Primary fallopian tube cancer (PFTC), often just
tubal cancer, is a malignant neoplasm that originates from the
fallopian tubeThe Fallopian tubes, named after Gabriel Fallopius , 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.- Fallopian Tube :The tube connects the ovary to...
.
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 is a cancerous growth arising from different parts of the ovary.The most common form of ovarian cancer arises from the outer lining of the ovary.. However, recent evidence shows cells that line the Fallopian tube also to be prone to develop into the same kind of cancer as seen in...
, and the highest incidence was found in white, non-Hispanic women and women aged 60–79.
Primary fallopian tube cancer (PFTC), often just
tubal cancer, is a malignant neoplasm that originates from the
fallopian tubeThe Fallopian tubes, named after Gabriel Fallopius , 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.- Fallopian Tube :The tube connects the ovary to...
.
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 is a cancerous growth arising from different parts of the ovary.The most common form of ovarian cancer arises from the outer lining of the ovary.. However, recent evidence shows cells that line the Fallopian tube also to be prone to develop into the same kind of cancer as seen in...
, 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
BRCA1BRCA1 is a human gene, some mutations of which are associated with a significant increase in the risk of breast cancer, as well as other cancers. BRCA1 belongs to a class of genes known as tumor suppressors, which maintains genomic integrity to prevent dangerous genetic changes...
and
BRCA2BRCA2 is a protein that in humans is encoded by the BRCA2 gene. BRCA2 belongs to the tumor suppressor gene family and the protein encoded by this gene is involved in the repair of chromosomal damage with an important role in the error-free repair of DNA double strand breaks.The BRCA2 gene is...
are at higher risks for the development of PFTC.
Pathology
The most common cancer type is the
adenocarcinomaAdenocarcinoma is a cancer originating in glandular tissue. This tissue is also part of a larger tissue category known as epithelial. Epithelial tissue includes skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium is 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
leiomyosarcomaLeiomyosarcoma , aka LMS, is rare type of cancer that is a malignant neoplasm of smooth muscle. Smooth muscle cells make up the involuntary muscles, which are found in most parts of the body, including the uterus, stomach and intestines, the walls of all blood vessels, and the skin...
, and the
transitional cell carcinomaTransitional cell carcinoma is a type of cancer that typically occurs in the urinary system: the kidney, urinary bladder, and accessory organs...
.
As the tumor is often enmeshed with the adjacent
ovaryThe ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in females are homologous to testes in males, in that they are both gonads and endocrine glands.-Human anatomy:...
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.
Diagnosis
A pelvic examination may detect an
adnexal massAn adnexal mass is a lump in tissue near the uterus, usually in the ovary or fallopian tube. In premenopausal women, adnexal masses include ovarian cysts, ectopic pregnancies, and benign or malignant tumors, endometriomas, polycystic ovaries, tubo-ovarian abscess.In postmenopausal women, adnexal...
. 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
pelvisIn human anatomy, the pelvis is the part of the trunk inferioposterior to the abdomen in the transition area between the trunk and the lower limbs...
.
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
uterusThe uterus is a major female hormone-responsive reproductive sex organ of most mammals, including humans. It is within the uterus that the fetus develops during gestation. The term uterus is used consistently within the medical and related professions; the Germanic term, womb is more common in...
and ovary, a total abdominal
hysterectomyA 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 washings are taken, the
omentumOmentum can refer to two different components of the peritoneum:* greater omentum* lesser omentum...
is removed, and pelvic and paraaortic
lymph nodeA lymph node is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells that use oxygen to process. Thus they are important in the proper...
s are sampled.
StagingThe stage of a cancer is a descriptor of how much 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
chemotherapyChemotherapy, in its most general sense, is the treatment of disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen...
.
Also radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications
Staging
FIGOThe International Federation of Gynecology and Obstetrics, usually just FIGO as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique, founded in 1954 is a worldwide NGO organisation representing obstetricians and gynecologists 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
Prognosis
Prognosis depends to a large degree on the stage of the condition. In 1991 it was reported that about half of the patients with advanced stage disease survived 5 years with a surgical approach followed by cisplatinum-based chemotherapy.