What Is Fallopian Tube Cancer?

Overview

Cancer can appear in one or both of the tubes that connect the ovaries and the uterus. These tubes are known as the fallopian tubes (or uterine tubes or oviducts). The cells lining the fallopian tubes are the site of over 95% of cancers. These oviducts are a pair of long, thin, hollow tubes on either side of the uterus. They are 11 to 12 cm long, with the central opening measuring less than 1 mm. These tubes are seromuscular organs that originate from the uterine “side” horns at the top of the uterus and extend laterally, i.e. towards the outer left and right sides of the body. The tubes end close to the ovary, situated on the same side. The fallopian tube comprises four anatomical areas located increasingly further away from the main uterus structure: uterine, isthmus, ampulla, and infundibulum. The uterine part of the fallopian tube is located nearest to the uterus. The ampulla, a common site for fertilisation, is located beside the isthmus and is a little farther away from the uterus. The infundibulum lies the furthest away from the uterus and finishes at an abdominal ostium that opens into the peritoneal cavity and fimbriae, which collect the released immature egg or germ cell (also known as an oocyte) during each menstrual cycle. The interior of the infundibulum is connected to the adjacent ovary by one fimbria, known as the fimbria ovarica. The fallopian tubes serve as 

both a place for fertilisation and a pathway for the fertilised egg (known as an ovum or gamete) to travel from the ovary to the uterus.^1,2

In those assigned female at birth (AFAB), ovarian, fallopian tube, and primary peritoneal carcinomas collectively account for 2.5% of all new instances of cancer in the United States (11.6 new cases per 100,000 AFAB annually, or more than 22,000 diagnoses). Despite being relatively uncommon, epithelial ovarian cancer is the fifth-leading cause of cancer-related mortality, accounting for more than 14,000 deaths yearly (7.2 deaths per 100,000). A total of 4,500 cases of epithelial ovarian cancer (EOC) and 40 cases of primary fallopian tube carcinoma (PFTC) are documented annually in England and Wales. Unfortunately, because there are not many effective screening methods, most diagnoses occur in the advanced stages of the disease, where the 5-year survival rate is less than  30%. Fallopian tube cancer typically occurs in women between 40–60 years of age, though some cases have been reported at an earlier age.^3,4

Credits: https://www.histology.leeds.ac.uk/female/oviduct.php

Causes and types of fallopian tube cancer

The possible causes of fallopian tube cancer are, so far, unidentified. Hormonal, reproductive, and even genetic variables are known to raise the risk of EOC and PFTC. 

High parity proved protective, and the use of oral contraceptives and a history of pregnancies also reduced the incidence of PFTC. Infertility, pelvic inflammatory disease (PID), prior hysterectomy, endometriosis, lactose intolerance, age, race, weight, and smoking had no significant association with PFTC. In fact, the development of cancer in both fallopian tubes was five times more in infertile compared to fertile patients. Women who had never had children  (nulliparous) had a better prognosis than those who had children. There may even be molecular similarities between breast, serous ovarian, uterine carcinomas, and PFTC due to the frequency and structure of the chromosomal abnormalities (BRCA-1 or BRCA-2 mutations) seen in PFTC.⁴ Looking at fallopian cancer itself, there are different types  of fallopian tube cancer, and the image below highlights these differences: The image below shows different types

Created by: Deepika Rana ^5,6

Adenocarcinoma, Brenner tumours, Leiomyosarcoma, Transitional cell carcinoma

Signs and symptoms

Often, there are no early warning signs or symptoms for ovarian, fallopian tube, or peritoneal cancer. When signs or symptoms do 

appear, the cancer is frequently at an advanced stage. The following are possible signs and symptoms:-

• Bleeding or spotting  from the vagina
• Pain in the abdomen, whether colicky or dull
• Pelvic or abdominal mass
• Ascites
• Uncommon manifestations (acute abdomen, a palpable nodule in the groin area (inguinal node), umbilical-bone cerebral metastases, and cerebellar degeneration)
• Postmenopausal bleeding or spotting with a negative PAP smear
• 15% of instances documented have what is known as the “Latzko's triad of symptoms”, which include irregular, profuse serosanguinous vaginal discharge, colicky pain relieved by discharge, and abdominal or pelvic mass.^4,7

Diagnosis

The combination of the following diagnostic techniques detects the possibility of fallopian tube cancer:

• Medical history and physical examinations

A complete medical history is required to identify any potential risk factors with any history of cancer. The next step is to conduct a blood test and thorough physical examinations of the breast, pelvic (including a pap test), and rectal areas.

