Fallopian Tube Cancer

Fallopian tube cancer is a rare disease that forms in the tubes connecting the ovaries to the uterus. Often silent in its early stages, this cancer shares many features with ovarian cancer and requires similar treatment approaches.

What is fallopian tube cancer?
Associated anatomy
How common is it?
Signs and symptoms
Causes and risk factors
Diagnosis
Staging
Treatment
Outlook and prognosis
Prevention
Living with fallopian tube cancer

What is fallopian tube cancer?

Fallopian tube cancer, also known as tubal cancer, is a disease in which malignant (cancer) cells form in the fallopian tubes. The fallopian tubes are the ducts that carry eggs from the ovaries to the uterus^[1]. Most fallopian tube cancer starts in the same tissue, called epithelial tissue, and acts like ovarian cancer and primary peritoneal cancer. Healthcare providers diagnose, treat and manage these cancers similarly^[1].

Recent research has changed our understanding of this disease. Doctors now think that the most common type of ovarian cancer usually starts in the end of the fallopian tube, rather than the ovary^[3]. Fallopian tube cancer typically starts at the very end of the fallopian tube where it joins the ovary. This part is called the fimbriae^[3]. It can sometimes be difficult for doctors to tell the difference between fallopian tube and ovarian cancer^[3].

Doctors classify your cancer as fallopian tube cancer if the cancer is in the fallopian tube, even if it is also in the ovary, or if they find precancerous cells on the inside surface of the fallopian tube. These are called STIC lesions, which stands for serous tubal intraepithelial carcinomas^[3].

Associated anatomy

Fallopian tubes
Ovaries
Uterus
Peritoneum

How common is it?

For years, medical experts thought of fallopian tube cancer as the rarest cancer that affects the female reproductive system, also called gynecological cancers. As few as 1% of gynecological cancers start in the cells lining your fallopian tubes^[1]. It is very rare and accounts for only 1 percent to 2 percent of all gynecologic cancers^[4].

About 1,500 to 2,000 cases of fallopian tube cancer have been reported worldwide, and approximately 300 to 400 women are diagnosed with the condition annually in the United States^[4].

However, new research shows that the most common type of ovarian cancer, called epithelial ovarian cancer, likely starts in the fallopian tube. It forms at the end of the tubes where eggs enter from your ovaries, and then spreads to the surface of your ovary and the rest of your pelvis and abdomen^[1].

Signs and symptoms

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^[1]. The symptoms of fallopian tube cancer can be very unclear and difficult to spot^[3].

Signs and symptoms of fallopian tube cancer include^[1]^[3]:

Pelvic pain or a feeling of pressure in the abdomen
Abdominal pain, swelling or bloating
Loss of appetite or feeling full quickly
Nausea or feeling sick
Changes in your bowel habits, such as constipation or diarrhea
Urinary symptoms such as needing to pee more often or urgently
Abnormal vaginal bleeding, especially after menopause
Abnormal vaginal discharge that is white, clear, pinkish, watery, or bloody

A particular feature of fallopian tube cancer is a blood-stained watery vaginal discharge. This discharge results from intermittent hydrosalphinx, also known as hydrops tubae profluens^[5].

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].

Causes and risk factors

Researchers aren’t sure what causes fallopian tube cancer^[1]. Because this cancer is so rare, little is known about what causes it^[4]. They do know that 90% of the time, it develops in glands that line your organs, including epithelial cells. These are the same type of cells where most ovarian cancers start. Most fallopian tube and ovarian tumors are high-grade serous tumors. This means they spread fast^[1].

The most common cancer type within this disease is adenocarcinoma, which accounts for about 88% of cases. According to research, half of the cases were poorly differentiated, 89% occurred on one side only, and the distribution showed a third each with local disease only, with regional disease only, and with distant extensions^[5].

The remaining fallopian tube cancers start in connective tissue, called sarcomas^[1]. Rarer forms of tubal cancer include leiomyosarcoma and transitional cell carcinoma^[5].

Risk factors

Factors that increase your chances of developing fallopian tube cancer include^[1]:

Age: More than half of people with fallopian tube cancer or ovarian cancer are over 63. Fallopian tube cancer typically affects women between the ages of 50 and 60, although it can occur at any age^[4].
Ethnicity: People living in North America or those of Northern European or Ashkenazi Jewish descent are more likely to get fallopian tube cancer. It is more common in Caucasian women^[4].
Family history: Your risk is greater if you have a first-degree biological relative (mother, sister, daughter) who’s had breast cancer, ovarian cancer, or fallopian tube cancer.
Genetic mutations: Changes to the breast cancer (BRCA) gene increase your risk. There is evidence that women who have inherited the gene linked to breast and ovarian cancer, called BRCA1, are also at an increased risk of developing fallopian tube cancer^[4].
Health conditions: Inherited conditions such as Lynch syndrome and Peutz-Jeghers syndrome increase fallopian cancer risk. Endometriosis is also a risk factor.
Pregnancy and childbirth history: You’re more likely to develop fallopian tube cancer if you’ve never been pregnant or if you had your first full-term pregnancy past age 35. It is more common in women who have had few or no children^[4].
Menstrual cycle history: Getting your first period before age 12 and going through menopause late increases risk.

Diagnosis

Because fallopian tube cancer is so rare, and its symptoms can resemble other problems, it can be difficult to diagnose^[4]. In some cases, women don’t learn they have fallopian tube cancer until a tube has been removed surgically during an operation to treat another illness or problem^[4]. It may be found at an early stage when removing the tubes and ovaries as a preventive measure^[5].

Diagnosis is by blood tests, medical imaging, and pathologic assessment of fallopian tissue^[5]. Your doctor will start by asking about any symptoms you may be experiencing, as well as reviewing your medical history and conducting a thorough physical exam^[4].

Tests that may be performed include^[3]^[4]^[5]:

Pelvic exam: This test involves feeling the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size.
Blood tests: These include a CA125 test, which checks levels of a blood protein known as CA125, a tumor marker for gynecological diseases. An estimated 85 percent of women with gynecological disease have increased levels of CA125. A complete blood count (CBC) may also be done.
Ultrasound scan: This includes transvaginal and abdominal ultrasound.
CT scan: A computed tomography scan of your abdomen and pelvis may help determine the size, shape, and structure of your ovaries.
MRI scan: Magnetic resonance imaging may be used.
Surgery and biopsy: Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary or fallopian tube and have it tested for signs of cancer. Pathologic assessment may include SEE-FIM Protocol.

A pelvic mass may be detected on a routine gynecologic examination^[5].

Staging

Fallopian tube cancer is staged the same way that ovarian cancer is staged^[12]. Staging is the process of learning how much cancer is in your body and where it is. The International Federation of Gynecology and Obstetrics (FIGO) staging system is used to stage cancers in the ovaries, fallopian tubes, and peritoneum^[3]^[5].

There are four stages, numbered 1 to 4. Stage 1 is the earliest stage and stage 4 is the most advanced stage^[3]. The staging is based on^[12]:

If the cancer has spread, and if so, how far
How much cancer is in your body

The stages are defined as follows^[5]:

Stage 0: Carcinoma in situ (very early cancer)
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 (spread to other organs)

Advanced cancer means cancer that has spread outside the ovary. It might have spread within the pelvis or abdomen, or to other parts of the body such as the lungs^[17].

Treatment

Doctors treat fallopian tube cancer in the same way as ovarian cancer^[3]. The initial approach to tubal cancer is generally surgical, and similar to that of ovarian cancer^[5]. Treatment involves surgically removing your uterus (hysterectomy), your fallopian tubes (salpingectomy), and ovaries (oophorectomy)^[1].

As the cancer will spread first to the adjacent uterus and ovary, a total abdominal hysterectomy is an essential part of this approach, removing the ovaries, the tubes, and the uterus with the cervix. Also, peritoneal washings are taken, the omentum is removed, and pelvic and paraaortic lymph nodes are sampled^[5].

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^[5].

The treatments include^[3]:

Surgery: This is typically the first treatment approach
Chemotherapy: This is usually recommended as a follow-up treatment to surgery. Treatment generally involves a combination of surgery and chemotherapy^[18]
Targeted cancer drugs: If genetic testing reveals that a patient has a BRCA mutation, they’re eligible for maintenance medications called PARP inhibitors. Those are given to patients after chemotherapy for about two years to try to keep them in remission^[18]
Hormone therapy: May be used in some cases
Radiotherapy: Radiation treatment may be an option
Treatment to help with symptoms

Staging at the time of surgery and pathological findings will determine further steps^[5]. Genetic testing determines if additional treatment is needed^[18].

Outlook and prognosis

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^[1].

Currently, about 70% of women with high-grade serous ovarian carcinomas (HGSOC), the subtype that accounts for approximately 75% of ovarian cancers and shares features with fallopian tube cancer, are diagnosed with advanced stage disease^[7].

Sometimes it is possible to cure cancer that is advanced at diagnosis. But this isn’t usually the case. It depends partly on the exact stage of your cancer and also on what treatment you can have, and how well the treatment works^[17].

Research has found that there is a window of several years between the development of abnormal cells or lesions in the fallopian tubes and the start of ovarian cancer. Using a mathematical model, researchers estimated that the average time between the development of STIC lesions and ovarian cancer was 6.5 years. They found that while the lesions were slower to develop, in patients with metastatic lesions, the time between the start of the ovarian carcinoma and development of metastases appears to have been rapid, averaging 2 years^[7].

Treatment can sometimes control the cancer and relieve symptoms for many months and years. But it might be a shorter time if you are very unwell, or you can’t have further treatment^[17].

Prevention

Although fallopian tube cancer cannot be prevented, you should talk to your doctor about setting up regular screenings if you have^[8]:

A family history of fallopian tube, ovarian, or breast cancer
The BRCA1 gene

Women with an increased risk of ovarian cancer may consider surgery to lessen the risk^[1]. Studies conducted more than a decade ago provided evidence that lesions found in the fallopian tubes, called serous tubal intraepithelial carcinomas (STICs), might be precursors for most HGSOCs. Those earlier studies identified STIC lesions in women with BRCA1 or BRCA2 mutations who’d had prophylactic surgery to remove their fallopian tubes and ovaries to reduce their cancer risk^[7].

Living with fallopian tube cancer

Coping with side effects

Treatment comes with short- and long-term side effects, some of which may be permanent^[18]. Chemotherapy comes with side effects that vary from person to person. Short-term side effects include muscle and joint aches, weak legs, peripheral neuropathy (numbness and tingling in the fingers and toes), nausea, vomiting, fatigue, and lack of appetite^[18].

Fallopian tube cancer and its treatment can also affect the bowels. Some patients have diarrhea or constipation, but probably the most serious side effect is bowel obstruction^[18].

Most long-term side effects begin in the short term and become long-term. For example, the effects of chemotherapy can linger for months. Peripheral neuropathy is sometimes permanent, and the bowels and bladder may not normalize for a year. It can take a full year to recover from chemotherapy. You’re not going to have your typical energy level right away^[18].

“Chemo brain” is the term used to describe thinking and memory problems that can occur after chemotherapy^[18].

If you’re experiencing any of these issues, talk to your care team. Many short-term side effects can be treated to improve your quality of life^[18].

Emotional and practical support

Living with cancer can make you feel a variety of emotions: frustration, sadness, guilt, and exhaustion, to name a few. Give yourself permission to feel your emotions. Remember that feelings don’t define who you are^[20].

You don’t have to go through this experience alone. Develop a support team that can help you along the way by reaching out to^[20]:

Professional help (such as a counselor or therapist)
Family and friends
Other people with cancer (through online forums or gynecologic cancer events)
Ovarian or gynecologic cancer advocacy groups, which can provide emotional support, education for you and your care partner, financial assistance, and connection to other women living with gynecologic cancer

Fear of recurrence

You may find yourself worrying about ovarian cancer’s high recurrence rate^[18]. Recurrence occurs in more than 80% of patients with advanced ovarian cancer, so knowing what to look for may better help you prepare with your healthcare team. Maintenance therapy may be an option to help delay the time before the cancer may return^[20].

Symptoms of recurrence may include abdominal pain, swelling, or bloating; changes in bowel movements; fatigue; elevated CA-125 levels; pelvic and lower back pain; and urinary issues^[20].

After treatment, regular screening is recommended to detect recurrence^[20]. Advanced cancer and its treatment can cause physical symptoms. These can be difficult to cope with. It is important that you feel as well as you possibly can^[17].