A 40-year-old woman complains of irregular bleeding for 7 months after delivery of her fourth baby. Curettage is performed and histology reveals a choriocarcinoma. Her serum beta hCG level is 2x105 IU/L.What is the most appropriate next step in the management?: (A) Commence treatment with intramuscular methotrexate, (B) Commence treatment with multi-agent combination chemotherapy, (C) Perform a hysterectomy, (D) Repeat serum hCG after 4 weeks
Answer is B. Ans. is b, i.e. Commence treatment with multi-agent combination chemotherapyThis woman is at high risk as she has a prognostic score of 7:Antecedent normal pregnancy - 2Age more than 40 years - 1Antecedent pregnancy 7 months ago - 2Serum hCG level 2x105-2Therefore, she needs treatment with multi-agent comnination chemotherapy with EMA-CO.