Fallopian-Tube Cancer

Content provided by the Faculty of the Harvard Medical School

Fallopian-Tube Cancer

What Is It?

The fallopian tubes are the passageways that connect the ovaries and the uterus. Fallopian tube cancer occurs when cells in the fallopian tubes multiply out of control and form a tumor. As this tumor grows, it can eventually press against the inside of the fallopian tube, stretching the tube and causing pelvic pain. Over time, the tumor can eventually spread throughout the pelvis and abdomen.

Fallopian tube cancer is very rare. It accounts for less than 1% of all cancers of the female reproductive organs. Only 1,500 to 2,000 cases have been reported worldwide, primarily in postmenopausal women. It is more common for cancer to spread to a fallopian tube from elsewhere in the body (usually the ovary, breast or endometrium) than for a new cancer to develop in the fallopian tube.

Scientists don't know whether any environmental or lifestyle factors increase the risk of this cancer. Researchers are looking at the possibility that there might be some inherited (genetic) tendency to develop the illness. There is some evidence that women who inherit a mutation in the BRCA1 gene, a gene already linked to breast and ovarian cancer, seem to have an increased risk of developing fallopian tube cancer. Recent research has confirmed this. In one recent analysis of several hundred women who were carriers of the BRCA1 gene mutation, the incidence of fallopian tube cancer was increased more than 100-fold. Likewise, a substantial proportion of women with the diagnosis of fallopian tube cancer test positively for either the BRCA 1 or BRCA2 gene mutation. Recent recommendations suggest that any woman with a diagnosis of fallopian tube cancer be tested for the BRCA mutations.

Symptoms

Symptoms of fallopian tube cancer can include:

• Abnormal vaginal bleeding, especially after menopause

• Abdominal pain or a feeling of pressure in the abdomen

• Abnormal vaginal discharge (white, clear, or pinkish)

• The presence of an abdominal or pelvic mass

These symptoms also are caused by other gynecological problems.

Diagnosis

Because fallopian tube cancer is so rare, and its symptoms can be similar to the symptoms of other problems, your doctor may suspect that you have some other gynecological problem. Because of this, your doctor may ask you questions to evaluate your risk for gynecological infections, ovarian tumors or endometrial cancer. These conditions have symptoms similar to fallopian tube cancer and are more common than fallopian tube cancer.

Fallopian tube cancer should be considered when a woman has a vaginal discharge or bleeding and a positive Pap test but no evidence of cancer of the cervix or lining of the uterus (endometrial cancer). If the blood test for CA-125 (a tumor marker) shows an abnormally high reading, this adds further support to the diagnosis of fallopian tube cancer. But it still does not prove that a woman has this cancer.

A doctor may suspect fallopian tube cancer if he or she feels an abnormal mass during an internal pelvic exam. A pelvic ultrasound or computed tomography (CT) scan may show an abnormal growth in the area of the tube.

In most cases, women don't learn that they have fallopian tube cancer until a fallopian tube has been removed surgically to treat another illness or problem and is examined in a laboratory.

Any woman who is diagnosed with fallopian tube cancer should consider being tested for the BRCA mutation.

Expected Duration

Once it develops, fallopian tube cancer continues to grow until it is removed. Without surgery, fallopian tube cancer can spread to other organs in the pelvis and abdomen.

Prevention

Because the risk factors for fallopian tube cancer are unknown, there is no way to prevent it. However, blood tests might some day identify women who are more likely to develop fallopian tube cancer or ovarian cancer. These screening tests may identify BRCA1 mutations.

Treatment

Treatment for fallopian tube cancer includes surgery and chemotherapy. The extent of surgery depends on the how far the tumor has spread. If the tumor is contained in the fallopian tube, the surgeon will remove the fallopian tubes, ovaries and uterus (a hysterectomy).

Following removal of the tumor, many consider administering postoperative radiation therapy. In one study, a longer disease-free interval was found in women who receive administration of pelvic or abdominal radiotherapy after surgery.

If the tumor has spread to larger areas of the reproductive tract, pelvic lymph nodes and other involved tissue may need to be removed. Chemotherapy typically includes paclitaxel (Taxol) and carboplatin. Other studies have shown some anticancer activity for cisplatin (Platinol).

Sequential monitoring of the CA-125 blood levels are important prognostically, especially in helping determine if there is either residual disease after surgery and radiation therapy or whether there has been a recurrence following treatment of the initial cancer.

When To Call A Professional

Call your family doctor or gynecologist if you have abnormal vaginal bleeding, persistent or severe abdominal or pelvic pain, or abnormal vaginal discharge. In particular, a woman who has entered menopause should contact her doctor right away if she begins to have vaginal bleeding or a pinkish vaginal discharge.

Prognosis

The outlook depends on how deeply the cancer has invaded the fallopian tube. If the cancer is limited to the tube's inner lining, the prognosis is excellent, with 91% of women surviving for at least 5 years after diagnosis. However, if the cancer has penetrated the wall of the fallopian tube, then the 5-year survival rate drops to 53%. For tumors that have spread through the wall to the tube's outer surface, the 5-year survival rate is less than 25%.

Additional Info

National Cancer Institute (NCI) U.S. National Institutes of Health Public Inquiries Office Building 31, Room 10A03 31 Center Drive, MSC 8322 Bethesda, MD 20892-2580 Phone: 301-435-3848 Toll-Free: 1-800-422-6237 TTY: 1-800-332-8615 E-mail: cancergovstaff@mail.nih.gov http://www.nci.nih.gov/

American Cancer Society (ACS) 1599 Clifton Road, NE Atlanta, GA 30329-4251 Toll-Free: 1-800-227-2345 http://www.cancer.org/

American College of Obstetricians and Gynecologists 409 12th St., S.W. P.O. Box 96920 Washington, DC 20090-6920 Phone: 202-638-5577 http://www.acog.org/

National Women's Health Information Center (NWHIC) 8550 Arlington Blvd. Suite 300 Fairfax, VA 22031 Toll-Free: 1-800-994-9662 TTY: 1-888-220-5446 http://www.4woman.org/

Last updated:	August 14, 2008