nih-gov/medlineplus.gov/ency/article/001496.htm
2025-02-26 13:17:41 -05:00

288 lines
No EOL
30 KiB
HTML
Raw Permalink Blame History

This file contains invisible Unicode characters

This file contains invisible Unicode characters that are indistinguishable to humans but may be processed differently by a computer. If you think that this is intentional, you can safely ignore this warning. Use the Escape button to reveal them.

This file contains Unicode characters that might be confused with other characters. If you think that this is intentional, you can safely ignore this warning. Use the Escape button to reveal them.

<!DOCTYPE html>
<html lang="en" id="article" class="nojs us" data-root="//medlineplus.gov" itemid="https://medlineplus.gov/ency/article/001496.htm" itemtype="http://schema.org/MedicalWebPage" itemscope="">
<head>
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1"/>
<meta http-equiv="window-target" content="_top"/>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/>
<meta charset="utf-8"/>
<meta property="fb:app_id" content="1042245625821448"/>
<meta name="expires" content="Wed, 05 02 2025"/>
<meta name="ac-dictionary" content="medlineplus-ac-dictionary"/>
<link rel="shortcut icon" href="https://medlineplus.gov/images/favicon.ico" type="image/x-icon"/>
<link rel="apple-touch-icon" href="//medlineplus.gov/images/touch-icon.png"/>
<meta name="viewport" content="width=device-width, initial-scale=1"/>
<link rel="stylesheet" href="https://medlineplus.gov/css/common_new.css?04272023"/>
<!--[if IE 8]> <link rel="stylesheet" href="https://medlineplus.gov/css/ie8/common.css"><![endif]-->
<link rel="stylesheet" href="https://medlineplus.gov/uswds/css/uswds_styles.css"/>
<link rel="stylesheet" href="https://medlineplus.gov/css/ency/ency2.css?07162024"/>
<script type="text/javascript">document.querySelector("html").className = document.querySelector("html").className.replace(/nojs[\s]*/g, '');</script>
<script src="https://medlineplus.gov/uswds/js/uswds-init.min.js" type="text/javascript">
</script>
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&amp;l='+l:'';j.async=true;j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-MMVM77');</script>
<link rel="canonical" href="https://medlineplus.gov/ency/article/001496.htm" itemprop="url"/>
<link rel="alternative" hreflang="es" href="https://medlineplus.gov/spanish/ency/article/001496.htm"/>
<link rel="alternative" hreflang="en" href="https://medlineplus.gov/ency/article/001496.htm"/><meta property="og:title" content="Choriocarcinoma: MedlinePlus Medical Encyclopedia"/><meta property="og:url" content="https://medlineplus.gov/ency/article/001496.htm"/><meta property="twitter:title" content="Choriocarcinoma: MedlinePlus Medical Encyclopedia"/><meta name="twitter:card" content="summary_large_image"/><meta name="description" content="Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops"/><meta itemprop="description" name="description" content="Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops"/><meta property="og:description" content="Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops"/><meta property="twitter:description" content="Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops"/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_1.jpg"/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_2.jpg"/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_3.jpg"/><meta property="twitter:image" content="https://medlineplus.gov/images/share_ency_1.jpg"/>
<title>Choriocarcinoma: MedlinePlus Medical Encyclopedia</title>
</head>
<body><link href="http://schema.org/Patient" itemprop="audience"/>
<!-- Google Tag Manager -->
<noscript><iframe title="googletagmanager" src="//www.googletagmanager.com/ns.html?id=GTM-MMVM77" height="0" width="0" style="display:none;visibility:hidden">
</iframe>
</noscript>
<!-- End Google Tag Manager -->
<a name="top" id="top">
</a>
<a class="hide-offscreen" href="#start">Skip navigation</a>
<section class="usa-banner" aria-label="Official website of the United States government">
<div class="usa-accordion">
<header class="usa-banner__header">
<div class="usa-banner__inner">
<div class="grid-col-auto">
<img aria-hidden="true" class="usa-banner__header-flag" src="https://medlineplus.gov/uswds/img/us_flag_small.png" alt=""/>
</div>
<div class="grid-col-fill tablet:grid-col-auto" aria-hidden="true">
<p class="usa-banner__header-text">
An official website of the United States government
</p>
<p class="usa-banner__header-action">Heres how you know</p>
</div>
<button type="button" class="usa-accordion__button usa-banner__button" aria-expanded="false" aria-controls="gov-banner-default-default">
<span class="usa-banner__button-text">Heres how you know</span>
</button>
</div>
</header>
<div class="usa-banner__content usa-accordion__content" id="gov-banner-default-default">
<div class="grid-row grid-gap-lg">
<div class="usa-banner__guidance tablet:grid-col-6">
<img class="usa-banner__icon usa-media-block__img" src="https://medlineplus.gov/uswds/img/icon-dot-gov.svg" role="img" alt="" aria-hidden="true"/>
<div class="usa-media-block__body">
<p>
<strong>Official websites use .gov</strong><br/>A
<strong>.gov</strong> website belongs to an official government
organization in the United States.
