| Primary fallopian tube cancer | |
|---|---|
 | |
| Specialty | Oncology,gynaecology |
| Symptoms | Early: Vague, none[1][2] Later:Abnormal vaginal bleeding,abdominal distension, blood stained wateryvaginal discharge,pelvic pain, loss of appetite,weight loss, feelfull[1][2] |
| Diagnostic method | |
| Differential diagnosis | Ovarian cancer,peritoneal cancer[1] |
Primary fallopian tube cancer (PFTC), also known astubal cancer, is a malignantneoplasm that originates from thefallopian tube.[1][3] Along withprimary ovarian andperitoneal carcinomas, it is grouped under epithelial ovarian cancers; cancers of the ovary that originate from a fallopian tube precursor.[4][5]
In the early stages, symptoms are typically vague.[2] Other symptoms may includeabnormal vaginal bleeding, blood stained wateryvaginal discharge,pelvic pain, orabdominal distension.[2] An affected person may feelfull or haveweight loss.[1]
Vaginal discharge in fallopian tube carcinoma results fromintermittent hydrosalphinx, also known ashydrops tubae profluens.[6]
The most common cancer type within this disease isadenocarcinoma; in the largest series of 3,051 cases as reported by Stewart et al. 88% of cases fell into this category.[7] 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 includeleiomyosarcoma, andtransitional cell carcinoma.
As the tumor is often enmeshed with the adjacentovary, 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 is by blood tests,medical imaging, and pathologic assessment of fallopian tissue.[1] Blood tests includeCa-125 andCBC.[1] Imaging includestransvaginal andabdominalultrasound,CT scan, andMRI.[2] Pathologic assessment may includeSEE-FIM Protocol.[1] A pelvic mass may be detected on a routine gynecologic examination.[2] It may be found at an early stage whenremoving the tubes andovaries as a preventive measure.[1]
Ovarian and peritoneal cancers may present in a similar way.[1]
| Stage | Definition |
|---|---|
| Stage 0 | Carcinoma in situ[1] |
| Stage I | Growth limited to fallopian tubes[1] |
| Stage II | Growth involving one or both fallopian tubes with extension to pelvis[1] |
| Stage III | Tumor involving one or both fallopian tubes with spread outside pelvis[1] |
| Stage IV | Growth involving one or more fallopian tubes with distantmetastases[1] |
The initial approach to tubal cancer is generally surgical, and similar to that of ovarian cancer. As the lesion will spread first to the adjacentuterus and ovary, a total abdominalhysterectomy is an essential part of this approach, removing the ovaries, the tubes, and the uterus with the cervix. Also,peritoneal washings are taken, theomentum is removed, and pelvic and paraaorticlymph nodes are sampled.Staging 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.[8][9]Radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications.[10]
Five-year survival rate is around 65%, though may range from 30% to 92% depending on stage at diagnosis and the amount of tumor remaining after surgery.[1][4]
Tubal cancer is thought to be a relatively rare primary cancer among women, accounting for 1 to 2 percent of allgynecologic cancers,[11] In the US, tubal cancer had an incidence of 0.41 per 100,000 women from 1998 to 2003.[7] Demographic distribution is similar to that ofovarian cancer, and the highest incidence is found in white, non-Hispanic women aged 60–79.[7] However, recent evidence suggests tubal cancer to be much more frequent.[1]
Evidence is accumulating that individuals with mutations ofBRCA1 andBRCA2 are at higher risk for the development of PFTC.[12][13]
The first descriptions were made by Renaud in 1847 andErnst Gottlob Orthmann in 1888.[14]
