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Choriocarcinoma is the rarest and most dangerous form of non-seminoma testicular cancer, made of placenta-like cells that pour out the pregnancy hormone hCG and spread early through the blood to the lungs, liver and brain, where they can bleed. Fewer than eight in ten men survive five years, against more than 95 for testicular cancer overall, so it is treated urgently with intensive chemotherapy.
Choriocarcinoma is a trophoblastic germ cell tumour of syncytiotrophoblasts and mononucleated trophoblasts, arising from germ cell neoplasia in situ and usually as a component of mixed tumours (Moch 2016). In the 1,010-orchidectomy series, pure and predominant choriocarcinoma together made up 1.5 percent; all patients had markedly raised serum beta-hCG (median 199,000 IU/L), tumours averaged 6.5 cm, and the histology showed expansile haemorrhagic nodules surrounded by trophoblastic cells with plexiform aggregates (Am J Surg Pathol 2014). Five-year survival is under 80 percent against over 95 percent for testicular germ cell tumours overall; the choriocarcinoma syndrome, bleeding from metastatic sites at presentation or on starting chemotherapy, is a medical emergency with high morbidity and mortality (Current Oncology Reports 2015).
How it differs from its parent: haematogenous rather than lymphatic spread, so lung, liver and brain metastases without bulky retroperitoneal nodes; beta-hCG in the tens or hundreds of thousands, which alone places a patient in the poor-risk group; and a tendency to bleed that shapes the first days of treatment.
How common: about 1.5 percent of orchidectomies for germ cell tumour when pure and predominant cases are combined (Am J Surg Pathol 2014).
Treatment: as poor-risk non-seminoma with four cycles of BEP or VIP, sometimes with a reduced first cycle to limit bleeding, aiming at marker normalisation; refractory disease goes to high-dose chemotherapy and trials such as TIGER; brain metastases are treated with chemotherapy first and surgery or radiotherapy for residual disease (Current Oncology Reports 2015; the parent page).
Rare: 6 pure (0.6 percent) and 9 choriocarcinoma-predominant (0.9 percent) tumours among 1,010 orchiectomies over 1999 to 2011 at one cancer centre; patients aged 20 to 39, median 29 (Am J Surg Pathol 2014).
Germ cell tumours drain along the spermatic cord to the para-aortic nodes high in the abdomen, not to the groin, which is why staging scans look at the retroperitoneum.
Same organ: Retroperitoneal germ cell tumour, Leydig cell tumour of the testis, Sertoli cell tumour of the testis, Spermatocytic tumour of the testis, Germ cell neoplasia in situ (GCNIS), Embryonal carcinoma of the testis, Yolk sac tumour of the testis, postpubertal type, Testicular germ cell tumours, Seminoma, Non-seminomatous germ cell tumour, Germ cell tumours of childhood and adolescence (extracranial and CNS)
Treated as poor-risk non-seminoma: four cycles of BEP or VIP with care for bleeding, resection of residual disease, high-dose chemotherapy or trials for refractory disease.
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Query for this cancer: (TITLE:"Choriocarcinoma of the testis" OR ABSTRACT:"Choriocarcinoma of the testis" OR TITLE:"Testicular choriocarcinoma" OR ABSTRACT:"Testicular choriocarcinoma" OR TITLE:"Choriocarcinoma very high hCG, haemorrhagic metastases" OR ABSTRACT:"Choriocarcinoma very high hCG, haemorrhagic metastases" OR TITLE:"Pure choriocarcinoma of the testis" OR ABSTRACT:"Pure choriocarcinoma of the testis" OR TITLE:"Choriocarcinoma-predominant germ cell tumour" OR ABSTRACT:"Choriocarcinoma-predominant germ cell tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Choriocarcinoma of the testis, not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce to 75% for CrCl 15-50.
Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.
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