</p>
</div>
</div>
<div class="usa-banner__guidance tablet:grid-col-6">
<img class="usa-banner__icon usa-media-block__img" src="https://medlineplus.gov/uswds/img/icon-https.svg" role="img" alt="" aria-hidden="true"/>
<div class="usa-media-block__body">
<p>
<strong>Secure .gov websites use HTTPS</strong><br/>A
<strong>lock</strong> (
<span class="icon-lock"><svg xmlns="http://www.w3.org/2000/svg" width="52" height="64" viewBox="0 0 52 64" class="usa-banner__lock-image" role="img" aria-labelledby="banner-lock-description-default" focusable="false">
<title id="banner-lock-title-default">Lock</title>
<desc id="banner-lock-description-default">Locked padlock icon</desc>
<path fill="#000000" fill-rule="evenodd" d="M26 0c10.493 0 19 8.507 19 19v9h3a4 4 0 0 1 4 4v28a4 4 0 0 1-4 4H4a4 4 0 0 1-4-4V32a4 4 0 0 1 4-4h3v-9C7 8.507 15.507 0 26 0zm0 8c-5.979 0-10.843 4.77-10.996 10.712L15 19v9h22v-9c0-6.075-4.925-11-11-11z">
</path>
</svg> </span>) or <strong>https://</strong> means youve safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
</p>
</div>
</div>
</div>
</div>
</div>
</section>
<div id="mplus-wrap">
<header>
<div id="mplus-header">
<!-- Orgs
================================================== -->
<div id="mplus-orgs">
<a title="National Institutes of Health" target="_blank" class="nih-org" href="//www.nih.gov/">
<img alt="National Institutes of Health" src="https://medlineplus.gov/images/nihlogo.png" class="nihlogo"/>
</a><a target="_blank" href="https://www.nlm.nih.gov/"> National Library of Medicine </a>
</div>
<!-- Logo
================================================== -->
<div id="mplus-logo" class="years-25">
<a href="https://medlineplus.gov">
<img src="https://medlineplus.gov/images/m_logo_25.png" title="MedlinePlus Trusted Health Information for You" alt="MedlinePlus Trusted Health Information for You"/>
</a>
</div>
<!-- Nav Menu
================================================== -->
<div id="mplus-nav">
<div class="sm-live-area hide-offscreen" aria-live="polite">The navigation menu has been collapsed.</div>
<!-- Menu Button-->
<button type="submit" aria-controls="mplus-menu-list" role="button" title="Menu" class="navmenu-btn" id="sm-menu-btn" aria-pressed="false" tabindex="0">Menu<span class="icon icon-nav-menu">
</span></button><ul class="nav-list" id="mplus-menu-list">
<li><a href="https://medlineplus.gov/healthtopics.html">Health Topics</a></li>
<li><a href="https://medlineplus.gov/druginformation.html">Drugs &amp; Supplements</a></li>
<li><a href="https://medlineplus.gov/genetics/">Genetics</a></li>
<li><a href="https://medlineplus.gov/lab-tests/">Medical Tests</a></li>
<li><a href="https://medlineplus.gov/encyclopedia.html">Medical Encyclopedia</a></li>
<li><a href="https://medlineplus.gov/about/">About MedlinePlus</a></li>
</ul><button type="submit" aria-controls="mplus-search" role="button" title="Search" class="navmenu-btn" id="sm-search-btn" aria-pressed="false" tabindex="0"><span class="hide-offscreen">Show </span>Search<span class="icon icon-nav-search">
</span></button>
<div class="top-1">
<!-- Search
================================================== -->
<form target="_self" title="Search MedlinePlus" action="//vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta" method="get" id="mplus-search">
<input type="hidden" value="medlineplus" name="v:project"/>
<input type="hidden" value="medlineplus-bundle" name="v:sources"/>
<div class="form-box text-combo">
<div class="form-area"><label for="searchtext_primary" class="hide-offscreen">Search MedlinePlus</label>
<span role="status" aria-live="polite" class="ui-helper-hidden-accessible">
</span><input type="text" aria-haspopup="true" aria-autocomplete="list" role="textbox" autocomplete="off" name="query" size="40" maxlength="400" title="Site Search input" alt="Site Search input" placeholder="Search MedlinePlus" class="form-text ui-autocomplete-input" id="searchtext_primary"/>
</div>
<div class="button-area">
<button type="submit" alt="Search MedlinePlus" title="Search MedlinePlus" class="form-btn">GO</button>
</div>
</div>
</form>
<!-- Secondary Nav
================================================== -->
<div class="secondarynav">
<ul class="nav-list">
<li><a href="https://medlineplus.gov/about/"><span>About MedlinePlus</span></a></li>
<li><a href="https://medlineplus.gov/whatsnew/"><span>What's New</span></a></li>
<li><a href="https://medlineplus.gov/sitemap.html"><span>Site Map</span></a></li>
