Fallopian tube cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a very rare gynaecological cancer that develops from the fallopian tubes in the female reproductive system. The fallopian tubes, also known as uterine tubes or oviducts, are a pair of hollow j-shaped tubes that connect the ovaries to the uterus.
The fallopian tubes are approximately 10-12 centimetres long and 1-4 millimetres in diameter. These structures have three primary functions, including the transportation of ova (also known as eggs or oocytes) from the ovaries to the uterus, the transportation of male sperm cellsthe basic structural and functional unit of all living things from the uterus to the ova, and to provide a suitable environment for the fertilisation process to take place. It is a common misconception that fertilisation occurs in the uterus, but it actually occurs in the fallopian tubes and forms a zygote (a fertilised egg). Once formed, the zygote travels from the fallopian tubes to the uterus, and implants itself into the uterine wall for the gestation (pregnancy) period.
Fallopian tube cancers are most common in women over the age of 50. However, it can affect anyone with fallopian tubes – including women, teenagers, transgender men, non-binary individuals, and intersex people – at any age.
Types of Fallopian Tube Cancer
There are three primary types of fallopian tube cancer, which are classified by the location that the cancer develops from.
Papillary Serous Adenocarcinoma
Papillary serous adenocarcinomas are the most common type of fallopian tube cancer, and develop from the mucus-producing cells that line the fallopian tubes. These tumours can be high gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells or low grade, have varying levels of aggressiveness and varying metastasiswhen the cancer has spread to other parts of the body, also known as mets rates. As such, the prognosisto predict how a disease/condition may progress and what the outcome might be of this subtype often varies.
Leiomyosarcoma
Leiomyosarcoma (LMS) is a rare form of sarcomacancer arising from bones and/or soft tissue (cancer arising from bone, connective tissuea group of cells that work together to perform a function and/or soft tissuetissue/the material that joins, holds up or surrounds inside body parts such as fat, muscle, ligaments and lining around joints) that develops in smooth muscle cells. It is most commonly found in the abdomenstomach, stomach area, belly or uterus; however, it can also be found in the skin, bloodthe red bodily fluid that transports oxygen and other nutrients around the body vessels, bones, or rarely, the fallopian tubes.
Leiomyosarcomas of the fallopian tubes are generally difficult to diagnose, highly aggressive and likely to metastasise. As such, they may not have as good of a prognosis as other types of fallopian tube cancer.
For more information on Leiomyosarcoma, please refer to the Rare Cancers Australia Leiomyosarcoma page.
Transitional Cell Carcinoma
Transitional cell carcinomas are a very rare subtype of fallopian tube cancer, and develop in the transitional cells (the cells that can change shape and stretch to allow for expansion without breaking) of the fallopian tubes. Because of how rare these cancers are, there has limited research done into the aggressiveness and prognosis of this disease.
Rare types of Fallopian Tube Cancer
These types of fallopian tube cancer are considered very rare:
- Clear cell carcinomacancer arising from tissues that line organs.
- Endometrioid carcinoma.
- Adenosquamous carcinoma.
- Squamous cell carcinoma (SCC).
Treatment
If fallopian tube cancer is detected, it will be staged and graded based on size, metastasis, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Fallopian tube cancers can be staged using the Federation of Gynecology and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to cervix tissue only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have spread to the upper two-thirds of the vagina and/or other nearby tissue. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has spread to lower third of the vagina and/or the side of the pelvic wall. Lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid and kidneys may be affected. This is also known as advancedat a late stage, far along or metastatic cancer.
- Stage IV: the cancer has spread to the bladdera hollow, muscular sac in the pelvis that stores urine or rectumthe last section of the large intestine/bowel that holds waste until it is ready to be removed from the body, or to more distant organs, such as the lungs or the liver. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumoura tissue mass that forms from groups of unhealthy cells.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for fallopian tube cancers may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Hysterectomycomplete or partial removal of the uterus.
- Unilateralaffecting one side or bilateralaffecting both sides salpingectomyremoval of one (unilateral) or both (bilateral) fallopian tubes.
- Bilateral salpingo-oophorectomyremoval of both ovaries and fallopian tubes.
- Unilateral salpingo-oophorectomyremoval of one ovary and fallopian tube.
- Lymphadenectomysurgical removal of lymph node(s).
- Removal of other organs (only required in some cases where the cancer has spread beyond the pelvis).
- Omentectomya surgical procedure to remove part or all of the omentum, a fatty layer of tissue that surrounds the abdominal organs.
- Bowelportion of the digestive system that digests food (small bowel) and absorbs salts and water (large bowel); also called intestines resectionsurgical removal of tissue or part/all of an organ (advanced fallopian cancers that have metastasised to the intestinesportion of the digestive system that digests food (small intestine) and absorbs salts and water (large intestine), also called bowel).
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Hormone therapymedication that alters the levels of certain hormones in the body, such as oestrogen and progesterone.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells (rare).
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Fallopian Tube Cancer Treatment and Fertility
Treatment for fallopian tube cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor prior to the commencement of treatment.
Risk factors
While the cause of fallopian tube cancer remains unknown, the following factors may increase the likelihood of developing the disease:
- A family history of ovarian, breast, bowel, or fallopian tube cancer.
- Genetic mutations, especially of the BRAC1 and BRAC2 genes.
- Having Lynch syndrome (also known as hereditary nonpolyposis colonthe longest portion of the large bowel that absorbs water and salts from ingested food cancer or HNPCC).
- Never having had children.
- Ashkenazi (eastern European) Jewish ancestry.
Other potential riskthe possibility that something bad will happen factors include:
- Having previously had hormone replacement therapymedication that increase the levels of certain hormones in the body.
- Chronica long-lasting disease that changes slowly over time inflammation of fallopian tubes (salpingitis).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Fallopian tube cancer may appear asymptomatic in the early stages of disease. As the tumour progresses, some of the following symptoms may appear:
- An abdominal and/or pelvic massa growth of cells that come together to make a lump, may or may not be cancer.
- Pain, swelling and/or pressure in the abdomen, pelvis, lower legs and/or back.
- A feeling of abdominal fullness and/or heaviness.
- Changes in bathroom habits, potentially including:
- Constipationa condition where a person has difficulty passing faeces/stools.
- Feeling of incomplete urination.
- Polyuriafrequent urination.
- Urgent urination.
- Changes in digestion, potentially including:
- Feeling full quickly.
- Heartburn.
- Gas.
- Indigestion.
- Nauseato feel sick or likely to vomit and/or vomiting.
- Unexplainable weight loss/loss of appetite.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Abnormal vaginal bleeding and/or discharge between periods or after menopause.
- Painful intercourse.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have fallopian tube cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Pelvic examinationa physical exam of the external and internal female pelvic organs.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- Pelvic ultrasounda type of medical imaging that uses sound waves to create detailed images of the organs and structures within the pelvis, including the uterus, ovaries, and surrounding tissues.
- Transvaginal ultrasounda type of pelvic ultrasound that involves inserting a device (known as a transducer) into the vagina to produce sound waves and create images of internal female reproductive organs in greater detail.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Diagnostic laparoscopya minimally invasive surgical procedure that uses small incisions to access the body for procedures, often used for conditions that cannot be confirmed by scans and tests alone.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
