Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

that originates from the

fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ...

Signs and symptoms

The internal location of the fallopian tubes makes it difficult to reach an early diagnosis. Symptoms are nonspecific, and may consist of pain and

vaginal discharge Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amou ...

or bleeding. A pelvic mass may be detected on a routine gynecologic examination. Vaginal discharge in fallopian tube carcinoma results from ''intermittent hydrosalphinx'', also known as ''hydrops tubae profluens''.

Pathology

The most common cancer type within this disease is

adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, o ...

; in the largest series of 3,051 cases as reported by Stewart et al. 88% of cases fell into this category. According to their study, half of the cases were poorly differentiated, 89% unilateral, and the distribution showed a third each with local disease only, with regional disease only, and with distant extensions. Rarer forms of tubal neoplasm include

leiomyosarcoma Leiomyosarcoma is a malignant ( cancerous) smooth muscle tumor. A benign tumor originating from the same tissue is termed leiomyoma. While leiomyosarcomas are not thought to arise from leiomyomas, some leiomyoma variants' classification is evo ...

, and

transitional cell carcinoma Transitional cell carcinoma, also called urothelial carcinoma, is a type of cancer that typically occurs in the urinary system. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. It accounts for 95% of ...

. As the tumor is often enmeshed with the adjacent

ovary The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the bod ...

, it may be the pathologist and not the surgeon who determines that the lesion is indeed tubal in origin. Secondary tubal cancer usually originates from cancer of the ovaries, the endometrium, the GI tract, the peritoneum, and the breast.

Diagnosis

A pelvic examination may detect an adnexal mass. A

CA-125 Mucin-16 (MUC-16) also known as Ovarian cancer-related tumor marker CA125 is a protein that in humans is encoded by the ''MUC16'' gene. MUC-16 is a member of the mucin family glycoproteins. MUC-16 has found application as a tumor marker or bioma ...

blood test is a nonspecific test that tends to be elevated in patients with tubal cancer. More specific tests are a gynecologic ultrasound examination, a

CT scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

, or an MRI of the pelvis. Occasionally, an early fallopian tube cancer may be detected by chance during pelvic surgery.

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 Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...

Treatment

The initial approach to tubal cancer is generally surgical, and similar to that of ovarian cancer. As the lesion will spread first to the adjacent

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...

and ovary, a total abdominal

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may ...

is an essential part of this approach, removing the ovaries, the tubes, and the uterus with the cervix. Also, peritoneal washings are taken, the

omentum Omentum (Latin for 'apron') is a medical term referring to layers of peritoneum that surround abdominal organs. The term may refer to: * Greater omentum * Lesser omentum {{Disambig ...

is removed, and pelvic and paraaortic

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inc ...

s are sampled.

Staging Staging may refer to: Computing * Staging (cloud computing), a process used to assemble, test, and review a new solution before it is moved into production and the existing solution is decommissioned * Staging (data), intermediately storing data b ...

at the time of surgery and pathological findings will determine further steps. In advanced cases when the cancer has spread to other organs and cannot be completely removed, cytoreductive surgery is used to lessen the tumor burden for subsequent treatments. Surgical treatments are typically followed by adjuvant, usually platinum-based,

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...

. Radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications

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 Cisplatin is a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, cervical cancer, breast cancer, bladder cancer, head and neck cancer, esophageal cancer, lung cancer, mesothelioma, brain ...

-based chemotherapy.

Frequency

Tubal cancer is thought to be a relatively rare primary cancer among women, accounting for 1 to 2 percent of all gynecologic cancers, accessed 08-14-2008 In the US, tubal cancer had an incidence of 0.41 per 100,000 women from 1998 to 2003. Demographic distribution is similar to that of

ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...

, and the highest incidence is found in white, non-Hispanic women aged 60–79. However, recent evidence suggests tubal cancer to be much more frequent . Evidence is accumulating that individuals with mutations of

BRCA1 Breast cancer type 1 susceptibility protein is a protein that in humans is encoded by the ''BRCA1'' () gene. Orthologs are common in other vertebrate species, whereas invertebrate genomes may encode a more distantly related gene. ''BRCA1'' is a ...

and

BRCA2 ''BRCA2'' and BRCA2 () are a human gene and its protein product, respectively. The official symbol (BRCA2, italic for the gene, nonitalic for the protein) and the official name (originally breast cancer 2; currently BRCA2, DNA repair associated) ...

are at higher risk for the development of PFTC.BRCA mutations link to tubal cancer
accessed 08-14-2008

References

External links

{{DEFAULTSORT:Fallopian Tube Cancer Gynaecological cancer Rare cancers