<li><a target="_blank" href="https://support.nlm.nih.gov/knowledgebase/category/?id=CAT-01231&amp;category=medlineplus&amp;from=//medlineplus.gov/ency/article/001496.htm"><span>Customer Support</span></a></li>
</ul>
</div>
</div>
<!-- Nav Bar
================================================== -->
<div id="mplus-nav-bar">
<ul class="nav-list">
<li><a href="https://medlineplus.gov/healthtopics.html">Health Topics</a></li><li><a href="https://medlineplus.gov/druginformation.html">Drugs &amp; Supplements</a></li><li><a href="https://medlineplus.gov/genetics/">Genetics</a></li><li><a href="https://medlineplus.gov/lab-tests/">Medical Tests</a></li><li><a href="https://medlineplus.gov/encyclopedia.html">Medical Encyclopedia</a></li>
</ul>
</div>
<a title="Español" id="mplus-lang-toggle" href="../../spanish/ency/article/001496.htm">Español</a>
</div>
</div>
</header>
<!-- Content
================================================== -->
<div id="mplus-content">
<!-- Breadrcumbs -->
<div id="breadcrumbs"><div itemtype="http://schema.org/BreadcrumbList" itemscope="" itemprop="breadcrumb"><span class="hide-offscreen">You Are Here:</span>
<div itemscope itemprop="itemListElement" itemtype="http://schema.org/ListItem">
<a href="https://medlineplus.gov" itemprop="item"><span itemprop="name">Home</span></a>
&rarr;
<meta itemprop="position" content="1"/>
</div>
<div itemscope itemprop="itemListElement" itemtype="http://schema.org/ListItem">
<a href="https://medlineplus.gov/encyclopedia.html" itemprop="item"><span itemprop="name">Medical Encyclopedia</span></a>
&rarr;
<meta itemprop="position" content="2"/>
</div>
</div><div><span>Choriocarcinoma</span></div></div>
<span class="page-url print-only">URL of this page: //medlineplus.gov/ency/article/001496.htm
</span>
<!-- Article -->
<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
</a><h1 class="with-also" itemprop="name">Choriocarcinoma</h1>
</div><div class="page-actions">
</div>
<noscript>
<span class="js-disabled-message">To use the sharing features on this page, please enable JavaScript.</span>
</noscript></div><div class="main"><div id="ency_summary"><p>Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops during pregnancy to feed the fetus.</p><p>Choriocarcinoma is a type of <a test="test" href="./007333.htm">gestational trophoblastic disease</a>.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-1"><p>Choriocarcinoma is a rare cancer that occurs as an abnormal pregnancy. A baby may or may not develop in this type of pregnancy.</p><p>The cancer may also occur shortly after a normal pregnancy. But it most often occurs with a complete <a test="test" href="./000909.htm">hydatidiform mole</a>. This is a growth that forms inside the womb at the beginning of a pregnancy. The abnormal tissue from the mole can continue to grow even after attempted removal, and can become cancerous. About one half of all women with a choriocarcinoma had a hydatidiform mole, or molar pregnancy.</p><p>Choriocarcinomas may also occur after an early pregnancy that does not continue (miscarriage). They may also occur after an <a test="test" href="./000895.htm">ectopic pregnancy</a> or genital <a test="test" href="./001310.htm">tumor</a>.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-2"><p>A possible symptom is abnormal or irregular <a test="test" href="./003156.htm">vaginal bleeding</a> in a woman who recently had a hydatidiform mole or pregnancy.</p><p>Other symptoms may include:</p><ul><li>Irregular vaginal bleeding</li><li>Pain, which may be associated with the bleeding, or due to enlargement of the ovaries that often occurs with a choriocarcinoma</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-3"><p>A pregnancy test will be positive, even if you are not pregnant. The pregnancy hormone (HCG or human chorionic gonadotropin) level will be high.</p><p>A pelvic exam may find an enlarged uterus and ovaries.</p><p>Blood tests that may be done include:</p><ul><li><a test="test" href="./003510.htm">Quantitative serum HCG</a></li><li><a test="test" href="./003642.htm">Complete blood count</a></li><li><a test="test" href="./003435.htm">Kidney function tests</a></li><li><a test="test" href="./003436.htm">Liver function tests</a></li></ul><p>Imaging tests that may be done include:</p><ul><li>CT scan</li><li>MRI </li><li>Pelvic ultrasound</li><li>Chest x-ray</li></ul><p>You should be carefully monitored after a hydatidiform mole or at the end of a pregnancy. Early diagnosis of choriocarcinoma can improve the outcome.