Fallopian tube cancer is a rare form of cancer that develops in the tubes connecting the ovaries to the uterus. While once considered extremely uncommon, new research suggests that many ovarian cancers may actually originate in the fallopian tubes, making this disease more significant than previously thought.
Understanding Fallopian Tube Cancer
Fallopian tube cancer forms in the slender ducts that connect your ovaries to your uterus. These tubes, roughly the size and shape of an almond on each side, play a vital role in reproduction by carrying eggs from the ovaries through to the womb. When cancer develops in these tubes, it typically begins in special cells called epithelial cells, which are the same type of cells that line your organs and glands[1].
For many years, medical experts believed fallopian tube cancer was the rarest type of cancer affecting the female reproductive system, accounting for only one to two percent of all gynecological cancers. However, groundbreaking research has changed this understanding. Scientists now recognize that the most common type of ovarian cancer, called epithelial ovarian cancer, likely begins at the very end of the fallopian tube where it meets the ovary, in an area called the fimbriae. The cancer then spreads to the surface of the ovary and throughout the pelvis and abdomen[1].
This discovery has important implications for how doctors think about and treat these cancers. Healthcare providers now often group fallopian tube cancer together with ovarian cancer and primary peritoneal cancer (cancer of the tissue lining the abdominal wall) because they form in similar tissue types and behave in comparable ways. This means they are diagnosed, treated, and managed using similar approaches[3].
How Common Is This Cancer?
Historically, only about one percent of gynecological cancers were thought to start in the cells lining the fallopian tubes. Worldwide, approximately 1,500 to 2,000 cases of fallopian tube cancer have been reported, with around 300 to 400 women diagnosed annually in the United States alone[4].
The condition most commonly affects women between the ages of 50 and 60, though it can occur at any age. More than half of people diagnosed with fallopian tube cancer or ovarian cancer are over 63 years old[1].
Fallopian tube cancer is more frequently seen in certain populations. Women of Northern European or Ashkenazi Jewish descent, as well as those living in North America, have higher rates of this disease. Caucasian women who have had few or no children appear to face increased risk as well[4].
Research published in 2017 revealed that the genetic changes seen in ovarian tumors in many patients were already present in lesions that had formed years earlier in their fallopian tubes. Scientists estimated an average of 6.5 years between the development of these abnormal areas in the fallopian tubes and the onset of ovarian cancer. However, once the cancer spreads beyond the tubes, it can progress rapidly, with metastases developing in as little as two years on average[7].
What Causes Fallopian Tube Cancer?
Researchers are still working to understand exactly what causes fallopian tube cancer to develop. What they do know is that ninety percent of these cancers develop in epithelial cells, the same type where most ovarian cancers begin. The majority of fallopian tube and ovarian tumors are classified as high-grade serous tumors, which means they tend to grow and spread quickly throughout the body[1].
The remaining ten percent of fallopian tube cancers start in connective tissue and are called sarcomas. These behave differently from cancers that originate in epithelial cells[1].
Because fallopian tube cancer is so rare and difficult to study in large numbers, scientists have limited information about its root causes. However, they continue to investigate whether genetics and other factors play important roles in its development[4].
Who Is at Risk?
Several factors can increase a person’s likelihood of developing fallopian tube cancer. Understanding these risk factors can help people and their healthcare providers make informed decisions about monitoring and prevention.
Age is a significant risk factor. Women over 63 account for more than half of all cases. This makes sense given that many reproductive system cancers tend to occur later in life[1].
Genetics play a crucial role in fallopian tube cancer risk. Women who carry mutations in genes called BRCA1 or BRCA2 face substantially higher risk. These are the same genetic changes that increase the likelihood of breast and ovarian cancer. The connection is strong enough that some women with these mutations choose to have their fallopian tubes and ovaries removed preventively to reduce their cancer risk[1][7].
