All About Fallopian Tube Cancer

Neha Vapiwala, MD and Christine Hill-Kayser, MD
Updated by: Karen Arnold-Korzeniowski, BSN RN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 14, 2016

What are the fallopian tube(s)?

The fallopian tubes are a pair of thin tubes that transport a woman's eggs (ova) from her ovaries (where they are housed) to her uterus (aka "womb") where they are either fertilized by male sperm or discarded during menstruation. Typically, an egg is released from one of the ovaries into the adjacent fallopian tube once each month during ovulation, which occurs in women who are of reproductive age. The tube helps to move the egg along its journey to the uterus with small hair-like projections called cilia that line the inside of the tubes.

What is fallopian tube cancer?

Normally, cells in the body will grow and divide to replace old or damaged cells in the body. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells stop dividing. Tumors occur when there is an error in this regulation and cells continue to grow in an uncontrolled way. Tumors can either be benign or malignant. Although benign tumors may grow in an uncontrolled fashion sometimes, they do not spread beyond the part of the body where they started (metastasize) and do not invade into surrounding tissues. Malignant tumors, however, will grow in such a way that they invade and damage other tissues around them. They also may spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located. Over time, the cells within a malignant tumor become more abnormal and appear less like normal cells. This change in the appearance of cancer cells is called the tumor grade, and cancer cells are described as being well-differentiated, moderately-differentiated, poorly-differentiated, or undifferentiated. Well-differentiated cells are quite normal appearing and resemble the normal cells from which they originated. Undifferentiated cells are cells that have become so abnormal that often we cannot tell what types of cells they started from.

Cancer of the fallopian tubes is an abnormal growth of malignant cells in one or both of a woman's fallopian tubes. The vast majority of fallopian tube cancers are papillary serous adenocarcinomas. These cancers grow from cells that line the fallopian tubes, which have become abnormal. When the cells begin to divide abnormally and gain the ability to invade other organs or spread to other parts of the body, tumors may form. Very occasionally, tumors can form from smooth muscle in the fallopian tubes, in which case they are called sarcomas (leiomyosarcomas), or from other cells that line the fallopian tubes, in which case they are called transitional cell carcinomas.

What causes fallopian tube cancer and am I at risk?

Primary fallopian tube cancer is the rarest (only about 1%) of all gynecologic cancers. Fallopian tube cancer affects women from ages 18-88, with the most common occurrence being between 40 and 65 years old. The diagnosis is more common in Caucasian women than in African American women.

Given how are it is, the causes and risk factors for developing primary fallopian tube cancer are not clearly defined. There has been some association with chronic infection and/or inflammation of the fallopian tubes (due to untreated sexually transmitted diseases, for example), although a cause-effect relationship is not certain. It is also believed that not having children and not having used birth control pills can also put a woman at higher risk for developing fallopian tube cancer.

A family history of fallopian tube or ovarian cancer puts a woman at higher risk. There are several genetic mutations that have been reported in women with primary fallopian tube cancer. The mutations involve the hereditary breast and ovarian cancer genes, and particularly BRCA1. Given how rare fallopian cancer is, any woman diagnosed with this disease should undergo thorough family history assessment, and be offered genetic counseling. Conversely, if a woman knows that she carries a BRCA mutation, they should discuss their risk and options for risk reduction with their care providers.

How can I prevent fallopian tube cancer?

Fallopian tube cancer is not preventable. You may be able to lower your risk by having used hormonal birth control or by having had children. If you have a family history of fallopian tube cancer or BRCA1 gene, you will be monitored more closely. In some cases, women with these genetic abnormalities may choose to undergo prophylactic removal of the ovaries and fallopian tubes to reduce risk.

What screening tests are available for fallopian tube cancer?

There are no specific screening tests for fallopian tube cancer.

What are the signs of fallopian tube cancer?

