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fallopian-tube-cancer

Fallopian Tube Cancer

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What is Fallopian Tube Cancer?

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 part of a woman’s reproductive system. Every woman has two fallopian tubes, one located on each side of the uterus.

Fallopian tube cancer begins when normal 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 can begin in any of the different cell types that make up the fallopian tubes. 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.     

Symptoms & Signs

Women with fallopian tube cancer may experience the following symptoms or signs. 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 or sign on this list, please talk with your doctor.

Irregular or heavy vaginal bleeding, especially after menopause

Occasional abdominal or pelvic pain or feeling of pressure

Vaginal discharge, which may be clear, white, or tinged with blood

A pelvic mass or lump

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

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.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often 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 talking about them with 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. 

Because there are no certain risk factors for fallopian tube cancer, there is no known way to prevent the disease.

Diagnosis

Doctors use many tests to diagnose cancer and find out 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:

Age and medical condition

Type of cancer suspected

Severity of symptoms

Previous test results

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, often done with a pelvic exam, is used to find and diagnose cervical cancer, not 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).

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy .

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.

After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

Stages and Grades

Staging is a way of describing where the cancer is located, if or where it has spread, and whether 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 judges three factors: 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:

How large is the primary tumor and where is it located? (Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized (spread) to other parts of the body? (Metastasis, M)

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.

N1: 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.

M1: 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: Cancer 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 but not elsewhere (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 but not to distant parts of the body (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. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

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 barely resemble normal cells (poorly differentiated).

G4: The cells do not look like normal cells (undifferentiated).

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