Choriocarcinoma

　　The vast majority of绒癌 are related to pregnancy, developing after hydatid mole, abortion, or normal delivery. There are also reports that it can directly originate from the trophoblasts of the ovum, or even from the trophoblasts of the ova contained in teratomas. It is very rare for it to occur in tubal pregnancy or abdominal pregnancy.

　　绒癌 mostly occurs in the uterus, but there are also cases where the primary tumor is not found in the uterus and only metastatic lesions appear. Uterine绒癌 can form a single or multiple uterine wall tumors, which are deep red, purple, or brownish, with a diameter of 2 to 10 cm, consisting of hemorrhagic necrotic tissue. The tumor can protrude into the uterine cavity, invade the uterine wall, or protrude from the serous layer, with a fragile texture and prone to bleeding. Cancer emboli are often found in the parauterine veins, and polycystic lutein cysts can form in the ovaries.

　　Histologically,绒癌 is very different from general cancers.绒癌 does not have the usual connective tissue stroma cells, but only necrotic foci composed of trophoblasts, blood clots, and coagulative necrotic tissue. It also does not have its own blood vessels, and cancer cells directly contact the host's blood to obtain nutrition. In the center of the tumor, cancer cells are often not found, and the closer to the edge, the more obvious the tumor cells are, but the villous structure is not seen, only a mass of trophoblasts.

　　For irregular vaginal bleeding after hydatid mole, postpartum, or post-abortion, if the uterus does not recover as expected, it is large and soft, it should be considered as a possibility of绒毛膜癌. The vast majority of绒癌 are related to pregnancy, developing after hydatid mole, abortion, or normal delivery. There are also reports that it can directly originate from the trophoblasts of the ovum, or even from the trophoblasts of the ova contained in teratomas. It is very rare for it to occur in tubal pregnancy or abdominal pregnancy.

　　The clinical characteristics of绒毛膜癌 are:

　　For irregular vaginal bleeding after hydatid mole, postpartum, or post-abortion, if the uterus does not recover as expected, it is large and soft, it should be considered as a possibility of绒毛膜癌.绒毛膜癌 is a highly malignant tumor that develops after hydatid mole, abortion, or term delivery.

　　The specific preventive measures for绒毛膜癌 are as follows:

　　1. Widely carry out the popularization of eugenics and family planning knowledge, do a good job of contraception, reduce the chance of pregnancy. Have a civilized sexual life, prevent the spread of sexually transmitted diseases, and send the tissue after the operation for pathological examination.

　　2. After the recent cure of绒癌, consolidation chemotherapy should be carried out for 1 to 3 courses. After that, blood β-HCG should be measured once a week. For those with normal levels, consolidation chemotherapy should be carried out once again after 3 months. Thereafter, chemotherapy should be carried out every six months. Those without recurrence for 2 years should not receive chemotherapy.

　　3. The risk of malignant transformation in benign trophoblastic tumors is about 10% to 20% according to current literature reports. Therefore, follow-up work should be continued for at least 2 years, and those with conditions should be followed up for a long time.

　　The diagnostic steps for绒毛膜癌 are as follows:

　　1. For those with histological examination, the histological diagnosis is considered definitive.绒癌 in histological examination shows only a large number of trophoblasts and hemorrhagic necrosis. If villi are seen, the diagnosis of绒癌 can be excluded.

　　2. For those without histological examination, if symptoms or metastatic lesions appear after abortion, delivery, or ectopic pregnancy, and with elevated hCG levels,绒癌 can be diagnosed.绒癌 also occurs after the evacuation of hydatid mole one year or more after the procedure.

　　3. When there is a suspicion of brain metastasis, CT and B-ultrasound examinations can be performed to show the metastatic foci, but when the lesions are small, it may not be possible to make a clear diagnosis. Brain spinal fluid and plasma hCG levels can be measured, and if the brain spinal fluid hCG level is greater than 1:60 than the plasma hCG level, it indicates that hCG is directly secreted into the brain spinal fluid, and brain metastasis can be diagnosed.

　　The diet of绒毛膜癌 should be light and nutritious, balanced. This article will introduce the food therapy recipes and dietary taboos during chemotherapy:

　　One, food therapy recipes

　　1. Stir-fried flat beans. 400 grams of flat beans, 20 grams of green onions, and 10 grams of garlic, prepared in the conventional way of home-style stir-fry, add salt, sugar, monosodium glutamate, and other seasonings. This dish can inhibit tumor growth and has anti-cancer and anti-tumor effects.

　　2. Braised cauliflower. 250 grams of cauliflower, 100 grams of fresh mushrooms and carrots each, prepared in the usual way of home-style stir-fry, add chopped green onions, soy sauce, salt, monosodium glutamate, and other seasonings. Cauliflower contains various indole derivatives that have anti-cancer effects, and carrots and fresh mushrooms also have such effects. Regular consumption can enhance human function and moisturize the skin to prevent cancer.