The most common symptoms are vaginal bleeding, vaginal discharge, and/or abdominal pain. As a general rule, any vaginal bleeding in postmenopausal women should be quickly and carefully evaluated. Blood tinged vaginal discharge can be associated with infection. Your provider may order a course of antibiotic treatment. If the discharge does not resolve it may signify the presence of cancer. The pelvic pain associated with fallopian tube cancer occurs because of trapped fluid blocking and distending the fallopian tube. The pain is typically referred to as colicky or dull.

How is fallopian tube cancer diagnosed?

It is difficult to see something abnormal growing on the inside of a tube. This makes fallopian tube cancer difficult to diagnosis. One of the most important steps in evaluating any patient with a gynecologic complaint is a proper pelvic examination. The healthcare provider (HCP) should examine the uterus, ovaries, fallopian tubes, and vagina. During this test your provider will most likely perform a Pap smear. A Pap smear is a test in which your provider will use a thin tool to scrape a sample of cells from your cervix, which will then be tested. An abnormal pap smear does not mean you have fallopian tube cancer. An abnormal Pap smear test can mean nothing or it can provide answers about what else could be going on in your body. And though a pelvic exam and pap smear is helpful in diagnosing a gynecological issue it is not the determinate test of fallopian tube cancer.

Thought to be more helpful in diagnosing fallopian tube cancer specifically is ultrasound. Ultrasound is an imaging test in which high-energy sound waves bounce off of tissues or organs making echoes that form a picture, called a sonogram. Your provider may start with a transabdominal ultrasound. During this test a probe covered with a gel is moved around the skin on top of your abdomen to produce a picture of your abdominal organ. This test is useful but if your provider still suspects fallopian tube cancer, he or she will order a transvaginal ultrasound. During this test, a probe will be placed into the vagina to produce a picture of the internal organs. A transvaginal ultrasound is the most effective technique for imaging the fallopian tubes. CT scan and MRI are routinely used in conjunction with ultrasound to image the organs in the abdomen.

Serum levels of a marker called CA-125 can be abnormally high in patients with gynecologic diseases, both cancer and non-cancer types (ie: pelvic inflammatory disease, endometriosis, early pregnancy). Although CA-125 is nonspecific, and may be elevated due to many problems that are not cancer, checking a preoperative level is often recommended in a postmenopausal woman with a pelvic mass, if for no other reason than to establish a baseline value for later comparison and assessment of response to therapy.

Although imaging and lab test results are helpful in diagnosing fallopian tube cancer, most providers feel that the diagnosis requires surgery to evaluate the fallopian tubes and obtain tissue specimens to test for cancer cells.

How is fallopian tube cancer staged?

In order to guide treatment and offer some insight into prognosis, fallopian cancer is staged using the FIGO system (International Federation of Gynecologists and Obstetricians). Healthcare providers also use the TNM system (also called tumor - node - metastasis system). This system describes the size and local invasiveness of the tumor (T), which, if any, lymph nodes are involved (N), and if it has spread to other more distant areas of the body (M). This is then interpreted as a stage somewhere from I (one), denoting more limited disease, to IV (four), denoting more advanced disease. Generally, the higher the stage, the more serious the cancer. The staging system is quite technical, but is provided here for your reference.

American Joint Committee on Cancer (AJCC) TNM and FIGO Staging System for Fallopian

Primary Tumor (T)

TNM

FIGO

 

TX

 

Primary tumor cannot be assessed

T0

 

No evidence of primary tumor

Tis

 

Carcinoma in situ (limited to tubal mucosa)

T1

I

Tumor limited to the fallopian tubes

T1a

IA

Tumor limited to one tube, without penetrating the sersosal surface; no ascites

T1b

IB

Tumor limited to both tubes, without penetrating the sersosal surface; no ascites

T1c

IC

Tumor limited to one or both tubes with extension onto or through the tubal serosa, or with malignant cells in ascites or peritoneal washings