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-4"><p>After you are diagnosed, a careful history and exam will be done to make sure the cancer has not spread to other organs. <a test="test" href="./002324.htm">Chemotherapy</a> is the main type of treatment. It is usually effective.</p><p><a test="test" href="./002915.htm">Hysterectomy</a> to remove the womb and radiation treatment are rarely needed.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Support Groups</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-5"><p>You can ease the stress of illness by joining a <a test="test" href="./002166.htm">cancer support group</a>. Sharing with others who have common experiences and problems can help you not feel alone.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-6"><p>Most women whose cancer has not spread can be cured and will still be able to have children. A choriocarcinoma may come back within a few months to 3 years after treatment.</p><p>The condition is harder to cure if the cancer has spread and one or more of the following happens:</p><ul><li>Disease spreads to the liver or brain</li><li>Pregnancy hormone (HCG) level is higher than 40,000 mIU/mL when treatment begins</li><li>Cancer returns after having chemotherapy</li><li>Symptoms or pregnancy occurred for more than 4 months before treatment began</li><li>Choriocarcinoma occurred after a pregnancy that resulted in the birth of a child </li></ul><p>Many women (about 70%) who have a poor outlook at first go into remission (a disease-free state).</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-7"><p>Contact your health care provider if you develop symptoms within 1 year after a hydatidiform mole or pregnancy.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-Alt"><p>Chorioblastoma; Trophoblastic tumor; Chorioepithelioma; Gestational trophoblastic neoplasia; Cancer - choriocarcinoma</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div class="section-body" id="section-Ref"><p>National Cancer Institute website. Gestational trophoblastic disease treatment (PDQ) - health professional version. <a href="https://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq" target="_blank">www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq</a>. Updated October 20, 2022. Accessed April 22, 2024.</p><p>Salani R, Bixel K, Copeland LJ. Malignant diseases and pregnancy. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds.<em> Gabbe's Obstetrics: Normal and Problem Pregnancies</em>. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 55.</p></div></div></section>
<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 4/16/2024</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div>
<div id="section-version" class="section-body"><p>Updated by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. </p>
</div></div></section><section><div class="section ency-citation"><div class="section-header"><div class="section-title ency-citation"><div id="citation-how-to"><button><span>Learn how to cite this page</span></button></div></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Related MedlinePlus Health Topics</h2></div><div class="section-button"><button type="submit" aria-controls="section-mtp" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
</span></button></div><div class="sm-live-area hide-offscreen" aria-live="polite">
</div></div><div name="Related MedlinePlus Health Topics" class="section-body" id="section-mtp"><ul class="side-nav"><li><a href="https://medlineplus.gov/miscarriage.html">Miscarriage</a></li>
<li><a href="https://medlineplus.gov/tumorsandpregnancy.html">Tumors and Pregnancy</a></li>
<li><a href="https://medlineplus.gov/uterinecancer.html">Uterine Cancer</a></li>
</ul></div></div></section></div></div></article>
</div>
<footer>
<div class="provider-box group">
<div class="urac-logo">
<a href="https://accreditnet.urac.org/directory/#/certification/HCP-2/info"><img src="https://medlineplus.gov/images/CertifiedSeal.png"/></a>
<p class="urac-logo-info">Health Content Provider<br>06/01/2025</p>
</div>
<p class="adam-info">
<a href='javascript:urac_open();'>A.D.A.M., Inc. is accredited by URAC</a>, for Health Content Provider (www.urac.org). URAC's <a href='javascript:hwsopen();'>accreditation program</a> is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s <a href='javascript:edpolopen();'>editorial policy, editorial process</a>, and <a href='javascript:ppopen();'>privacy policy</a>. A.D.A.M. is also a founding member of Hi-Ethics. This site complies with the HONcode standard for trustworthy health information: <a href='javascript:honc_open();'>verify here</a>.