Family history matters greatly. Your risk increases if a first-degree biological relative, such as your mother, sister, or daughter, has had breast cancer, ovarian cancer, or fallopian tube cancer. This family connection suggests inherited genetic factors that can pass from one generation to the next[1].
Pregnancy and childbirth history influence risk. Women who have never been pregnant or who had their first full-term pregnancy after age 35 are more likely to develop fallopian tube cancer compared to women who had children earlier or multiple times[1].
Menstrual cycle history also plays a role. Getting your first period before age 12 or going through menopause later than average can increase risk. These factors expose the body to more years of hormonal changes, which may contribute to cancer development[1].
Recognizing the Symptoms
One of the greatest challenges with fallopian tube cancer is that symptoms often don’t appear in the early stages when the disease is most treatable. When symptoms do occur, they can be vague and easy to dismiss or confuse with other, less serious conditions. Many people don’t notice anything wrong until the cancer has spread throughout the abdomen[1].
Common symptoms include pain or pressure in the pelvic area. You might feel a mass or lump in this region during a physical examination. Abdominal pain, swelling, or bloating are frequent complaints, making everyday activities uncomfortable[1].
Digestive changes often occur. You may lose your appetite, feel full quickly even after small meals, or experience nausea. Your bowel habits might change, with alternating periods of constipation or diarrhea[3].
Urinary symptoms can develop as well. Many women notice they need to urinate more frequently or feel sudden urgent needs to use the bathroom[1].
Changes in menstrual patterns or bleeding after menopause should prompt immediate medical attention. Some women experience abnormal vaginal discharge that may be watery, clear, pinkish, white, or blood-tinged. This discharge can result from a condition called intermittent hydrosalphinx, where fluid builds up in the fallopian tube and periodically drains[5][8].
Because these symptoms mirror those of many other gynecological problems, they can be difficult to recognize as signs of cancer. Anyone experiencing these changes, especially those with risk factors or a family history of cancer, should see their healthcare provider for evaluation[1].
How Is Fallopian Tube Cancer Diagnosed?
Diagnosing fallopian tube cancer presents significant challenges. Because it’s so rare and its symptoms resemble other conditions, doctors may not immediately suspect it. Sometimes women don’t learn they have fallopian tube cancer until a tube is surgically removed during an operation for another illness or problem[4].
The diagnostic process typically begins with your doctor asking about symptoms you’re experiencing and reviewing your complete medical history. A thorough physical examination follows, including a careful pelvic exam. During this exam, the doctor inserts gloved fingers into the vagina while pressing down on the abdomen to feel the uterus, ovaries, fallopian tubes, bladder, and rectum. They’re checking for any abnormalities in shape, size, or texture of these organs[1][3].
Blood tests play an important role in diagnosis. One key test measures levels of a protein called CA-125, which serves as a tumor marker for gynecological diseases including fallopian tube cancer. Approximately 85 percent of women with gynecological disease show increased levels of this protein in their blood. However, CA-125 levels can also be elevated in other conditions, so this test alone cannot confirm cancer[4].
Imaging tests help doctors see inside your body without surgery. An ultrasound scan uses sound waves to create pictures of your ovaries and surrounding structures. This might be done through your abdomen or transvaginally, with a probe inserted into the vagina for clearer images. Other imaging options include CT scans and MRI scans, which provide detailed cross-sectional views of your pelvic organs and can help determine the size, shape, and structure of your ovaries and fallopian tubes[1][3].
Sometimes doctors cannot make a definitive diagnosis without surgery. In these cases, they may need to remove an ovary or fallopian tube and examine it under a microscope for signs of cancer. During this surgery, they often take samples of fluid from the abdomen, remove fatty tissue called the omentum, and sample nearby lymph nodes to see if cancer has spread[5].
A specialized examination called the SEE-FIM Protocol involves careful pathological assessment of fallopian tube tissue. This detailed examination can sometimes detect very early cancer or precancerous changes that might otherwise be missed[1][5].
Doctors classify fallopian tube cancer as such if the cancer is found in the fallopian tube (even if also present in the ovary) or if they discover precancerous cells called STIC lesions (serous tubal intraepithelial carcinomas) on the inside surface of the tube[3].
Can Fallopian Tube Cancer Be Prevented?
While fallopian tube cancer cannot be completely prevented, certain steps may help reduce risk, especially for women with known genetic mutations or strong family histories of related cancers.
For women who carry BRCA1 or BRCA2 gene mutations, preventive surgery offers the most significant risk reduction. Doctors may recommend surgically removing the fallopian tubes and ovaries before cancer develops. This is called prophylactic salpingectomy and oophorectomy. Studies of women with BRCA mutations who underwent this preventive surgery have found STIC lesions in their removed fallopian tubes, confirming that these abnormal areas can be precursors to cancer[7][8].
Some gynecologic cancer experts now advocate for removing the fallopian tubes during other pelvic surgeries, such as hysterectomies performed for non-cancer reasons. This approach, sometimes called opportunistic salpingectomy, removes the tubes when a woman no longer needs them for reproduction, potentially eliminating the site where many ovarian and fallopian tube cancers begin[11].
Women with family histories of breast, ovarian, or fallopian tube cancer should consider genetic counseling and testing. Understanding your genetic risk allows you and your healthcare team to develop an appropriate monitoring or prevention plan tailored to your specific situation[1][8].
Regular screening becomes important for high-risk women. Although there are no perfect screening tests for fallopian tube cancer, women with elevated risk should talk to their doctors about setting up routine gynecologic care, pelvic exams, and potentially monitoring CA-125 levels over time[8].
How the Disease Develops in the Body
Understanding how fallopian tube cancer changes normal body functions helps explain why certain symptoms occur and why early detection proves so difficult.
Cancer begins when cells in the fallopian tube undergo genetic changes that cause them to grow and multiply uncontrollably. The most common type, adenocarcinoma, accounts for approximately 88 percent of cases. In the largest study of fallopian tube cancer cases, researchers found that half were poorly differentiated, meaning the cancer cells looked very abnormal under the microscope and tended to grow aggressively. About 89 percent involved only one fallopian tube rather than both[5].
The cancer typically begins at the fimbriated end of the fallopian tube, the finger-like projections that help capture eggs from the ovary. From this starting point, it can spread in several directions. It may grow along the inside of the tube, extend through the tube wall, or spread to nearby structures[3].
As the tumor grows, it often becomes enmeshed with the adjacent ovary, making it difficult even for pathologists to determine whether the cancer originated in the tube or the ovary. This is one reason why distinguishing between fallopian tube cancer and ovarian cancer can be challenging[5].
High-grade serous tumors spread rapidly. They can shed cancer cells into the peritoneal cavity, the space within the abdomen that contains your intestines and other organs. These floating cancer cells can implant on the surfaces of organs throughout the abdomen, including the outside of the bowels, the liver surface, and the omentum (the fatty apron that hangs from the stomach)[1].
Because fallopian tube cancer often sits on the outside of the bowels, bowel problems become some of the most common and serious complications. The cancer can interfere with normal intestinal function, leading to constipation or diarrhea. In severe cases, it can cause bowel obstruction, a dangerous condition where the intestines become blocked. This can prevent bowel movements and cause nausea and vomiting[18].
The cancer can also spread through the lymphatic system, traveling to lymph nodes in the pelvis and around the aorta (the large blood vessel in the abdomen). Less commonly, it can spread through the bloodstream to distant organs such as the lungs or liver. This pattern of spread determines how doctors stage the cancer and influences treatment decisions[5].
Research has shown that while the initial development of abnormal cells in the fallopian tubes may be relatively slow, taking several years, the transformation to aggressive cancer and subsequent spread can happen quite rapidly once the process accelerates. This helps explain why so many women are diagnosed with advanced-stage disease even though the cancer may have been developing for years[7].
