Fallopian Tube CancerLast Updated: October 13, 2009 This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/09 Overview
Fallopian tube cancer begins in a woman’s fallopian tubes, the small ducts that link a woman’s ovaries to her uterus. The fallopian tubes are a part of a woman’s reproductive system and every woman has two fallopian tubes, one located on each side of the uterus. Fallopian tube cancer begins when cells in one or both fallopian tubes change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Cancer may begin in any of the different cell types that make up the fallopian tubes, and the most common type is adenocarcinoma (a cancer of cells from glands). Leiomyosarcoma (a cancer of smooth muscle cells) and transitional cell carcinoma (a cancer of the cells lining the fallopian tubes) are less common. As a tumor in the fallopian tube grows, it can push against the walls of the tube and cause abdominal pain. If untreated, the cancer can spread into and through the walls of the fallopian tubes and eventually into the pelvis (lower abdomen) and stomach areas. Statistics Fallopian tube cancer is rare, accounting for about 1% of all cancers of a woman’s reproductive system. It is more common for other cancers to spread to the fallopian tubes rather than for cancer to begin there. For example, the fallopian tubes are a common site of metastasis (spread) of cancers that started in the ovaries, uterus, endometrium, appendix, or colon. If detected early, fallopian tube cancer can often be successfully treated. At its earliest stage, where the cancer is only in the lining of the fallopian tube, the five-year relative survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 95%. The relative survival rate decreases as the cancer spreads. If cancer has spread to the walls of the fallopian tube, the five-year relative survival rate is about 75%; if it has spread outside of the fallopian tube the five-year relative survival rate is 45%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with fallopian tube cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Source: Oncolink, The University of Pennsylvania. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices. Because fallopian tube cancer is so rare, not much is known about the risk factors. However, the following factors may raise a woman’s risk of developing fallopian tube cancer: Age. Fallopian tube cancer occurs mostly in postmenopausal women in their 50s and 60s. Family history. A family history of fallopian tube cancer can increase a woman’s risk of developing this cancer. Genetic mutations. Recent studies have suggested that a mutation in the BRCA1 gene, which is linked to breast and ovarian cancer, may also increase the risk of developing fallopian tube cancer. Learn more about BRCA gene mutations and hereditary breast and ovarian cancer. Because there are no certain risk factors for fallopian tube cancer, there is no known way to prevent the disease from occurring. Symptoms
Women with fallopian tube cancer may experience the following symptoms. Sometimes, women with fallopian tube cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Diagnosis
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
In addition to a physical examination, the following tests may be used to diagnose fallopian tube cancer: Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. A Pap test, usually done with a pelvic exam, neither finds nor diagnoses fallopian tube cancer. Ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. Learn more about what to expect when having common tests, procedures, and scans. Find out more about common terms used during a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each individual. Specific tumor stage information is listed below: TX: The primary tumor cannot be evaluated. T0: There is no tumor. Tis: The tumor is carcinoma in situ (early-stage cancer that has not spread to nearby tissue). T1: The tumor is limited to the fallopian tube(s). T1a: The tumor is contained within one fallopian tube. No part of the tumor has spread to the surface of the tube, and no cancer cells are found in abdominal fluid. T1b: An encapsulated (self-contained) tumor is in both fallopian tubes, but neither tumor is touching a tube surface. No cancer cells are found in abdominal fluid. T1c: The tumor is in one or both fallopian tubes, but the capsule has ruptured (burst) or the tumor has spread to the tube surface, or cancer cells are found in the abdominal fluid. T2: The tumor involves one or both fallopian tubes and has spread to the pelvis. T2a: Tumor extensions (areas of tumor growth also called implants) are found on the uterus and/or ovaries but no cancer cells are found in the abdominal fluid. T2b: There is cancer in other pelvic tissue, but no cancer cells are found in the abdominal fluid. T2c: Tumor extensions in the pelvis are present, such as in T2a or T2b, but cancer cells are also in the abdominal fluid. T3: The tumor involves one or both fallopian tubes and has spread microscopically into the abdominal area outside the pelvis. T3a: Microscopic metastasis is present in the peritoneal area (the area around the organs in the abdomen) beyond the pelvis. T3b: Metastasis measuring 2 centimeters (cm; a little smaller than 1 inch) or smaller is present outside the pelvis. T3c: Metastasis larger than 2 cm is present in areas outside the pelvis. Nodes. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the pelvis are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. NX: The regional lymph nodes cannot be evaluated. N0: There is no cancer in the regional lymph nodes. NI: The cancer has spread to the pelvic lymph nodes. Metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body. MX: Distant metastasis cannot be evaluated. M0: There is no cancer beyond the peritoneal area. MI: The cancer has spread beyond the peritoneal area. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: Refers to carcinoma in situ (Tis, N0, M0). Stage I: Tumor is located only in the fallopian tubes (T1, N0, M0). Stage IA: An encapsulated tumor is located in only one fallopian tube with no spread to pelvic lymph nodes or other parts of the body (T1a, N0, M0). Stage IB: An encapsulated tumor is in both fallopian tubes, with no spread to pelvic nodes or other parts of the body (T1b, N0, M0). Stage IC: Cancer is in one or both fallopian tubes with either a ruptured capsule or tumor spread to the ovarian surface, or cancer cells are in the abdominal fluid (T1c, N0, M0). Stage II: Cancer is in one or both fallopian tubes and has grown into the pelvis (T2, N0, M0). Stage IIA: Cancer has spread to the uterus or ovaries, but not to the pelvic lymph nodes or distant organs (T2a, N0, M0). Stage IIB: Cancer has spread to other pelvic tissue, but not to lymph nodes or distant organs (T2b, N0, M0). Stage IIC: Cancer has spread into the pelvic area and is shedding cancer cells into abdominal fluid (T2c, N0, M0). Stage III: Cancer is in one or both fallopian tubes and the pelvis and has spread into the peritoneum (T3, N0, M0). Stage IIIA: Cancer has spread microscopically throughout the pelvis (T3a, N0, M0). Stage IIIB: Cancer has spread into the peritoneal area with implants that are 2 cm or smaller (T3b, N0, M0). Stage IIIC: Describes any cancer that has spread into the peritoneal area in implants larger than 2 cm (T3c, N0, M0), or the tumor has spread to lymph nodes and/or the pelvis, but not to other parts of the body (any T, N1, M0). Stage IV: Describes any cancer that has spread to distant organs (any T, any N, M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. Histologic grade (G). Doctors may also assign a grade to the disease. A tumor’s grade uses the letter “G” and a number, and describes how closely the cancer cells resemble normal tissue under a microscope. Cells that look like healthy cells are low grade, and those that look like cancer cells are high grade. In general, the lower the grade, the better the prognosis. GX: The tumor grade cannot be identified. G1: Describes cells that look more like normal tissue cells (well differentiated). G2: The cells are somewhat different (moderately differentiated). G3: The tumor cells do not look like normal cells (poorly differentiated). G4: The cells barely resemble normal cells (undifferentiated). Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.cancerstaging.net. Treatment
The treatment of fallopian tube cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. This section outlines treatments that are the standard of care (best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. Descriptions of the most common treatment options for fallopian tube cancer are listed below. Surgery A surgical oncologist is a doctor who specializes in treating cancer using surgery. The stage of the tumor determines the type of surgery used. Early stage fallopian tube cancer, when the tumor is limited to the fallopian tubes, is treated by surgical removal of the fallopian tubes and ovaries (called a salpingo-oophorectomy). If the cancer has spread, the surgeon may remove the uterus (called a hysterectomy) and other structures in the pelvis, including nearby lymph nodes, to evaluate them for the presence of cancer cells. Learn more about cancer surgery. Depending on the extent of the surgery, a woman’s fertility (ability to bear children in the future) may be affected. If both ovaries are removed, a woman can no longer become pregnant. The loss of both ovaries also eliminates the body’s source of sex hormones, resulting in premature menopause, which means that the patient is likely to experience menopausal symptoms, including hot flashes and vaginal dryness after surgery. Women are encouraged to talk with their doctors before and after surgery and other cancer treatments about sexual and fertility concerns, and ways to address them. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. Chemotherapy is usually given after surgery for fallopian tube cancer. The most common types of chemotherapy to treat fallopian tube cancer are paclitaxel (Taxol) and carboplatin (Paraplat, Paraplatin). The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy. Find out more about common terms used during cancer treatment. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with fallopian tube cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, or a new method of treatment or prevention. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating fallopian tube cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with fallopian tube cancer. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill”. The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. Because fallopian tube cancer is so rare, specific trials for this cancer are uncommon, but some clinical trials on ovarian cancer may be open to people with fallopian tube cancer. For specific topics being studied for fallopian tube cancer, learn more in the Current Research section. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatment you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. In addition to physical side effects, there may be psychosocial (emotional and social) effects are well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. Learn more about late effects or long-term effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for fallopian tube cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Although there are no specific guidelines defined for follow-up care for women who have finished fallopian tube cancer treatment, the plan may include x-rays, CT scans, ultrasound studies, or MRI scans. Discuss any new symptoms with your doctor. Women recovering from fallopian tube cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about healthy living after cancer. Find out more about common terms used after cancer treatment is complete. Current Research
Research for fallopian tube cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor. Because fallopian tube cancer is so rare, fallopian tube cancer-specific clinical trials may be hard to find. However, because it is similar to ovarian cancer, researchers are trying to determine if it can be treated similarly. Therefore, many clinical trials may include patients with either ovarian or fallopian tube cancer. In addition, genetic research has shown that mutations to the BRCA1 gene may increase the risk of developing fallopian tube cancer. Further research in this area may help clarify the risk and also result in better patient counseling for women who carry a mutation to this gene. Questions to Ask the Doctor
Regular communication with your doctor is important for making informed decisions about your health care. Consider asking the following questions of your doctor:
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