</p>
</div>
<p class="adam-info">
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997-2025 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
</p>
<div class="adam-logo">
<a href="https://www.adam.com/about" target="_blank"><img width="49" height="10" alt="About A.D.A.M." src="https://medlineplus.gov/ency/images/ency/ftrAdamlogo.gif"/></a>
</div>
<div id="mplus-footer">
<div class="footer1">
<ul class="secondarynav">
<li><a href="https://medlineplus.gov/about/">About MedlinePlus</a></li>
<li><a href="https://medlineplus.gov/whatsnew/">What's New</a></li>
<li><a href="https://medlineplus.gov/sitemap.html">Site Map</a></li>
<li><a name="contact" target="_blank" href="https://support.nlm.nih.gov/knowledgebase/category/?id=CAT-01231&amp;category=medlineplus&amp;from="><span>Customer Support</span></a></li>
</ul>
<ul class="follow-footer">
<li><a href="https://medlineplus.gov/rss.html" class="follow-item">Subscribe to RSS<img src="https://medlineplus.gov/images/feed.png" class="social-media-toolkit-icon" alt="RSS" title="RSS"></a></li>
<li><span class="follow-label">Follow us</span>
<a href="https://twitter.com/medlineplus" class="follow-item" target="_blank"><img src="https://medlineplus.gov/images/i_share_twitter.png" class="follow-icon" alt="X" title="X"></a>
<a href="https://facebook.com/Mplus.gov/" class="follow-item" target="_blank"><img src="https://medlineplus.gov/images/i_share_fb.png" class="follow-icon" alt="Facebook" title="Facebook"></a>
<a href="https://www.instagram.com/mplusgov/" class="follow-item" target="_blank"><img src="https://medlineplus.gov/images/Instagram_Glyph_Gradient_RGB.png" class="follow-icon" alt="Instagram" title="Instagram"></a>
</li>
<li><a href="https://medlineplus.gov/social-media-toolkit/" class="social-media-toolkit-item">Social Media Toolkit<img src="https://medlineplus.gov/images/i_social_media_toolkit.png" class="social-media-toolkit-icon" alt="Social Media Toolkit" title="Social Media Toolkit"></a></li>
</ul>
</div>
<div class="footer2">
<ul>
<li><a href="https://www.nlm.nih.gov/web_policies.html" target="_blank">NLM Web Policies</a></li>
<li><a href="https://medlineplus.gov/about/using/usingcontent/" >Copyright</a></li>
<li><a href="//medlineplus.gov/accessibility.html">Accessibility</a></li>
<li><a href="https://medlineplus.gov/about/using/criteria/">Guidelines for Links</a></li>
<li><a href="//medlineplus.gov/plugins.html">Viewers &amp; Players</a></li>
<li><a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" target="_blank">HHS Vulnerability Disclosure</a></li>
<li><a href="https://medlineplus.gov/medlineplus-connect/">MedlinePlus Connect for EHRs</a></li>
<li><a href="https://medlineplus.gov/about/developers/">For Developers</a></li>
</ul>
<div class="address">
<a href="//www.nlm.nih.gov" target="_blank">National Library of Medicine</a>
<span>8600 Rockville Pike, Bethesda, MD 20894</span>
<a href="//www.hhs.gov" target="_blank">U.S. Department of Health and Human Services</a>
<a href="//www.nih.gov" target="_blank">National Institutes of Health</a>
</div>
<div class="return-top"><a href="#top" title="Return to top"><img class="return-top-icon" alt="Return to top" src="https://medlineplus.gov/images/return-top.png"></a></div>
</div>
</div>
</footer>
</div><!-- End Wrap -->
<script src="https://medlineplus.gov/jslib/jquery-3.6.0.min.js" type="text/javascript">
</script>
<script src="https://medlineplus.gov/jslib/mplus-frontend-controls.js" type="text/javascript">
</script>
<!--[if lte IE 9]>
<script src="https://medlineplus.gov/jslib/jquery.placeholder.js" type="text/javascript"></script>
<![endif]-->
<script src="https://medlineplus.gov/jslib/mplus-share.js?id=1112022" type="text/javascript">
</script>
<script src="https://medlineplus.gov/jslib/control.js" type="text/javascript">
</script>
<script src="https://medlineplus.gov/uswds/js/uswds.min.js" type="text/javascript">
</script>
<script src="https://medlineplus.gov/jslib/ency/ency.js" type="text/javascript">
</script>
</body>
</html>