Metastastic choriocarcinoma in a term pregnancy: a case study.

The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.