Fallopian tube cancer
Encyclopedia
Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant neoplasm that originates from the fallopian tube
.
, and the highest incidence was found in white, non-Hispanic women and women aged 60–79. However, recent evidence suggests tubal cancer to be much more frequent .
Evidence is accumulating that individuals with mutations of BRCA1
and BRCA2
are at higher risks for the development of PFTC.
; in the largest series of 3,051 cases as reported by Stewart et al. 88% of cases fell into this category. According to them half of the cases were poorly differentiated, 89 % unilateral, and the distribution showed a third each with local, regional, and distant extensions. Rarer forms of tubal neoplasm include the leiomyosarcoma
, and the transitional cell carcinoma
.
As the tumor is often enmeshed with the adjacent ovary
it may be the pathologist and not the surgeon who will determine 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.
Vaginal discharge in fallopion tube carcinoma result from intermittent hydrosalphinx that is called as hydrops tubae profluens.
. A CA-125
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, or an MRI of the pelvis
.
Occasionally, an early fallopian tube cancer may be detected serendipitously during pelvic surgery.
and ovary, a total abdominal hysterectomy
is an essential part of this approach and removes the ovaries, the tubes, and the uterus with the cervix. Also, peritoneal washing
s are taken, the omentum
is removed, and pelvic and paraaortic lymph node
s 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
.
Also radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications
staging is done at the time of surgery:
Fallopian tube
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
.
Frequency
Tubal cancer is thought to be a relatively rare primary cancer among women accounting for 1 to 2 percent of all gynecologic cancers, In the USA tubal cancer had an incidence of 0.41 per 100,000 women from 1998 to 2003. Demographic distribution is similar to ovarian cancerOvarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
, and the highest incidence was found in white, non-Hispanic women and women aged 60–79. However, recent evidence suggests tubal cancer to be much more frequent .
Evidence is accumulating that individuals with mutations of BRCA1
BRCA1
BRCA1 is a human caretaker gene that produces a protein called breast cancer type 1 susceptibility protein, responsible for repairing DNA. The first evidence for the existence of the gene was provided by the King laboratory at UC Berkeley in 1990...
and BRCA2
BRCA2
BRCA2 is a protein that in humans is encoded by the BRCA2 gene.BRCA2 orthologs have been identified in most mammals for which complete genome data are available....
are at higher risks for the development of PFTC.
Pathology
The most common cancer type is the adenocarcinomaAdenocarcinoma
Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Epithelial tissue includes, but is not limited to, the surface layer of skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium can be derived embryologically from...
; in the largest series of 3,051 cases as reported by Stewart et al. 88% of cases fell into this category. According to them half of the cases were poorly differentiated, 89 % unilateral, and the distribution showed a third each with local, regional, and distant extensions. Rarer forms of tubal neoplasm include the leiomyosarcoma
Leiomyosarcoma
Leiomyosarcoma , aka LMS, is a malignant cancer of smooth muscle....
, and the transitional cell carcinoma
Transitional cell carcinoma
Transitional cell carcinoma is a type of cancer that typically occurs in the urinary system: the kidney, urinary bladder, and accessory organs. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus...
.
As the tumor is often enmeshed with the adjacent ovary
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
it may be the pathologist and not the surgeon who will determine 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.
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 or bleeding. A pelvic mass may be detected on a routine gynecologic examination.Vaginal discharge in fallopion tube carcinoma result from intermittent hydrosalphinx that is called as hydrops tubae profluens.
Diagnosis
A pelvic examination may detect an adnexal massAdnexal mass
An adnexal mass is a lump in tissue of the adnexa of uterus, usually in the ovary or fallopian tube. Adnexal masses can be benign or cancerous.-Causes:...
. A CA-125
CA-125
CA-125 also known as mucin 16 or MUC16 is a protein that in humans is encoded by the MUC16 gene. MUC16 is a member of the mucin family glycoproteins...
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, or an MRI of the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
.
Occasionally, an early fallopian tube cancer may be detected serendipitously during pelvic surgery.
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 uterusUterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and ovary, a total abdominal hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
is an essential part of this approach and removes the ovaries, the tubes, and the uterus with the cervix. Also, peritoneal washing
Peritoneal washing
Peritoneal washing is a procedure used to look for malignant cells, i.e. cancer, in the peritoneum.Peritoneal washes are routinely done to stage abdominal and pelvic tumours, e.g. ovarian cancer.-External links:*...
s are taken, the omentum
Omentum
Omentum may refer to:* greater omentum* lesser omentum...
is removed, and pelvic and paraaortic lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s are sampled. Staging
Cancer staging
The stage of a cancer is a description of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to , and whether it has spread to distant organs...
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
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
.
Also radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications
Staging
FIGOInternational Federation of Gynecology and Obstetrics
The International Federation of Gynaecology and Obstetrics, usually just FIGO as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique, is a worldwide NGO organisation representing obstetricians and gynaecologists in over one hundred territories...
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