High-grade serous epithelial ovarian carcinoma, fallopian tube, and peritoneal carcinomas share clinical behavior and treatment.
Primary fallopian tube cancer is rare. Patients are usually postmenopausal at the time of diagnosis.
Risk factors for fallopian tube cancer include
Most (> 95%) fallopian tube cancers are papillary serous adenocarcinomas; a few are sarcomas.
Spread, like that of ovarian cancer, is as follows:
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
Usually, fallopian tube cancer is not diagnosed until it is advanced, when it is obvious because a large mass or severe ascites is present.
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:
Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and supracolic omentectomy are usually done at the same time as surgical staging.
Treatment
(See also National Comprehensive Cancer Network (NCCN): NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer.)
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.
Key Points
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Fallopian tube cancer is rare and most often affects postmenopausal women.
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Most patients present with an adnexal mass or report vague abdominal or pelvic symptoms (eg, abdominal discomfort, bloating, pain).
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If fallopian tube cancer is suspected, do CT, followed by surgery to confirm the diagnosis and stage and to treat the cancer.
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Treat with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and supracolic omentectomy and, if the cancer appears advanced, cytoreductive surgery.
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A predictive index score (eg, the Fagotti score) can be used to determine whether cytoreductive surgery is appropriate; if not, chemotherapy is recommended as primary treatment.
More Information
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
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National Cancer Institute: Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment: This web site provides links to information about causes, genetics, prevention, and treatment of ovarian, fallopian tube, and primary peritoneal cancer, as well as links to information about screening, statistics, and supportive and palliative care.
