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Remission of Cancer
Female Reproduction System
|What Is Fallopian Tube Cancer?
It is where cancer cells are found in the lining of the fallopian tubes. The fallopian tubes are the ducts or tubes which connect the ovaries (where eggs are produced) to the uterus (womb) and allow the transport of eggs from one to the other. Typically if an egg encounters sperm in the fallopian tubes it will be fertilized and then moves to the womb where it settles and develops into an embryo. As there are two ovaries, there are two fallopian tubes, one on each side of the pelvis. Cancer which starts in the fallopian tube tissue is very rare and accounts for only 1 percent of all gynecologic cancers. In total only about 1500 cases of fallopian tube cancers have been recorded in America since records were started in 1847. Most cancers found in the fallopian tubes do not begin there. They are actually metastases (have spread) from cancer in the ovaries or womb rather than being primary fallopian tube cancer. The majority of the 1500 primary cases were found in women between the ages of 50 and 60 - there has only ever been one documented case in a teenager. Clinical experience of this disease is very limited and diagnosis is only usually possible after exploratory surgery. Experts think that fallopian tube cancer acts very much like ovarian cancer and so the treatment is usually similar. However, one major difference is that fallopian tube cancer is more likely to be diagnosed early because symptoms are more obvious.
Are There Different Types?
Yes, cancer can start in any of the cells which form the fallopian tubes. A tumor which forms in the gland cells (the most common type) is called adenocarcinoma. A tumor in the smooth muscle cells is called leiomyosarcoma and cancer in the cells which line the tube itself is known as transitional cell carcinoma.
What Are The Symptoms?
Usually women with the disease will feel a vague discomfort as the tumor presses on the bladder or rectum. A tumor mass is present in 75 percent of women at time of diagnosis.
Most women report a watery or bloody vaginal discharge. It may be white, clear or tinged with pink. If you experience this, your doctor will want to take a swab (a sample of cells) of your vagina and may also carry out a Pap test if you have not had one recently.
Abnormal vaginal bleeding is one of the symptoms of fallopian tube cancer- that is bleeding which occurs after menopause, between periods, after douching or after sexual intercourse.
Abdominal pain or pressure is another sign. Pain of course is a very vague symptom and it can be caused by something as minor as premenstrual syndrome (PMS) to the other end of the scale, cancer. If you do experience pelvic pain which lasts longer than 2 weeks, ask your doctor to check it out.
Some women may however be asymptomatic (that means they show no symptoms of cancer).
What Are The Risk Factors?
As the disease is so rare obtaining hard evidence for risk factors is difficult to obtain.
It appears to be more common in women who have had few or no pregnancies. On the other hand there is a decreased risk in women who have used hormone contraceptives (the pill) as well as those who have breast-fed children.
Women who have had several tubal infections and pelvic inflammatory disease (PID) are more prone to fallopian tube cancer. PID is an inflammation disorder of the upper female reproductive tract which includes the fallopian tubes and uterus. It is usually caused by a Chlamydia trachomatis infection which is a sexually transmitted disease. Read more: Fallopian tube cancer prevention.
According to cases registered on the National Cancer Institute (NCI) SEERs database, 84 percent of incidences are diagnosed in women aged 50 or older with 33 percent of cases in women 70 and older. The average age is between 50 and 60 years old. It is most common in white postmenopause women.
Recent reports indicate that women with fallopian tube cancer might also be at risk of breast and ovarian cancer. It is suspected that women who carry BRCA genetic mutations (traditionally linked to ovarian and breast cancer) may also be at increased risk for fallopian tube cancer. BRCA1 mutations have been identified in 16 to 43 percent of women with primary fallopian tube cancer. This is why women who do develop fallopian tube cancer are recommended to talk to a genetic advisor and consider genetic testing. Women with the disease may be offered a prophylactic oophorectomy to remove both ovaries as a preventative measure. For more about BRCA mutations read about genetic testing for breast cancer.
If one member of the family has developed the disease, this increases the risk factors for other women in the family. Also, if 2 or more very close relatives (sister, mother, daughter) have had ovarian cancer, this increases your risk of fallopian tube cancer.
Related: Causes of fallopian tube cancer.
How Is It Diagnosed?
It can be difficult to diagnose the disease. A fallopian tube cancer diagnosis before surgery is rare.