T2

II

Tumor involves one or both Fallopian tubes with pelvic extension

T2a

IIA

Extension and/or metastasis to the uterus and/or ovaries

T2b

IIB

Extension to other pelvic structures

T2c

IIC

Pelvic extension with malignant cells in ascites or peritoneal washings

T3

III

Tumor involves one or both fallopian tubes, with peritoneal implants outside the pelvis

T3a

IIIA

Microscopic peritoneal metastasis outside the pelvis

T3b

IIIB

Macroscopic peritoneal metastasis outside the pelvis 2cm or less in greatest dimension

T3c

IIIC

Peritoneal metastasis outside the pelvis and more than 2cm in diameter

Regional Lymph Nodes (N)

NX

 

Regional lymph nodes cannot be assessed

N0

 

No regional lymph node metastasis

N1

IIIC

Regional lymph node metastasis

Distant Metastasis (M)

M0

 

No distant metastasis

M1

IV

Distant metastasis (excludes metastasis within peritoneal cavity)

Stage Grouping

Stage 0

Tis

N0

M0

Stage 1

T1

N0

M0

Stage IA

T1a

N0

M0

Stage IB

T1b

N0

M0

Stage IC

T1c

N0

M0

Stage II

T2

N0

M0

Stage IIA

T2a

N0

M0

Stage IIB

T2b

N0

M0

Stage IIC

T2c

N0

M0

Stage III

T3

N0

M0

Stage IIIA

T3a

N0

M0

Stage IIIB

T3b

N0

M0

Stage IIIC

T3c

Any T

N0

N1

M0

Stage IV

Any T

Any N

M1

How is fallopian tube cancer treated?

The treatment for fallopian tube cancer will take into account the patient's stage of disease, medical history, current health and personal preference, among other things. The goal of treatment of fallopian tube cancer is to eradicate the cancer completely with minimal side effects. A gynecologic oncologist typically treats this type of cancer, which is a doctor who specializes in treating gynecologic cancers. These physicians typically perform the surgery and manage the chemotherapy treatments, which is different from most cancer care providers for other types of cancer.

Surgery

Surgery for fallopian tube cancer is determined by the stage of the cancer from previous imaging tests. A procedure called a salpingo-oophorectomy is used in the treatment of early-stage fallopian tube cancer. A salpingo-oophorectomy is the surgical removal of the either one or both of the fallopian tubes, and either one or both of the ovaries. In more advanced stages the surgical procedures will include: total abdominal hysterectomy (removal of uterus), bilateral salpingo-oophorectomy, infracolic omenectomy (removal of abdominal lining), appendectomy (removal of appendix), peritoneal washings, and peritoneal biopsies. In patients with very advanced disease the goal is cytoreductive surgery, meaning the removal of as much cancerous tissue as possible. Treatment with surgery may be used in combination with radiation or chemotherapy, known as adjuvant therapy.

Radiation Therapy

Radiation therapy refers to use of high energy x-rays to kill cancer cells. Radiation is not considered a primary treatment for fallopian tube cancer because of its low efficacy and side effects. However, it may be used prior to surgery to help shrink a tumor in size to make surgery more manageable. It may also be used in cases where chemotherapy is refused or contraindicated.

Chemotherapy

Chemotherapy is the use of anti-cancer medications that go throughout the entire body. Chemotherapy is rarely used as the only treatment for fallopian tube cancer, but rather given after surgery to kill any remaining cancer cells. Platinum based chemotherapies (carboplatin and cisplatin) are most commonly used in the treatment of fallopian tube cancer. The two most commonly used medications are carboplatin and paclitaxel. A platinum based chemotherapy may be given alone or in combination with another type of chemotherapy. There are currently studies being conducted to determine which chemotherapy regimens work best with the least amount of side effects. In some cases, chemotherapy will be given directly into the abdomen (called intraperitoneal chemotherapy). Your provider will decide on a regimen that will best treat your cancer and your specific needs.

