Fallopian Tube Cancer Treatment
Surgery, Chemo & Radiation Therapy

Treating fallopian tube cancer

Hysterectomy with Salpingo Oophorectomy

Fallopian Tube Cancer Treatment

Contents

How Is It Treated?
Surgery
Chemotherapy
Radiotherapy
Hormonal Therapy
Follow Up Care
Effects On Fertility In Younger Women



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Fallopian Tube Cancer
Guide to Cancer

How Is It Treated?

Fallopian tube cancer treatment is primarily the same as ovarian cancer treatment. However the minimum treatment for fallopian tube cancer is usually a hysterectomy followed by chemotherapy. Radiation therapy and hormonal therapy are also occasionally used. Any treatment given to increase the patient's survival rate after the main therapy is known as adjuvant therapy. If it is given before the main treatment, it is called neoadjuvant treatment. If you have received a fallopian tube cancer diagnosis, discussing treatment options with doctors can be complex and intimidating. Do not be afraid to ask for clarifications and if you are not satisfied with any of the answers seek a second opinion. In fact your health insurance company may even insist on it. You may even be advised to take part in a cancer clinical trial which is researching new treatment methods for this rare disease.

Surgery

The type of cancer surgery recommended will depend on the extent of the tumor(s). If it has spread, as it will have in most cases, beyond one fallopian tube then the aim of the treatment is to leave the woman with as little infected tissue as possible. This will usually involve a hysterectomy (removal of the uterus) along with removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy). The omentum which is a piece of fatty tissue over the abdominal organs is also removed as most fallopian tube cancers spread to this area. Some local lymph nodes may also be extracted. The surgeon will also take several biopsies of the remaining surrounding tissue to ensure that no cancer remains behind. This is also an important part of the fallopian tube cancer staging process. Women with Stage 3 cancer may need to have a section of their bowel removed. Very advanced stages of the disease will be treated by cytoreduction or debulking surgery. The goal of this treatment is to remove as much of the tumor as is safely possible.

Will I Survive? See: Fallopian tube cancer survival rates.

Side Effects Of Surgery

Pain
Women who undergo a hysterectomy and oophorectomy will experience pain after surgery. During surgery most women will be given a general anesthetic and epidural injection. The epidural can be left in place for 3 days after surgery which provides continual pain relief. When it is removed, medications may be given until the worst symptoms have passed.

Fluid Buildup
If the surgeon removed some lymph nodes (lymphadenectomy), parts of the body may bloat with fluid because the lymphatic system is not working properly. This condition is called lymphedema. Symptoms may not even occur until a year or two after surgery. It can be treated with exercise, wearing special garments and massage.

Adhesions
Sometimes internal scarring can occur as a result of the operation. This scar tissue can glue other tissues of the body together as it sets. This is known as adhesions. If adhesions appear on the bladder or bowel, they will need to be treated by further surgery.

Menopause
If both ovaries are removed and you were having periods before surgery, you will be plunged instantly into premature menopause. That means you are likely to experience menopause symptoms such as hot flashes and night sweats (other problems which can occur include menopause depression and menopause skin problems). Symptoms may be more severe than those which occur as a result of natural menopause. Your doctor may recommend estrogen replacement therapy (ERT).

Infertility
After the removal of the uterus and ovaries, the woman (if she was fertile before the operation) is no longer able to conceive.

Recovery From Surgery

Most women feel better about 6 weeks after surgery but a full cancer surgery recovery can take up to 6 months. Heavy lifting should be avoided for 3 months and you will need to avoid driving for about 4 weeks. Vaginal sexual intercourse should be avoided for about 6 weeks.

Chemotherapy

Chemo (see chemo guide) is normally given as an adjuvant therapy after surgery. It is usually given by a needle inserted into the vein by oncologist nurses. Chemo drugs are given in cycles with each cycle followed by a period of rest. The number of cycles recommended is determined by the stage. Three to four cycles are recommended for Stage 1 and six for Stages 3 and 4. The most common chemo drugs prescribed for fallopian tube tumors are cisplatin, carboplatin and paclitaxel (Taxol). There is very little data on the use of chemotherapy specifically for fallopian tube cancer and given the small number of women with the disease any large scale randomized trials are unlikely. As most fallopian tumors are a type called 'serous', which is similar to epithelial ovarian cancer (see types of ovarian cancer), they are treated in the same way. In fact many ovarian cancer clinical trials will include fallopian tumor patients because of the similarity of their response to chemotherapeutic drugs.Yet the role of adjuvant chemotherapy in early stages of fallopian tube cancer remains unclear. One study of 115 patients with an early stage of fallopian tube carcinoma reported a 5 year survival rate of 53 percent for women receiving radiation therapy compared to 27 percent treated with the chemo drug cisplatin. This would certainly suggest that adjuvant radiation therapy may be better at treating very early stages of the disease.

