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Fallopian Tube Cancer

By Pedro T. Ramirez, MD, Professor, Department of Gynecologic Oncology and Reproductive Medicine, David M. Gershenson Distinguished Professor in Ovarian Cancer Research, and Director of Minimally Invasive Surgical Research and Education, The University of Texas MD Anderson Cancer Center ; David M. Gershenson, MD, Professor and Chairman, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center ; Gloria Salvo, MD, Rotating Research Resident, Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center

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Fallopian tube cancer is usually adenocarcinoma, manifesting as an adnexal mass or with vague symptoms. Diagnosis, staging, and primary treatment are surgical.

Primary fallopian tube cancer is rare. Patients are usually postmenopausal at the time of diagnosis.

Risk factors for fallopian tube cancer include

  • Age

  • Chronic salpingitis

  • Infertility

Most (> 95%) fallopian tube cancers are papillary serous adenocarcinomas; a few are sarcomas.

Spread, like that of ovarian cancer, is as follows:

  • By direct extension

  • By peritoneal seeding

  • Through the lymphatics

Symptoms and Signs

Most patients with fallopian tube cancer present with an adnexal mass or report vague abdominal or pelvic symptoms (eg, abdominal discomfort, bloating, pain). A few patients present with hydrops tubae profluens (a triad of pelvic pain, copious watery discharge, and adnexal mass), which is more specific for fallopian tube cancer.

Diagnosis

  • CT

  • Surgery to confirm diagnosis and to stage

Typically, CT is done. A distended solid adnexal mass and normal ovary suggest fallopian tube cancer. A pregnancy test is done to rule out ectopic pregnancy unless patients are postmenopausal.

If cancer is suspected, surgery is necessary for diagnosis, staging, and primary treatment. Surgical staging (similar to that for ovarian cancer) requires the following:

  • Washings from the pelvis, abdominal gutters, and diaphragmatic recesses

  • Multiple pelvic and abdominal peritoneal biopsies

  • Pelvic and para-aortic lymph node dissection or lymph node sampling

Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and supracolic omentectomy are usually done at the same time as surgical staging.

Treatment

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy

  • Supracolic omentectomy

  • Sometimes cytoreductive surgery

Treatment of fallopian tube cancer includes total abdominal hysterectomy, bilateral salpingo-oophorectomy, and supracolic omentectomy. If cancer appears advanced, cytoreductive surgery is indicated. These procedures can be done during surgical staging.

As in ovarian cancer, clinicians must determine whether primary cytoreductive surgery (done during surgical staging) is likely to result in no gross residual disease or whether chemotherapy and interval surgery (usually 3 cycles of neoadjuvant chemotherapy followed by cytoreductive surgery and 3 cycles of adjuvant chemotherapy) is the best approach for the patient.

Laparoscopy may be done to determine the extent of the cancer and, in some cases, to treat the cancer. Laparoscopy enables clinicians to thoroughly evaluate the pelvis, small and large bowel, upper abdomen, diaphragmatic surface, and all other peritoneal surfaces.

As in ovarian cancer, a predictive index score such as the Fagotti score can be used (see Table: Calculating the Fagotti Score to Predict the Likelihood of Optimal Cytoreduction). In this scoring system, several sites in the abdomen and pelvis are evaluated and assigned a score based on the extent of cancer. If patients score ≥ 8, primary cytoreduction is not considered the best option for that patient, and chemotherapy is recommended as primary treatment.

Postoperative treatment is identical to postoperative treatment for ovarian cancer. External beam radiation is rarely indicated.

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