Clinical Trials

There are clinical research trials for most types of cancer, and every stage of the disease. Clinical trials are designed to determine the value of specific treatments such as hormonal therapy for treatment of fallopian tube cancer. Trials are often designed to treat a certain stage of cancer, either as the first form of treatment offered, or as an option for treatment after other treatments have failed to work. They can be used to evaluate medications or treatments to prevent cancer, detect it earlier, or help manage side effects. Clinical trials are extremely important in furthering our knowledge of this disease. It is through clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your provider about participating in clinical trials in your area. You can also explore currently open clinical trials using the OncoLink Clinical Trials Matching Service.

Follow Up Care and Survivorship

After treatment for fallopian tube cancer, your care team will monitor you closely for recurrence of the disease and to monitor and treat any side effects you are experiencing from the treatment. You provider will do a physical exam at each appointment and will do blood tests to monitor for tumor markers. If you are exhibiting any symptoms of recurrence your provider may order further imaging tests. It is important to be open and honest with your provider regarding any new or recurring symptoms you are experiencing.

Fear of recurrence, sexuality and reproductive concerns, financial impact of cancer treatment, employment issues and coping strategies are common emotional and practical issues experienced by fallopian tube cancer survivors. Your healthcare team can identify resources for support and management of these practical and emotional challenges faced during and after cancer.

Cancer survivorship is a relatively new focus of oncology care. With some 15 million cancer survivors in the US alone, there is a need to help patients transition from active treatment to survivorship. What happens next, how do you get back to normal, what should you know and do to live healthy going forward? A survivorship care plan can be a first step in educating yourself about navigating life after cancer and helping you communicate knowledgeably with your healthcare providers. Create a survivorship care plan today on OncoLink.

Resources for More Information

National Ovarian Cancer Coalition
Through national programs and local Chapter initiatives, the NOCC's goal is to make more people aware of the early symptoms of ovarian cancer. In addition, the NOCC provides information to assist the newly diagnosed patient, to provide hope to survivors, and to support caregivers. http://ovarian.org/

Ovarian Cancer National Alliance
Connect survivors, women at risk, caregivers and health providers with the information and resources they need. http://www.ovariancancer.org/

Eyes on the Prize
Provides information and emotional support from the survivors' perspective to women with gynecologic cancers, their families and friends, and healthcare providers. Has a helpful discussion board where you can "chat" with other women. http://www.eyesontheprize.org/

Pregnant with Cancer
Dedicated to providing women diagnosed with cancer while pregnant with information, support and hope. http://www.pregnantwithcancer.org/

Foundation for Women’s Cancers
The Foundation offers comprehensive information by cancer type that can help guide you through your diagnosis and treatment. They also offer the ‘Sisterhood of Survivorship’ to connect with others facing similar challenges. http://www.foundationforwomenscancer.org/

FORCE (Facing our Risk of Cancer Empowered)
Provides support, education and resources to individuals and families affected by hereditary breast, ovarian, and related cancers. http://www.facingourrisk.org/

References

American Cancer Society. Ovarian Cancer. 2014. Found at: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-after-follow-up

Berek JS et al. Cancer of the ovary, fallopian tube, and peritoneum. International Journal of Gynecology and Obstetrics. 131 (2015) S111–S122.

DiSaia et al. Clinical Gynecological Oncology Eighth Edition. Elsevier. Fallopian Tube Cancer. 2012. Chapter 13. P 357-368.

Kalampokas E. et al. Primary Fallopian tube carcinoma. European Journal of Obstetrics & Gynecology and Reproductive Biology.  169(2013) 155-161.

National Institute of Health. National Cancer Institute. Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening PDQ. 2015. Found at: http://www.cancer.gov/types/ovarian

NCCN. American Joint Committee on Cancer (AJCC) TNM and FIGO Staging System for Fallopian Tube Cancer (7th ed., 2010)

Schwandt A et al. Randomized phase II trial of sorafenib alone or in combination with carboplatin/paclitaxel in women with recurrent platinum sensitive epithelial ovarian, peritoneal, or fallopian tube cancer. Investigational New Drugs. 2014. 32(4)729-738.

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