Trophoblastic Disease: Natural History, Diagnosis, and Treatment

Considerable progress has been made in recent years in the understanding and management of a family of gestational and nongestational tumors of chorionic origin. The occurrence of the gestational tumors varies greatly with geographic and ethnic distributions, but it is thought to be related to differences in socioeconomic and nutritional status rather than genetic factors. Multiple hormonal production is a unique feature of these tumors. Chorionic gonadotrophin titer is a sensitive diagnostic index as well as an accurate monitor for progress of the disease. Chemotherapy provides an efficacious cure for most women with metastatic uterine choriocarcinoma, which otherwise is 90% fatal. Early detection and treatment of the disease will undoubtedly further enhance the therapeutic success. Chemotherapy is palliative In 50% of patients with metastatic gonadal choriocarcinoma. Sustained total remission of the disease occurs in a small number only. Although there is a lack of conclusive evidence for a transplantation immunity in women affected by gestational tumors, there is a strong belief that the synergism between the cytotoxic effect of the drug and the host's own, still unknown immune interaction on the neoplastic cells is responsible for the therapeutic differences observed.