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Radiology
Choriocarcinoma
Built from Obstetric Imaging
What’s inside
8 sections · 56 slides
Overview
- What this deck covers
The disease
Where it comes from, what it is made of, and who gets it
- Pregnancy tissue that will not stop growing
- How the diagnosis is recognised
- The two cell layers a placenta is built from
- What choriocarcinoma is made of
- Tumour surrounded by fresh bleeding
- Tumour cells at high magnification
- 1 / 16,000
- Reading those numbers
- A complete mole to the naked eye
- The same mole on ultrasound
- Which pregnancy came before, and what the cells look like
- From pregnancy to widespread disease
How it shows up
The hormone that betrays it, the criteria, and where it travels
- The hormone that gives it away
- After a molar pregnancy, numbers make the diagnosis
- After an ordinary pregnancy, it hides
- The five ways FIGO allows the diagnosis to be made
- What the tumour looks like, and why you leave it alone
- Where it spreads, and how often
- Reading the spread map
- Symptoms that come from the deposit, not the womb
- Tumour cells inside the lung
Imaging the disease
Pelvic ultrasound, chest imaging, whole-body scans and brain MRI
- Nothing starts before the work-up is complete
- Start in the pelvis with ultrasound and Doppler
- What it looks like on ultrasound
- Chest imaging is compulsory
- The brain needs its own look
- What MRI shows in the uterus
- The order the scans are done in
Staging and risk
An anatomic stage, a prognostic score, and the treatment they choose
- Two systems that work together
- Reading the stage table
- FIGO staging of gestational trophoblastic neoplasia
- Reading the score table
- Revised FIGO scoring system
- The prognostic score sheet as printed
- Turning the score into a decision
- Which treatment the score chooses
Treatment
One drug for most, a combination for the rest, and near-total cure
- Low-risk disease: one drug is enough
- What the Cochrane review found
- Reading that result carefully
- The two single agents side by side
- When the first drug stops working
- High-risk disease: combination chemotherapy
- 67–78%
- Why EMA/CO is the first choice
- Cure is the expected outcome
- When the disease has reached the brain
After treatment
Watching the hormone fall, and keeping the next pregnancy out of the way
- Following hCG once remission is reached
- Why the follow-up runs so long
- Contraception, and the pregnancy after
Key points
What the referring physician needs to know
- What the referring physician needs to know
- What the referring physician needs to know
- The whole topic in six lines
- References
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition