Fallopian Tube Cancer Metastatic

Fallopian tube cancer that has spread beyond its original site to other parts of the body presents significant treatment challenges, yet understanding how this rare cancer behaves can help patients and their families navigate the journey ahead.

Table of contents

• What is Metastatic Fallopian Tube Cancer?
• How Fallopian Tube Cancer Spreads
• Signs and Symptoms
• Diagnosis and Staging
• Treatment Options
• Outlook and Survival

What is Metastatic Fallopian Tube Cancer?

Fallopian tube cancer forms in the tubes that carry eggs from the ovaries to the uterus. When this cancer is described as metastatic, it means the cancer cells have spread from the fallopian tubes to other parts of the body^[1]. Metastatic fallopian tube cancer is classified as Stage IV disease^[7].

Fallopian tube cancer is rare, making up as few as 1% of cancers affecting the female reproductive system. However, research shows that the most common type of ovarian cancer, called epithelial ovarian cancer, likely starts in the fallopian tube before spreading to the ovary^[1]. This discovery has changed how doctors understand and treat these cancers.

Most fallopian tube cancer starts in epithelial tissue, which are cells that line organs and glands. These cancers act like ovarian cancer and primary peritoneal cancer, and doctors diagnose, treat and manage all three types similarly^[1][5].

How Fallopian Tube Cancer Spreads

Understanding where ovarian and fallopian tube cancers spread can help patients know what to expect. When cancer is found outside the site where it started, it may be considered locally advanced when it reaches other parts of the pelvis, or metastatic when it spreads to more distant sites^[7].

The typical path of spread includes:

• Peritoneal dissemination: The cancer spreads throughout the lining of the abdomen, called the peritoneum^[4].
• Lymph node metastasis: Cancer cells travel to nearby lymph nodes in the pelvis and around the aorta^[4].
• Distant organs: If not treated successfully, the cancer can spread to the lungs, fluid around the lungs, or tissue inside the liver^[7].

While the typical course includes spread to the abdomen and lymph nodes, inguinal lymph node metastasis (spread to lymph nodes in the groin area) is rare. The initial presentation of fallopian tube cancer with an inguinal tumor is extremely rare^[4].

The challenge with fallopian tube cancer is that it spreads fast. Most fallopian tube and ovarian tumors are high-grade serous tumors, which means they grow and spread quickly^[1].

Signs and Symptoms

Symptoms of fallopian tube cancer can be hard to notice and easy to ignore, especially in early stages. You may not notice symptoms until the cancer has spread throughout your abdomen^[1].

Common signs and symptoms include:

• Pelvic pain or a mass in the pelvis
• Abdominal pain, swelling or bloating
• Loss of appetite, feeling full quickly or nausea
• Changes in bowel habits, like constipation or diarrhea
• Urinating more often than usual
• Abnormal periods or bleeding after menopause
• Watery or bloody vaginal discharge^[1]

You should see your healthcare provider anytime you notice a change in your health, especially if you have a family history of cancer or other risk factors^[1].

Diagnosis and Staging

When your healthcare providers think you may have fallopian tube cancer, they will order tests. These may include a pelvic exam, Pap test, ultrasound, and blood tests. However, a biopsy is the only way to know for sure if you have cancer. A biopsy looks at a piece of the fallopian tube for cancer cells and is used to find out the cancer type, how normal it is (called the grade), and if it has spread^[2].

A pathology report summarizes these results and is sent to your healthcare provider, often 5 to 10 days after the biopsy. This report is an important part of planning your treatment^[2].

To guide treatment, fallopian tube cancer is “staged.” Staging is the process of learning how much cancer is in your body and where it is^[16]. This stage is based on the size and location of the tumor, whether cancer cells are in the lymph nodes, and whether cancer cells are in other parts of the body^[2].

Stages range from Stage I (smallest, most confined tumors) to Stage IV (tumors that have spread to other parts of the body, also called metastatic cancer). Fallopian tube cancer is staged the same way that ovarian cancer is staged, using both the FIGO system (International Federation of Gynecologists and Obstetricians) and the TNM system described by the American Joint Committee on Cancer^[16].

Stage IV metastatic fallopian tube cancer means the cancer has spread to distant sites, such as the lungs or liver^[7].

Treatment Options

Treatment for metastatic fallopian tube cancer typically involves a combination of approaches. The stage and type of fallopian tube cancer will guide your treatment plan^[2].

Common treatments include:

• Surgery: Surgery can be used to remove the cancer. Treatment typically involves surgically removing the uterus (called a hysterectomy), the fallopian tubes (called a salpingectomy), and ovaries (called an oophorectomy)^[1].
• Chemotherapy: The use of medications to kill cancer cells, which can be given after surgery to kill any cancer cells that are still in the body^[2].
• Radiation: The use of high energy x-rays to kill cancer cells, which can be used before surgery to shrink the cancer^[2].
• Targeted therapies: These work against a certain target found on the cancer cells. You will be tested for certain targets to decide if these therapies are a choice for you^[2].

Fallopian tube cancer is curable if it’s treated early, when surgery can remove all of the cancer cells. The challenge is that it doesn’t often cause symptoms in the early stages, and it spreads fast. Most people aren’t diagnosed until fallopian tube cancer has spread and is harder to treat^[1].

In cases of recurrent and metastatic disease where the cancer cannot be surgically removed, palliative chemotherapy is the only available treatment. However, the effectiveness of standard chemotherapy regimens is not well-known, specifically in cases of extra-ovarian spread^[13].

Outlook and Survival

Certain factors affect treatment options and outlook. Patients who are diagnosed with Stage I and Stage II ovarian cancer (similar to fallopian tube cancer) have a 5-year survival rate of 90% and 70%, respectively. Patients diagnosed with Stage III have a 5-year survival rate of 39%^[7].

When looking at statistics, it is important to remember that these numbers represent a large group of patients and are not indicative of any one individual’s outlook. Each person’s situation is unique, and factors such as overall health, response to treatment, and the specific characteristics of the cancer all play a role^[7].

Living with metastatic fallopian tube cancer means understanding that things will change as you go along. You may have to adapt to shifting energy levels and schedule your life around doctor visits and treatment appointments^[21].

More than half of people with fallopian tube cancer or ovarian cancer are over 63 years old. Several risk factors increase the chances of developing this cancer, including a family history of breast, ovarian or fallopian tube cancer, genetic mutations in the BRCA gene, and inherited conditions such as Lynch syndrome^[1].