• Imaging tests

Computed tomography (CT scan) of the abdomen and pelvis identifies the degree of intra-abdominal disease. Transvaginal ultrasound produces pictures of the pelvis using sound waves. Magnetic resonance imaging (MRI) yields more precise imaging of the reproductive organs.

• Biopsy

Suspected lesions, lumps, or adhesions are examined with a biopsy or surgical excision. Peritoneal biopsies from random surfaces of the peritoneum, including those from the right side of the underside of the hemidiaphragm, the bladder reflection, the cul-de-sac, the right and left paracolic recesses, and pelvic sidewalls.

• Staging

This step helps to determine the extent and spread of the disease. Patients with early-stage or advanced-stage disease experience symptoms that are frequently very subtle and have similar symptom durations. 

• Tumour markers

Your physician will consider tumour markers such as CA125 and carcinoembryonic antigen (CEA). Epithelial ovarian, fallopian tube or peritoneal cancers will be the most typical diagnoses if there is a high CA125 level.

• Genetic testing

Inherited gene mutations feature in approximately 20% of ovarian, fallopian tube, and peritoneal cancers. Genetic testing can identify genetic mutations like BRCA1 or BRCA2 that can affect treatment options.⁸

Management and treatment

The management and treatment of fallopian tube cancer depends on many factors, such as the stage of the disease, type, the patient's general health, and personal preferences. A brief description of fallopian tube cancer management and treatment options follows :

Surgery

The type of surgery is based on the cancer's stage, determined by imaging studies. Treatment for early-stage fallopian tube cancer involves a salpingo-oophorectomy. It entails removing one or both ovaries with one or both fallopian tubes. In more advanced cancer stages, you might also require a total abdominal hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy, infrasonic omentectomy (removal of the abdominal lining), appendectomy (removal of the appendix), peritoneal washings, and peritoneal biopsies. The objective is to eradicate all possible cancer from patients with advanced disease. Surgery will involve either radiation therapy or chemotherapy afterward. This is also known as adjuvant therapy.  Staging and tumour debulking are two objectives of surgical intervention.

Radiation therapy

High-energy X-rays serve to kill cancer cells in this procedure. For fallopian tube cancer, radiation is not the main course of treatment. The adverse effects are frequent, and it could be more effective. It also helps the tumour shrink before surgery.

Chemotherapy and targeted therapies

Chemotherapy can be used following surgery to eradicate cancer cells that may remain. Recurrent or advanced fallopian tube cancer is treated with targeted therapies. The following table shows suggested interventions for various phases.

Talk with your healthcare provider about your treatment options, including any potentially positive and negative aspects. Personalised treatment plans are created according to each patient's unique diagnosis and situation.

Prevention

Since the specific causes are not entirely understood and some risk factors, such as genetic abnormalities, are uncontrollable, preventing fallopian tube cancer might be difficult. The American Cancer Society recommends genetic testing for women who have a known family history of the BRCA mutation, women who have been diagnosed with ovarian cancer, pancreatic cancer, breast cancer at a younger age, more than one family member with breast cancer, and breast cancer in a male family member. It is also possible to do genetic testing to detect sporadic mutations or any familial genetic mutations. The ovarian, fallopian tube and peritoneal malignancies have no known screening techniques that lower mortality rates. It is more probable to have false-positive results leading to unnecessary interventions because disease frequency is low and there aren't many high-quality screening tools available. Early detection by routine check-ups and heightened symptom awareness are crucial in controlling the disease.^8,12

FAQs

Is fallopian tube cancer aggressive?

A relatively aggressive gynaecological cancer is PFTC. One per cent of all female genital malignancies arise from it.⁹

How long does a person with fallopian tube cancer survive?

Patients with PFTC have a 22–57% 5-year overall survival rate. To predict patient outcomes more accurately, some prognostic indicators are studied. Stage, patient age, and the presence of a residual tumour following the initial operation are all consistently significant prognostic markers.¹³

Does removing fallopian tubes reduce cancer risk?

The likelihood of ovarian cancer is reduced by performing salpingectomy when individuals undergo surgery e.g. hysterectomy. Opportunistic salpingectomy has the potential to dramatically lower the risk of ovarian cancer, although it doesn't eliminate it.¹⁴

Summary

Effective management of fallopian tube cancer depends on early identification and immediate medical care. Consulting a healthcare expert is crucial if you have symptoms or risk factors. People diagnosed with fallopian tube cancer early, before the disease extends outside the pelvic area, have a good prognosis.