The Cancer That Pretends to Be Pregnant
How Choriocarcinoma Sneaks In After Birth—And Why It’s Curable. It is a rare, terrifying tumor that arises from pregnancy itself.
A few months after giving birth, one of my patients came back with what sounded, at first, like the most ordinary postpartum problem in the book: bleeding. Not a little spotting, but gushes. I examined her—her uterus was large. That raised my eyebrow. She also complained of shortness of breath. That raised both eyebrows.
So, we admitted her. The chest X-ray looked like it had been sprinkled with powdered sugar: nodules everywhere. Her pregnancy hormone, hCG, was not just high, it was off-the-charts—hundreds of thousands. That’s the sort of number you’d expect if she were carrying twins and a bonus baby, not three months postpartum. By now it should have been close to zero. A sonogram showed her uterus was more occupied than the New York subway at rush hour, but not by a baby.
We did a suction curettage, and out came grape-like tissue—the calling card of a disease with the unlovely name choriocarcinoma. Within hours, pathology confirmed it. Within days, she was on chemotherapy. Within a week, her breathing improved. Within a month, her hCG was back to normal. And just like that, the monster had been slain.
A Pregnancy That Won’t Take the Hint
Here’s the thing about choriocarcinoma: it isn’t really “her cancer” at all. It comes from pregnancy tissue—the trophoblast, the very cells that normally build a placenta. Think of it as the pregnancy that doesn’t understand when the party’s over. Everyone else has gone home, the baby’s in the crib, and the placenta should be compost—but no, this tissue lingers, multiplies, and starts invading organs like an over-enthusiastic houseguest.
The lungs are its favorite Airbnb, but it also books trips to the brain and liver. And unlike most cancers, which plod along, this one travels with frequent-flyer status.
How Do You Spot It?
The classic symptom is bleeding after pregnancy that doesn’t quit. But there’s more: cough, chest pain, seizures, or just feeling unwell. The diagnostic golden ticket is the hCG test. Postpartum, that hormone should plummet back to zero. When it skyrockets instead, you’ve got a problem.
Ultrasound can show the uterine mass. X-rays or CTs show the “snowstorm” nodules in the lungs. And curettage, with its grape-like clusters, seals the deal.
Treatment: A Medical Miracle
Here’s the paradox. Untreated, choriocarcinoma kills quickly. Treated, it’s almost always cured. That’s because these trophoblastic cells, for all their bravado, are exquisitely vulnerable to chemotherapy.
If the disease is “low-risk,” single-drug treatment like methotrexate can do the job.
If it’s “high-risk”—with sky-high hCG, spread to the lungs, liver, or brain—the standard is combination therapy, the uncatchy EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine).
The names are less important than the outcome: survival rates of over 90 percent, even in advanced cases. In the strange lottery of cancers, this is one you actually want your ticket punched for—because you get to live.
Risk Factors and Why It’s Rare
Choriocarcinoma usually follows a molar pregnancy, but it can happen after miscarriage, ectopic pregnancy, or a perfectly normal live birth. It’s more common at extremes of maternal age and in women who skip follow-up after abnormal pregnancies. But the truth is, it’s rare. In the U.S., it’s about 1 in 40,000 pregnancies after live birth. Rare enough that most doctors will never see it. Rare enough that when it does appear, it looks like something out of a case report—because it usually is.
The Follow-Up Game
Treatment doesn’t end with chemotherapy. The follow-up is just as important. We monitor blood hCG levels weekly until they normalize, then monthly for a year or more. During that time, patients are advised not to get pregnant again, because a new pregnancy would make it impossible to tell if a rising hCG is good news or very, very bad news.
Follow-up is critical, because relapses can happen—but caught early, they too are treatable. Patients who stick to the schedule do well. Patients who disappear from follow-up sometimes reappear months later, much sicker. In this disease, ghosts don’t bode well.
Lessons for Patients and Doctors
For patients: if you’ve had heavy bleeding weeks or months after pregnancy, don’t let anyone tell you “it’s normal.” And if you’ve had a molar pregnancy, follow your hCG like it’s your tax return.
For doctors: abnormal bleeding postpartum isn’t a throwaway complaint. If she’s coughing too, or her uterus feels off, check the hCG. The test costs a few dollars, but it can save a life.
Medicine’s Odd Triumph
Choriocarcinoma is medicine at its most paradoxical. It’s a cancer that spreads like wildfire, yet bows instantly to chemotherapy. It terrifies, then it retreats. In an age when so many cancers remain stubbornly resistant, here is one that we can actually beat—if we catch it.
My patient’s story is a reminder of why we should never shrug at symptoms. It’s also a reminder that sometimes, in medicine, the scary stories can end not just with survival, but with cure.
Reflection
There’s an ethical obligation here: to listen, to believe, and to act. New mothers are often told their complaints are “just hormones” or “just stress.” But sometimes it’s not “just.” Sometimes it’s choriocarcinoma.
The humor of this tumor is dark: a cancer that masquerades as pregnancy, a parasite that won’t quit the womb. But the punchline, if we do our jobs right, is a good one: life, cure, and a mother breathing easily again.