Radiotherapy

In some cases external radiation therapy to the pelvis and/or abdomen may be given following surgery and chemotherapy. The usefulness of radiation for this particular disease is still questionable which is why it is not used very often. It seems to be more effective if applied to the upper abdomen and pelvis as opposed to just the pelvis alone. Further studies are required to determine which women are better candidates for the procedure, what the optimal dosage is and what is the best way for it to be delivered.

Hormonal Therapy

Some female cancers depend on hormones for their growth. Hormonal therapy may help to reduce or block those hormones from helping cancer to grow - breast cancer hormone therapy is the main way this treatment is used. It is different to hormone therapies, such as HRT or ERT which introduce hormones into the body. Hormonal therapy works in the opposite way by restricting their production. The role of hormonal therapy in fallopian tube cancer is not clear but there have been varying degrees of success when megestrol acetate and medroxyprogesterone acetate is used in combination with chemotherapy.

Tubal Sarcomas

These are very rare fallopian tube tumors. The majority are malignant mixed mesodermal tumors. They are treated in the same way as adenocarcinoma tumors (the most common type) - that is, primary surgery followed by cisplatin based chemotherapy. However the prognosis for the patient is generally very poor.

Follow Up Care

Follow up care by your cancer medical team after treatment is very important. A regular check up will involve a physical examination and CA 125 blood test. CA 125 is a tumor marker which is found in many patients with both ovarian cancer and fallopian tube cancer. Elevated levels are normally found before treatment and they drop after surgery and during chemotherapy. If levels begin to rise again it could be a sign of a fallopian tube cancer recurrence. One study of 53 patients found rising levels in 90 percent of patients who presented with a clinical recurrence. However, there may be other reasons for CA 125 levels to rise including pelvic inflammatory disease and uterine fibroids.

Effects On Fertility In Younger Women

Although fallopian tube cancer tends to occur in postmenopause women, some younger women will develop the disease before they have completed their family. The added distress of losing fertility in addition the news that you have cancer can be devastating. If fertility is a factor, the woman should contact a reputable assisted reproductive clinic (various contact details below) to discuss her options. Cancer can affect a woman's chances of having a baby in two ways - by surgery or as a result of damage to the ovaries and eggs by chemotherapy. With the vast majority of fallopian tube cancer patients, treatment will require a hysterectomy which means loss of fertility. However, in a very few cases, if cancer is still confined to one fallopian tube it may be possible to retain the uterus and opposite ovary and fallopian tube. The woman will then retain some fertility. During a normal menstrual cycle an egg is released once a month from one of the ovaries, there does not appear to a set pattern as to which ovary releases the egg. If one ovary is surgically removed the remaining ovary takes over egg production. However in most instances saving an ovary is not possible because cancer has normally spread beyond the fallopian tube by the time it is diagnosed.

Also, read about alternative treatments for cancer which include acupuncture, mediation and nutrition, including cancer diet foods.

Useful Contact Details

United States

RESOLVE: National Infertility Association
1760 Old Meadow Road, Suite 500
McLean, VA 22102
Phone: 703-556-7172
Website: www.resolve.org

Great Britain

Human Fertilisation and Embryology Authority
Finsbury Tower
103-105 Bunhill Row
London EC1Y 8HF
Phone: 020 7291 8200
Email: admin@hfea.gov.uk
Website: www.hfea.gov.uk

Australia

Fertility Society of Australia
61 Danks St West
Port Melbourne VIC 3207
Phone: 03-9645-6359
Email: kimo@wsm.com.au
Website: www.fertilitysociety.com.au

Related Topics and Questions
What is the best treatment for cancer?
Recommended health screenings for women: Essential tests for each life stage.

  Related Articles on Fallopian Tube Cancer

For more gynecologic treatment information, see the following:

Fallopian tube cancer prevention: Reduce your risks.
Causes of fallopian tube cancer: Infections and inflammation.
Treatment of endometrial cancer: Hysterectomy and more.

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WOMENS HEALTH ADVICE: ABOUT FALLOPIAN TUBE CANCER
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