Fallopian Tube Cancer

The fallopian tube is a female reproductive organ whose primary purpose is to carry a fertilized egg into the uterus for implantation. The fallopian tubes arise from the uterus and typically measure approximately 4 inches long. The ends of the tubes, called “fimbria”, are adjacent to the ovary.

In the past, fallopian tube cancer was considered one of the rarest gynecologic malignancies, but recent evidence suggests cancers arising from the lining of this organ may be responsible for a significant subset of cancers initially thought to be of ovarian or primary peritoneal origin. Fallopian tube cancers are almost always epithelial type cancers with a papillary serous histology similar to many epithelial ovarian cancers.

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Symptoms

Patients with fallopian tube cancer may have symptoms that include irregular vaginal bleeding or discharge, lower abdominal pain, bloating, and pelvic pressure. Pain is a commonly reported symptom, and may be relieved with the passage of blood or watery discharge.

Risk Factors

Risk factors for fallopian tube cancer are not as well established, as this disease is less common than other gynecologic cancers. Genetic predisposition through deleterious mutations in the BRCA1 or BRCA2 genes are the best established risk factors for this disease.

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Diagnosis

Women with risk factors for fallopian tube cancer and persistent/progressive symptoms should undergo evaluation by their health care provider. This evaluation should initially involve a comprehensive medical history and physical exam, including examination of the pelvis with a rectal exam. Additional testing may include imaging studies of the pelvis (and abdomen) via ultrasonography (US) or computed tomography (CT). Transvaginal US, utilizing high-frequency sound waves, is typically the best way to identify growths and cysts on the fallopian tube. CT imaging, which involves a series of computerized X-rays, can identify masses outside of the tubes or ovaries that could be suggestive of spread of cancer.

Blood tests may be drawn to measure levels of a specific protein known as the CA-125. While fallopian tube cancer cells produce this protein, women with small cancers confined to the tube may not show any elevation in blood tests. Furthermore, elevated levels are seen with a variety of benign and normal conditions, such as fibroids, endometriosis, simple ovarian cysts, as well as gastritis, hepatitis, and diverticulitis. New blood tests, such as HE4, may also be used in the future to determine the likelihood of ovarian cancer.

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Treatments

Women with a known or suspected fallopian tube cancer should be evaluated by a gynecologic oncologist. Surgery, with removal of the affected tube and adjacent ovary, is typically the initial intervention. If cancer is found, the gynecologic oncologist will remove other affected organs to determine the stage of the disease (where the cancer has spread). Chemotherapy may also be indicated as part of the treatment plan.

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