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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
Gloria Salvo, MD, Rotating Research Resident, Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center

Fallopian tube cancer develops in the tubes that lead from the ovaries to the uterus.

  • Most cancers that affect the fallopian tubes have spread from other parts of the body.

  • At first, women may have vague symptoms, such as abdominal discomfort or bloating, or no symptoms.

  • Computed tomography is done to check for abnormalities.

  • Usually, the uterus, ovaries, fallopian tubes, adjacent lymph nodes, and surrounding tissues are removed, followed by chemotherapy.

In the United States, fewer than 1% of gynecologic cancers are fallopian tube cancers. Cancer that starts in the fallopian tubes is rare. Most cancers that affect the fallopian tubes originate elsewhere in the body.

Locating the Internal Female Reproductive Organs

Women are usually postmenopausal when fallopian tube cancer is diagnosed.

Risk factors for fallopian tube cancer include the following:

  • Older age

  • Long-term inflammation of the fallopian tubes (chronic salpingitis)

  • Infertility

More than 95% of fallopian tube cancers are adenocarcinomas, which develop from gland cells. A few are sarcomas, which develop from connective tissue.

Fallopian tube cancer spreads in much the same way as ovarian cancer:

  • Usually directly to the surrounding area

  • Through the shedding of cancer cells into the abdominal cavity

  • Through the lymphatic system to other parts of the pelvis and abdomen and eventually to distant parts of the body

Symptoms

Symptoms of fallopian cancer include vague abdominal discomfort, bloating, and pain in the pelvic area or abdomen. Some women have a watery discharge from the vagina. When cancer is advanced, the abdominal cavity may fill with fluid (a condition called ascites), and women may feel a large lump (mass) in the pelvis.

Diagnosis

  • Computed tomography

Fallopian tube cancer is seldom diagnosed early. Occasionally, it is diagnosed early when a mass or other abnormality is detected during a routine pelvic examination or an imaging test done for another reason. Usually, the cancer is not diagnosed until it is advanced, when it is obvious because a large mass or severe ascites is present.

If cancer is suspected, computed tomography (CT) is usually done. If the results suggest cancer, surgery is done to confirm the diagnosis, determine the extent of the spread, and remove as much of the cancer as possible.

Staging

Doctors stage the cancer based on how far it has spread:

  • Stage I: The cancer occurs only in one or both fallopian tubes.

  • Stage II: The cancer has spread to nearby tissues but is still within the pelvis (which contains the internal reproductive organs, bladder, and rectum).

  • Stage III: The cancer has spread outside the pelvis to lymph nodes or to abdominal organs (such as the surface of the liver).

  • Stage IV: The cancer has spread to distant organs.

Prognosis

The prognosis for women who have fallopian tube cancer is similar to that for women who have ovarian cancer. Prognosis depends on the stage of the cancer and the woman's age.

The percentages of women who are alive 5 years after diagnosis and treatment (the 5-year survival rate) are

  • Stage I: About 81%

  • Stage II: About 67%

  • Stage III: About 41%

  • Stage IV: About 33%

Treatment

  • Usually, removal of the uterus, ovaries, fallopian tubes, adjacent lymph nodes, and surrounding tissues

  • Sometimes more extensive surgery (cytoreductive surgery)

  • Chemotherapy

Treatment of fallopian tube cancer almost always consists of removal of the uterus (hysterectomy) and removal of the ovaries and fallopian tubes (salpingo-oophorectomy), adjacent lymph nodes, and surrounding tissues. These procedures can be done when surgery to stage the cancer is done. Sometimes surgery to stage and treat fallopian cancer can be done using a laparoscope.

For more advanced cancer that has spread to other parts of the body, doctors usually remove as much of the cancer as possible to prolong survival. This type of surgery is called cytoreductive surgery. Depending on where the cancer has spread, women may be treated with chemotherapy instead of or before surgery.

Chemotherapy (as for ovarian cancer) is usually necessary after surgery. Chemotherapy may be used to destroy any small areas of cancer that may remain. The most commonly used chemotherapy drugs are carboplatin plus paclitaxel. Radiation therapy is rarely useful.

For cancer that has spread to other parts of the body, removing as much of the cancer as possible improves the prognosis.

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