　　3. Sea cucumber, mushroom, and pork soup. After the sea cucumber (150 grams) is soaked in water and diced, the pork is minced, and then cooked with mushrooms and ginger in a pot of water. Add salt, monosodium glutamate, sesame oil, and other seasonings for taste. The polysaccharides contained in mushrooms have anti-cancer effects, while pork and sea cucumber can nourish the body and enhance nutrition.

　　4. Tomato scrambled eggs. This is a relatively common recipe, which is not only colorful and promotes appetite, but the lycopene contained in tomatoes also has anti-cancer effects. At the same time, tomatoes also contain a variety of vitamins that can increase nutrition.

　　Two, diet during chemotherapy

　　1. As the saying goes, 'Man is iron, food is steel, and without a meal, one feels hungry.' For normal people, three meals a day are important, and for cancer patients undergoing chemotherapy, it is even more important not to be negligent. In fact, about 50% of cancer patients have varying degrees of malnutrition before treatment. If patients eat too little or eat poor-quality food for a long time during and after chemotherapy, it will further worsen the condition of malnutrition, affecting the smooth completion of chemotherapy and the comprehensive recovery after chemotherapy.

　　2. During chemotherapy, it is best to include meat, eggs, milk, grains, and fruits and vegetables in all three meals, and make a reasonable match. Especially, it is necessary to break the superstition and not be blind to food taboos to prevent the diet range from being too narrow. In addition, some common dietary myths, such as using intravenous injections instead of eating, equating price with nutrition, drinking soup but not eating meat, eating only meat without vegetables, and overemphasizing the lightness of diet, are all unscientific. Of course, for the food of 'three meals a day', attention should also be paid to color, aroma, taste, and easy digestion, and try to cater to the patient's taste as much as possible. Pay attention to the following in diet:

　　①Diet should be comprehensive and diverse, including various proteins, fats, carbohydrates, vitamins, minerals, and trace elements.

　　②Eat fresh vegetables and fruits, such as apples, oranges, pears, rapeseed, cilantro, Chinese cabbage, carrots, and so on.

　　③ Increase the intake of foods with anti-cancer effects, such as mushrooms, black fungus, garlic, seaweed, and royal jelly, etc.

　　④ Increase the intake of foods with anti-cancer effects, such as mushrooms, black fungus, garlic, seaweed, and royal jelly, etc.

　　In principle, the diet of patients during chemotherapy should strive to achieve 'three highs and one more', that is, high calories, high protein, high vitamins, and plenty of water. The intake of high-calorie foods can ensure the basic physiological needs of the body and maintain the weight at a normal level. The intake of high-protein foods can help the skin, hair, mucosa, muscle, and other tissues repair after being damaged by chemotherapy. Specifically, meat, eggs, milk and its products, soy products, nuts, etc., can provide rich protein. Among them, fish and poultry are rich in easily digestible and absorbable high-quality protein. Rice, noodles, and other grain foods can provide easily digestible carbohydrates (calories). Fruits and fresh vegetables can provide vitamins, minerals, and fiber.

　　In addition, there are the following taboos in the diet of choriocarcinoma patients:

　　1. Indigestible foods, smoking, alcohol, and other spicy刺激性 foods are prohibited.

　　2. Chicken meat and fried foods.

　　3. Foods that are prone to cause heat, such as mutton, shrimp, crab, eel, salted fish, black fish, etc.

　　The Western medical treatment measures for choriocarcinoma are as follows:

　　First, Drug selection

　　In general early cases, a single drug can be used, with 5-Fu as the first choice. If the condition is urgent or has reached the late stage, then the combination of two or more drugs is needed. The commonly used is 5-fluorouracil (5-Fu) plus Regenerative toxin (ksm). 5-Fu and ksm have the best efficacy and few side effects, and are effective for metastasis to the lungs, gastrointestinal tract, urinary tract, and reproductive tract. It can be used for intravenous administration, arterial perfusion, intracavitary or intratumoral injection, and can also be taken orally.

　　Second, Common protocols

　　1. Monotherapy: The dosage used is larger than that of multiple drug use, such as 5-Fu 28-30mg/kg/day.

　　2. Combination therapy: The dosage is slightly smaller than that of monotherapy, and the number of days in the course is also shorter, such as 5-Fu 26mg/kg/day, Regenerative toxin 6ug/kg/day.

　　3. Drug dosage: To achieve satisfactory results, the dosage of various drugs must reach the maximum tolerance of the patient, especially for the first and second courses, which is more important. Appropriate drug selection and sufficient dosage can make most cases show rapid improvement. Specific dosage and usage are shown in the following table;

　　4, Administration speed: there are certain requirements for the administration speed of various drugs. For example, for 5-Fu, it must be infused within 2 to 8 hours after being added to 500ml of 5% glucose solution; if infused too quickly, the toxicity is greater, and if infused too slowly, it may affect the efficacy.

