Merck Manual

Please confirm that you are a health care professional

Loading

Fallopian Tube Cancer

By

Pedro T. Ramirez

, MD, The University of Texas MD Anderson Cancer Center;


Gloria Salvo

, MD, MD Anderson Cancer Center

Last full review/revision Feb 2019| Content last modified Feb 2019
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

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.

Key Points

  • Fallopian tube cancer is rare and most often affects postmenopausal women.

  • Most patients present with an adnexal mass or report vague abdominal or pelvic symptoms (eg, abdominal discomfort, bloating, pain).

  • If fallopian tube cancer is suspected, do CT, followed by surgery to confirm the diagnosis and stage and to treat the cancer.

  • Treat with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and supracolic omentectomy and, if the cancer appears advanced, cytoreductive surgery.

  • 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

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Also of Interest

Videos

View All
How to Manage Uterine Inversion
Video
How to Manage Uterine Inversion
3D Models
View All
Contents of the Female Pelvis
3D Model
Contents of the Female Pelvis

SOCIAL MEDIA

TOP