In short
Stage IV fallopian tube cancer represents the most advanced form of this disease, where cancer has spread beyond the pelvis and abdomen to distant parts of the body such as the liver, lungs, or distant lymph nodes.
What is stage IV fallopian tube cancer?
Fallopian tube cancer affects the tubes that carry eggs from your ovaries to your uterus. This cancer forms in the same type of tissue as ovarian cancer (cancer that starts in the ovaries) and primary peritoneal cancer (cancer that starts in the lining of the abdomen). Because of these similarities, doctors diagnose, treat, and manage all three cancers in the same way.
Stage IV is the most advanced stage of fallopian tube cancer. At this stage, the cancer has spread from the fallopian tubes to other parts of your body. The staging system used by doctors is called the FIGO system (International Federation of Gynecology and Obstetrics), which divides stage IV into two groups:
- Stage IVA: Cancer has caused a buildup of fluid in the lining around the lungs. This fluid contains cancer cells. This condition is called a malignant pleural effusion.
- Stage IVB: Cancer has spread to the inside of the liver or spleen, to lymph nodes outside the abdomen, or to other organs such as the lungs.
Most fallopian tube cancers start in epithelial tissue — the cells that line your organs and glands. These are the same type of cells where most ovarian cancers begin. Most fallopian tube and ovarian tumors are high-grade serous tumors, which means they spread quickly.
Symptoms and signs
Symptoms of fallopian tube cancer can be hard to notice and easy to ignore, especially in the early stages. You may not notice symptoms until the cancer has spread throughout your abdomen.
Signs and symptoms include:
- Pelvic pain or a feeling of a mass in the pelvis
- Abdominal pain, swelling, or bloating
- Loss of appetite, feeling full quickly, or nausea
- Changes in your bowel habits, such as constipation or diarrhea
- Peeing more often than usual
- Abnormal periods or bleeding after menopause
- Watery or bloody vaginal discharge
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.
Treatment approaches
The main treatments for stage IV fallopian tube cancer are surgery and chemotherapy (the use of medications to kill cancer cells). Your healthcare team will also consider targeted therapy — drugs that work against specific targets found on cancer cells.
Surgery
Your specialist surgeon will aim to remove as much of the cancer as possible. This is called cytoreductive surgery or debulking surgery. The surgeon will typically remove:
- Both ovaries
- Both fallopian tubes
- Your uterus (including the cervix)
The surgeon will also check where the cancer has spread in your pelvis and whether it is in your lymph nodes. Other tissue, including lymph nodes and portions of the bowel or bladder, may be removed as needed based on exactly where tumors are found before and during surgery.
It might not be possible to have surgery if your cancer has spread widely or you are not well enough. In these cases, you may have chemotherapy on its own to shrink the cancer as much as possible and to slow its growth.
Chemotherapy
Chemotherapy uses medications to kill cancer cells. For stage IV fallopian tube cancer, you might have:
- Chemotherapy after surgery — this is called adjuvant chemotherapy
- Chemotherapy before and after surgery — this is called neoadjuvant chemotherapy
- Chemotherapy into your abdomen during surgery — this is called hyperthermic intraperitoneal chemotherapy or HIPEC
Your healthcare team will discuss the best treatment approach for you. When you have chemotherapy will depend on your individual case.
Targeted cancer drugs
Some people may have treatment with a targeted cancer drug. This will depend on your situation. You might have a targeted cancer drug with chemotherapy, on its own, or after chemotherapy. You will be tested for certain targets to decide if these therapies are a choice for you.
Other treatments
You might have other treatments to help relieve your symptoms. This could be treatment for fluid in the abdomen or for a blocked bowel. Radiotherapy (the use of high energy rays to kill cancer cells) may be used to relieve symptoms like pain.
Prognosis and survival
Fallopian tube cancer is curable if it's treated early, when surgery removes all of the cancer cells. The challenge of this cancer 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.
The goal of treating stage IV fallopian tube cancer is to control it as long as possible. This can help you live longer and feel better. Your treatment plan will be based on your overall health, where the cancer has spread, and whether the specialist surgeon thinks they can remove all the cancer.
Researchers are always trying to improve the treatment and quality of life for people with ovarian and fallopian tube cancer.
