All About Fallopian Tube Cancer
What are the fallopian tubes?
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 (non-cancerous) or malignant (cancerous). Although benign tumors may grow in an uncontrolled fashion, they do not spread beyond the part of the body where they started (metastasize) and do not invade into surrounding tissues. Malignant tumors grow in such a way that they invade and damage other tissues around them. They may also spread to other parts of the body, usually through the bloodstream 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. 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. These are called sarcomas (leiomyosarcomas). These tumors can also come from another type of cell that lines 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.
The causes and risk factors for developing primary fallopian tube cancer are not known. In some cases, a woman may have a history of chronic infection and/or inflammation of the fallopian tubes (due to untreated sexually transmitted diseases, for example). 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 may also increase your risk for fallopian tube cancer. 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 a thorough family history assessment and be offered genetic counseling. If a woman knows that she carries a BRCA mutation, she should discuss her risk and options for risk reduction with her care providers.
How can I prevent fallopian tube cancer?
Fallopian tube cancer is not preventable. You may be able to lower your risk by using hormonal birth control or by having 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 abnormal vaginal bleeding, vaginal discharge, and/or abdominal pain. As a general rule, any vaginal bleeding in postmenopausal women should be quickly and carefully evaluated by your health care provider. 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 fallopian tube. This makes fallopian tube cancer difficult to diagnose. One of the most important steps in evaluating any patient with a gynecologic complaint is a proper pelvic examination. Your healthcare provider (HCP) should examine your 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.
Ultrasound is more helpful in diagnosing fallopian tube cancer. 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 organs. After this test, if your provider still suspects fallopian tube cancer, they 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 examine the organs in the abdomen.
Serum levels of a tumor 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. This can be done 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 biopsy 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 very complex, and the entire staging system is outlined at the end of this article. Though complicated, the staging system helps healthcare providers determine the extent of the cancer, and in turn, make treatment decisions for a patient's cancer. The stage of cancer, or extent of disease, is based on information gathered through the various tests done as the diagnosis and workup of the cancer is being performed.
How is fallopian tube cancer treated?
The treatment for fallopian tube cancer will take into account the patient's stage of the disease, medical history, current health and personal preference, and other factors. The goal of the treatment of fallopian tube cancer is to get rid of 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 providers typically perform the surgery and manage the chemotherapy treatments, which is different from most cancer care providers for other types of cancer.
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 either one or both of the fallopian tubes, and either one or both of the ovaries. In more advanced stages the surgical procedures may include total abdominal hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy, infracolic omenectomy (removal of abdominal lining), appendectomy (removal of the appendix), peritoneal washings, and peritoneal biopsies. In patients with very advanced disease, the goal is cytoreductive surgery. This means removing as much cancerous tissue as possible. Treatment with surgery may be used in combination with radiation or chemotherapy. This is known as adjuvant therapy.
Radiation therapy refers to the use of high energy x-rays to kill cancer cells. Radiation is not considered a primary treatment for fallopian tube cancer because it has not been shown to be effective and the side effects patients may experience. However, it may be used prior to surgery to help shrink a tumor in size to make surgery more manageable.
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 are most commonly used in the treatment of fallopian tube cancer and can be used in combination with other types of chemotherapy. The most commonly used medications are cisplatin (platinum-based), carboplatin (platinum-based), gemcitabine, docetaxel, liposomal doxorubicin, cyclophosphamide and paclitaxel. There are currently studies being conducted to determine which chemotherapy regimens work best with the least amount of side effects. In some cases, intraperitoneal chemotherapy will be used. This is when chemotherapy is injected directly into the abdomen and absorbed by the surrounding tissues and organs to kill cancer cells. Your provider will decide on a regimen that will best treat your cancer and your specific needs.
Several targeted therapies have recently been approved for the treatment of recurrent or advanced fallopian tube cancer. Targeted therapies work more specifically than standard chemotherapy by targeting something specific to the cancer cells, often inhibiting some function that is necessary for cell division. Bevacizumab, entrectinib and larotrectinib are targeted therapies that may be used in fallopian tube cancer treatment. Neratinib, olaparib, and rucaparib are targeted therapies used in BRCA+ fallopian tube cancer.
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 the 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. Your provider will do a physical exam at each appointment and will do blood tests to monitor for tumor markers. If you are having 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.
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.
Ovarian Cancer National Alliance
Connect survivors, women at risk, caregivers and health providers with the information and resources they need.
Pregnant with Cancer
Dedicated to providing women diagnosed with cancer while pregnant with information, support and hope.
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.
FORCE (Facing our Risk of Cancer Empowered)
Provides support, education and resources to individuals and families affected by hereditary breast, ovarian, and related cancers.
Appendix: Complete Fallopian Tube & Ovarian Cancer Staging
AJCC, Cancer Staging Manual, 8th Edition
Primary Tumor (T)
Primary tumor cannot be assessed
No evidence of primary tumor
Carcinoma in situ (limited to tubal mucosa)
Tumor limited to the ovaries (one or both) or fallopian tubes
Tumor limited to one ovary or tube, no tumor on surface; no malignant cells in peritoneal washings or ascites
Tumor limited to both ovaries or tubes, no tumor on surface; no malignant cells in peritoneal washings or ascites
Tumor limited to one or both tubes with any of the following:
Capsule ruptured before surgery or tumor on ovary or tube surface
Malignant cells in ascites or peritoneal washings
Tumor involves one or both Fallopian tubes with pelvic extension
Extension and/or implants on the uterus and/or fallopian tube(s) and/or ovaries
Extension to and/or implants on other pelvic structures
Tumor involves one or both fallopian tubes, or primary peritoneal cancer with peritoneal metastasis outside the pelvis and/or metastasis to retroperitoneal lymph nodes
Microscopic peritoneal metastasis outside the pelvis with or without positive retroperitoneal lymph nodes
Macroscopic peritoneal metastasis outside the pelvis 2cm or less in greatest dimension with or without positive retroperitoneal lymph nodes
Peritoneal metastasis outside the pelvis and more than 2cm in diameter with or without positive retroperitoneal lymph nodes
Regional Lymph Nodes (N)
Regional lymph nodes cannot be assessed
No regional lymph node metastasis
Isolated tumor cells, < 0.2mm, in regional lymph nodes
Positive retroperitoneal lymph nodes only
Metastasis < 10mm in greatest diameter
Metastasis > 10mm in greatest diameter
Distant Metastasis (M)
No distant metastasis
Pleural effusion with positive cytology
Liver or splenic metastases, metastases to organs or lymph nodes outside the abdomen, involvement of the intestine
Nx, N0, N1
Nx, N0, N1
Nx, N0, N1
American Cancer Society. Ovarian Cancer. 2016. Retrieved from: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-after-follow-up
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