSH receptor and the [ovaries](https://durgical.com/en/anatomy/ovary/) (theca-lutein cysts).

## Classification

- Invasive mole (mole that invades the myometrium)
- Choriocarcinoma (no villi, early blood-borne spread)
- Placental-site trophoblastic tumour (low hCG, human placental lactogen, less chemosensitive)
- Epithelioid trophoblastic tumour
- FIGO anatomical stage I to IV plus the WHO prognostic score: low risk (0 to 6) or high risk (7 or more)

## Symptoms and signs

- Irregular or persistent vaginal bleeding weeks to months after a pregnancy
- Uterus that stays enlarged and soft after delivery or evacuation
- Cough, haemoptysis or breathlessness from lung metastases
- Headache, seizures or focal deficits from brain metastases
- Purplish bleeding nodule in the vagina
- Signs of hyperthyroidism (tachycardia, tremor) when hCG is very high

## Red flags

- hCG that plateaus or rises after evacuation of a molar pregnancy
- Neurological symptoms in a woman of reproductive age with a recent pregnancy (brain metastasis)
- Massive vaginal or intra-abdominal bleeding from a vascular tumour
- Haemoptysis with lung nodules in a young woman with a positive pregnancy test

## Diagnosis

**Clinical**
Suspected in any woman with abnormal bleeding or unexplained metastatic disease after any pregnancy. After a molar pregnancy, GTN is diagnosed biochemically by the hCG curve (plateau or rise on serial measurements, or persistence for months), without needing a biopsy.

**Tests**
Serial quantitative serum beta-hCG is the key test and the tumour marker for response and follow-up. Complete blood count, [liver](https://durgical.com/en/anatomy/liver/), [kidney](https://durgical.com/en/anatomy/kidney/) and thyroid function. Biopsy of metastases is usually avoided because they bleed.

**Imaging**
Pelvic Doppler ultrasound (vascular myometrial mass) and [chest](https://durgical.com/en/anatomy/region/chest/) radiograph to stage and count lung metastases; if lung metastases are present, brain and abdominal CT or MRI to look for brain and liver disease.

## Differential diagnosis

- Persistent normal pregnancy or retained products of conception
- Ectopic pregnancy
- Non-gestational choriocarcinoma (ovarian germ cell tumour)
- Other cancers with lung metastases
- Phantom hCG (laboratory interference)

## Goal of treatment

Bring hCG back to normal and keep it there, curing the disease while preserving fertility whenever possible, with treatment intensity set by the FIGO/WHO risk score.

## Treatment

**Medical**
Low-risk disease: single-agent chemotherapy, classically methotrexate or dactinomycin, continued until hCG normalises and for a few consolidation cycles after that.

**Medical**
High-risk disease: multi-agent chemotherapy regimens (for example etoposide, methotrexate and dactinomycin combined with other agents), with intensified treatment for brain or liver metastases.

**Surgical**
Hysterectomy for women who do not want more children, for placental-site and epithelioid tumours (less sensitive to chemotherapy), or to control bleeding or resistant disease.

**Follow-up**
Serial hCG during and after treatment, with reliable contraception during follow-up so a new pregnancy does not confuse the hCG curve.

**Follow-up**
Safe handling of cytotoxic drugs, monitoring for bleeding, mucositis, infection and low blood counts, and emotional support around fertility.

## Complications

- Severe haemorrhage (uterine, vaginal or from metastases)
- Respiratory failure from extensive lung metastases
- Intracranial haemorrhage from brain metastases
- Uterine perforation by invasive mole
- Hyperthyroidism or thyroid storm from very high hCG
- Relapse and chemotherapy toxicity

## Prognosis

One of the most curable solid cancers. Low-risk GTN is cured in nearly all cases, usually with fertility preserved. High-risk disease is still cured in most women with combination chemotherapy; outlook is worse with brain or liver metastases, very high hCG or a long interval since the last pregnancy.

## Prevention

- Prompt evacuation of molar pregnancies with weekly hCG follow-up until it normalises
- Contraception during the hCG follow-up period
- Measuring hCG in any woman with abnormal bleeding long after a pregnancy

## Test yourself

Think of the answer, then tap the question to see it.

## Which marker is used to diagnose and follow gestational trophoblastic neoplasia?

Quantitative serum beta-hCG, measured serially.

## What is the most common site of metastasis of choriocarcinoma?

The lungs.

## How is GTN diagnosed after a molar pregnancy?

By a plateau or rise of hCG on serial measurements; a biopsy is not needed.

## What is the first-line treatment class for low-risk GTN?

Single-agent chemotherapy (methotrexate or dactinomycin).

## Why is contraception advised during hCG follow-up?

A new pregnancy would raise hCG and hide a relapse.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/gestational-trophoblastic-neoplasia/)

## Related conditions

- [Molar pregnancy (hydatidiform mole)](https://durgical.com/en/conditions/molar-pregnancy/)
- [Miscarriage (early pregnancy loss)](https://durgical.com/en/conditions/miscarriage/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Hyperemesis gravidarum](https://durgical.com/en/conditions/hyperemesis-gravidarum/)
- [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/)
- [Brain metastases](https://durgical.com/en/conditions/brain-metastases/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Ovarian germ-cell and sex cord–stromal tumours](https://durgical.com/en/conditions/ovarian-germ-cell-and-sex-cord-stromal-tumours/)
- [Preeclampsia](https://durgical.com/en/conditions/preeclampsia/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Gestational Trophoblastic Disease Treatment (PDQ®)–Patient Version](https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq) (National Cancer Institute, 2024); [Choriocarcinoma](https://medlineplus.gov/ency/article/001496.htm) (MedlinePlus (U.S. National Library of Medicine), 2024).

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Source: https://durgical.com/en/conditions/gestational-trophoblastic-neoplasia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/gestational-trophoblastic-neoplasia/