　　5, Duration of the course: if the course is too long, the toxicity is greater, and if the course is too short, the efficacy is poor. Therefore, a course of treatment is generally recommended to be 8 to 10 days.

　　6, Administration route: the same drug, different administration routes have different effects. Therefore, it is best for patients with lung metastases to use intravenous administration, for patients with gastrointestinal metastases to use oral medication, and for patients with liver metastases to use portal vein administration, which has a good therapeutic effect.

　　7, Interval between courses: mainly based on the needs of the disease and the disappearance of drug toxicity. If the toxicity is mild, the blood count recovers quickly after stopping medication, and the interval can be shorter; if the toxicity is severe, the blood count recovers slowly, and the interval should be longer. The toxicity of 5-Fu or KSM is mild, about two weeks, while the toxicity of 6-mP and MTX is severe, about four weeks.

　　8, Observation of efficacy: after medication, the efficacy is generally not immediately observed. A significant decrease in the HCG content in blood and urine may appear after about 2 weeks after completing one course of treatment. The absorption of lung metastatic shadows also needs to be significantly observed about 3 weeks after stopping medication. Therefore, auxiliary examinations for observing efficacy should not be carried out too early, otherwise, it is easy to cause misjudgment, thinking that the treatment is ineffective.

　　9, Criteria for stopping medication: to achieve radical cure and reduce recurrence, the treatment must reach the standard of complete recovery.

　　 The criteria for recovery include: clinical symptoms are absent; the lung metastatic lesions have completely disappeared; after the HCG level is continuously normal, 1 to 2 courses of consolidation therapy should be given before stopping medication and observation. Sometimes, in order to prevent recurrence in patients with severe symptoms, several courses of consolidation therapy can be used.

　　Three, surgical treatment

　　After the effectiveness of chemotherapy has been proven, surgical treatment is no longer as important as before, but in some cases, such as large lesions, it is estimated that chemotherapy cannot completely conquer the disease, or the HCG level decreases slowly during the treatment process, or uterine perforation with bleeding of intraperitoneal metastases, surgery is still an important method for treating choriocarcinoma to save the patient's life. Generally, a wide hysterectomy and bilateral omentectomy, parauterine venous plexus, and ovarian venous plexus resection are performed.

　　Four, Radiotherapy

　　Choriocarcinoma and malignant hydatidiform mole are sensitive to radiotherapy. If there are solitary lesions in the lungs, pelvis, abdomen, etc., where surgery is difficult or the regression after multiple courses of chemotherapy is not obvious, radiotherapy can be considered, using cobalt-60 or deep X-ray radiation, whole brain radiation can be performed for brain metastasis, and local treatment with radium can also be used for inoperable vaginal metastatic nodules. The appropriate dose of choriocarcinoma is 3000-4000cGy/3-4 weeks, and that of malignant hydatidiform mole is 2000-3000cGy/2-3 weeks.

　　Five, Treatment of Metastatic Lesions

　　1. Treatment for Vulvar and Vaginal Bleeding: If the metastatic tumor has not broken down, in addition to 5-Fu intravenous drip, 5Fu 250-500mg can be injected into the metastatic tumor. Inject once every 2-3 days until the metastatic tumor is significantly reduced. If the metastatic tumor has broken down and bled, a gauze pad can be used to apply pressure to stop the bleeding, or the gauze pad can be coated with sterile hemostatic drugs, such as Yunnan Baiyao, which is also effective. If the above methods still cannot stop the bleeding, surgery or suture can be considered.

　　2. Treatment for Intraperitoneal Hemorrhage: In case of acute and obvious intraperitoneal hemorrhage, immediate laparotomy should be performed to remove the uterus. Postoperative systemic chemotherapy should be continued.

　　3. Treatment for Brain Metastasis: Systemic chemotherapy. The first choice of drug is the commonly used combination chemotherapy of 5-Fu and ksm; symptomatic treatment, to make chemotherapy effective, to reduce intracranial pressure using mannitol or sorbitol 250ml, once every 4-6 hours, dripping for half an hour; sedation and control of convulsions can be achieved with diazepam, barbital, or Durotropine, etc.; prevent complications such as coma, convulsions, falls, bites, aspiration pneumonia, and good nursing care should be done. At the same time, timely correction of electrolyte imbalance and acid-base balance disorders should be carried out.

　　4. Treatment for Hemoptysis: It is difficult to treat in case of massive hemoptysis, and there is currently no very ideal treatment method. 20u of pituitary posterior lobe hormone can be added to 500ml of 5% glucose solution for intravenous drip; hemostatic drugs such as止血芳酸 and carboxybenzamide can be used; surgery, if the bleeding site can be determined, and conditions and time permit, consider emergency lobectomy. At the same time, attention should be paid to antishock and correction of anemia. Anti-infection and prevention of asphyxia caused by hemoptysis should be carried out.