Fallopian tube cancer

Other Names: Cancer of the fallopian tube

Fallopian tube cancer develops in the tubes that connect a woman's ovaries and uterus. It is very rare and accounts for only 1-2% of all gynecologic cancers. While some fallopian tube cancers actually begin in the tubes themselves, fallopian tube cancer is more often the result of cancer spreading from other parts of the body to the tubes. For example, the fallopian tubes are a common site of metastasis (spread) of cancers that started in the ovaries, uterus, endometrium, (the tissue lining the uterus) appendix, or colon.

Cause

The cause of fallopian tube cancer is not known, but suspected risk factors include: Advancing age (most women with this type of cancer are diagnosed when they are between 50 and 60 years) Post menopause

Risk factors

Evidence is accumulating that individuals with mutations of BRCA1 and BRCA2 are at higher risk for the development of PFTC.

Types

Cancer can begin in any of the different cell types that make up the fallopian tubes. The most common type is called adenocarcinoma (a cancer of cells from glands). Leiomyosarcoma (a cancer of smooth muscle cells) and transitional cell carcinoma (a cancer of the cells lining the fallopian tubes) are more rare.

Signs and symptoms

Women with fallopian tube cancer may experience symptoms, although some affected women may have no symptoms at all. The signs of fallopian tube cancer are often non-specific, meaning that they can also be signs of other medical conditions that are not cancer. Signs and symptoms of fallopian tube cancer can include: irregular or heavy vaginal bleeding (especially after menopause); occasional abdominal or pelvic pain or feeling of pressure; vaginal discharge that may be clear, white, or tinged with blood; and a pelvic mass or lump.

Diagnosis

Doctors use many tests to diagnose cancer of the fallopian tubes. Some of these tests may include: pelvic examination, transvaginal ultrasound, a blood test that measures the tumor marker CA-125, computed tomography (CT or CAT) scan, and magnetic resonance imaging (MRI),Keyhole surgery (laparoscopy),exploratory abdominal surgery (laparotomy),biopsy of the suspected cancer tissue.

Staging

International Federation of Gynecology and Obstetrics (FIGO) staging is done at the time of surgery:

Stage 0 :Carcinoma in situ

Stage I :Growth limited to fallopian tubes

Stage II :Growth involving one or both fallopian tubes with extension to pelvis

Stage III:Tumor involving one or both fallopian tubes with spread outside pelvis

Stage IV :Growth involving one or more fallopian tubes with distant metastases

Treatment

Fallopian tube cancer can be best treated when detected early. If the cancer has spread to the walls of the tubes or outside of the tubes, then there is a lower chance that the disease can be treated successfully. The stage of the cancer determines the type of treatment needed. Most women will need surgery and some will go on to have chemotherapy and/or radiation therapy. Treatment may include:

• Salpingo-oophorectomy – surgery to remove the diseased fallopian tube and its ovary
• Bilateral salpingo-oophorectomy – surgery to remove both of the fallopian tubes and the ovaries
• Hysterectomy – surgery to remove the internal reproductive organs, including fallopian tubes, ovaries and uterus
• The omentum is removed (this is an apron of fat that hangs down from the stomach), and multiple biopsies (small samples of tissue) are usually taken to fully stage the cancer (check if there are any signs of spread of the cancer outside of the tube).
• Bowel resection – surgery may be needed if the cancer has spread to include the bowel
• Chemotherapy – the use of cancer-killing drugs, often in combination. Chemotherapy can be helpful in controlling secondary cancers because the whole body is treated. This is usually required for these cancers after surgery
• Radiation therapy – the use of precisely targeted x-rays to kill cancer cells. This is not commonly used.

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.

• Bevacizumab (Brand name: Avastin)approved in combination with carboplatin and paclitaxel, followed by Avastin as a single agent, to treat patients with stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer following initial surgical resection. December 2016 approved either in combination with carboplatin and paclitaxel or in combination with carboplatin and gemcitabine, followed by Avastin as a single agent, to treat patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
• Olaparib (Brand name: Lynparza)
• Rucaparib (Brand name: Rubraca) approved for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy.
• Niraparib (Brand name: Zejula) Indicated for maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.

Prognosis

Prognosis depends to a large degree on the stage of the condition. In 1991 it was reported that about half of the patients with advanced stage disease survived 5 years with a surgical approach followed by cisplatinum-based chemotherapy.

NIH genetic and rare disease info

• NIH info on Fallopian tube cancer

Fallopian tube cancer is a rare disease.

Fallopian tube cancer Resources
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