Fallopian tubes are the pair of ducts through which a woman’s eggs travel from the ovaries to the uterus, either to be fertilized or expelled during menstruation.
Primary carcinoma of the fallopian tube is one of the rarest gynecological cancers. Only about 1,500 to 2,000 cases have ever been reported in the United States. Secondary cancers due to metastasis from the ovaries, endometrium, gastrointestinal tract or breast are more common.
The most common types of fallopian tube cancer are serous and endometrioid adenocarcinomas. Leiomyosarcomas, which form in the smooth muscle of the fallopian tube, and transitional cell carcinomas, have also been reported.
Sometimes women with fallopian tube cancer may be asymptomatic or experience vague symptoms resembling other gynecologic or gastrointestinal problems. Because fallopian tube cancer is so rare, it can be difficult to diagnose and an evaluation by a physician is essential.
The more common symptoms include:
Because of its rarity, the causes and risk factors for developing primary fallopian tube cancer are not clearly understood. Researchers are, however, investigating the roles of genetics and hormones.
Factors that may affect a woman’s risk of developing fallopian tube cancer include:
Age: While this cancer can occur in women of any age, it most often occurs in Caucasian postmenopausal women between age 50 and 60, who have had few or no children. The peak incidence is in women aged 60 to 66 years.
Family History: A family history of fallopian tube cancer has been shown to increase a woman’s risk of developing this cancer.
Genetic Mutations: There is evidence that women who carry BRCA mutations – linked to high risk of breast and ovarian cancer – or one of the genes that cause HNPCC (hereditary nonpolyposis colorectal cancer) have a higher risk of developing fallopian tube cancer. BRCA mutations, particularly BRCA1, have been identified in 16-43% of women with primary fallopian tube cancer.
There is a decreased risk of developing fallopian tube cancer among women who have used hormonal contraception, as well as among those who have delivered and breast-fed children, with the protective effect increasing with the number of children a woman has delivered.
Having one or more of the symptoms listed above does not necessarily mean you have fallopian tube cancer. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.
The first step in making a diagnosis is a pelvic examination, in which the physician examines the uterus, ovaries, fallopian tubes and vagina. It is during this examination that the pelvic mass or lump may be discovered. However, the presence of this mass is not enough to make a diagnosis of fallopian tube cancer.
The physician may use several tests to make the diagnosis. Tests for fallopian tube cancer may include:
Ultrasound of the pelvis: High-frequency sound waves are used to create a pattern of echoes, called a sonogram, in which images of healthy tissues, cysts and tumors can be differentiated.
Computed tomography (CT) scan: A computer linked to an X-ray machine takes a series of detailed images of areas inside the body. Sometimes a contrast dye is injected or swallowed to make organs or tissues show up more clearly.
Magnetic resonance imaging (MRI): Magnetic fields, rather than X-rays, produce detailed images of the body.
Surgical biopsy: The only way to confirm a diagnosis of fallopian tube cancer is for a pathologist to look at the fallopian tube tissue. A sample of tissue is usually obtained during surgery.
CA125 test: This blood test checks levels of CA125, a protein known as a tumor marker for gynecological diseases. About 85% of women with such diseases have increased levels of CA125. An abnormally high reading adds support to the diagnosis, but on its own does not prove that a woman has this cancer.
Staging is the process used to determine if, where and to what extent the cancer has spread, and if it is affecting the function of other organs in the body. The Federation Internationale de Gynecologie et d’Obstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging for fallopian tube cancers as follows:
Stage I: The tumor is limited to one or both fallopian tubes.
Stage II: The tumor involves one or both tubes and has spread to the pelvic area and/or has metastasized to the uterus, ovary or other pelvic tissues.
Stage III: The tumor involves one or both tubes and the pelvis, and has spread to the abdominal cavity and/or regional lymph nodes.
Stage IV: The cancer has spread to the lung, liver or other distant organs.
Treatment for fallopian tube cancer depends on the size, location and stage of the tumor, as well as the woman’s age, overall health and desire to have children. Treatment outcomes for fallopian tube cancer depend on diagnostic procedures, the tumor stage and how much cancer remains after surgery. Because fallopian tube cancer is so rare, there have been few controlled studies from which to obtain accurate data for prognosis.
Surgery, followed by chemotherapy, is the most common treatment for fallopian tube cancer. The type of surgery is determined by the stage of the tumor, and may involve removal of the fallopian tubes, ovaries, uterus and cervix, as well as nearby lymph nodes.
Generally, the follow-up treatment to surgery for fallopian tube cancer is systemic chemotherapy, the use of powerful drugs to kill cancer cells. These drugs may be given through a vein or directly into the peritoneal space, where it will come in direct contact with the cancer. The most common drugs used to treat fallopian tube cancer are cisplatin, paclitaxel (Taxol), and carboplatin. The physician will develop the chemotherapy regimen according to the patient’s individual needs.
Radiation therapy is generally not used to treat fallopian tube cancer except in special circumstances for palliation of localized disease.
New treatments are currently being tested in clinical trials and women diagnosed with fallopian tube cancer may want to consider participating in one of these research studies. Women with fallopian tube cancer are usually eligible to participate in clinical trials designated for ovarian cancer patients. If interested, patients should search for both fallopian tube trials as well as ovarian cancer trials and check the eligibility criteria for participation.
Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help and hope.
Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support Web sites or message boards for those who may not have access to a traditional meeting.
Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, Tai Chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture.
Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.
Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.
Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers.
Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own Web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.