First your doctor will carry out a pelvic examination. If he does this at the time of symptoms he may discover a pelvic mass which is likely to be fluid-filled. If the mass bursts then vaginal discharge will increase. Although pain may reduce because of less pressure in the area, cancer will continue to grow. However further diagnostic tests are necessary because this may also be an indication of ovary cancer.
An abdominal or transvaginal sonography may help doctors identify the presence of a mass. Scans can also help to differentiate between tumors and cysts such as ovarian cysts.
A CT scan is an advanced X-ray machine that takes detailed images of inside the body. Sometimes a contrast die is swallowed or injected to help outline organs more clearly. It may or may not confirm the presence of a tumor. An MRI scan, which uses magnetic fields to produce images of the body may be used as an alternative.
CA 125 Blood Test
This blood test checks for a tumor marker which is present in about 85 percent of gynecological cancer cases. Although an abnormally elevated level will point to cancer, it does not prove it. Other factors can cause elevated levels such as uterine fibroids, PID and pregnancy.
The only way to conclusively diagnose if cancer is present is for a pathologist to study a sample of fallopian tube tissue (biopsy) under a microscope. The sample may be obtained by laparotomy, a surgical procedure which involves making a large incision through the abdominal wall and then removing a sample from the fallopian tubes. However in most instances laparoscopic surgery will be used (also known as minimally invasive surgery, keyhole surgery and bandaid surgery). This procedure only needs a minor incision and uses a laparoscope (lighted tube with small surgical devices on it) to look inside the organs and snip tissue samples.
If cancer is found near an ovary or includes the ovary, it can be very difficult to determine where it started. Did cancer start in the ovary or in the fallopian tubes? This is an important call which the pathologist needs to make. Determining which type of cancer is present may be important for prognosis (survival rate).
How Is It Treated?
Fallopian tube cancer treatment is usually much the same as ovarian cancer treatment. However the minimum treatment for fallopian tube cancer is a total abdominal hysterectomy, that includes the removal of the uterus, cervix and both fallopian tubes and ovaries. Nearby pelvic lymph nodes may also be removed. Fluid from the stomach is normally extracted during surgery for testing in the lab. This is because fallopian tube cancer nearly always spreads to the upper abdomen. The follow-up treatment usually involves the use of systemic chemotherapy. This may be injected through the vein, so it works throughout the body, or it can be placed directly into the abdominal cavity if cancer cells are found there. This is to ensure that any remaining cancer cells after surgery are destroyed. The most common chemo drugs used for fallopian cancer are cisplatin, carboplatin and paclitaxel (Taxol). External radiation therapy is not normally used as a follow-up to surgery except in instances of localized disease or for palliative care.
Also, read about Fallopian tube cancer recurrence.
New treatments are being researched in cancer clinical trials. Women who are diagnosed with fallopian tube cancer may want to consider joining a trial. However, as there are too few instances of the disease to carry out specific trials, most trials are rolled in with ovarian cancer trials.
How Is It Staged?
As soon as a diagnosis of cancer is confirmed the pathologist will want to stage the disease. That is, to determine the extent of it - the size and location of the tumor, the specific type of cancer cell involved and whether or not metastasis has occurred (spreading to other parts of the body). This process is known as fallopian tube cancer staging.
American Joint Committee on Cancer (AJCC) Staging Of Fallopian Tube Cancer:
Tumor is limited to 1 or both fallopian tubes. There may or may not be ascites (that is fluid buildup in the lining of abdominal tissue).
Tumor involves either 1 or both tubes. It has spread to the pelvic area and/or to the uterus or ovaries.
Tumor involves either 1 or both tubes. Cancer has spread to peritoneal tissue (the tissue which covers all abdominal organs) outside of the pelvis and/or regional lymph nodes.
Cancer has spread to other parts of the body (distant metastasis).
57 percent of women who are diagnosed after 60 are likely to be diagnosed in stages 3 or 4 compared to only 42 percent of women under the age of 60.
What Are The Survival Rates?
Fallopian tube cancer survival rates are based on the amount of women who are still alive between 5 and 10 years after their original diagnosis. As the disease is so rare, the figures are based on a very small sample. According the NCI's database, the 10 year survival rate can range between 44 and 86 percent, depending on the stage. If you have questions on this or any other topic, see womens health questions.