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Cancer Medicine :: Fallopian Tube Cancer

Fallopian Tube Cancer

Treatment Options

This section outlines treatments that are the standard of care (best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. 

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For fallopian tube cancer, the team may include a gynecologic oncologist, a doctor who specializes in diagnosing and treating cancer in a woman’s reproductive system.

Descriptions of the most common treatment options for fallopian tube cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. 

Women with fallopian tube cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before, during, and after cancer treatment. If both ovaries are affected, 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. This means that the patient is likely to experience menopausal symptoms such as hot flashes and vaginal dryness. Talk with your doctor about possible side effects related to your sexual health.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. 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 test for the presence of cancer cells. 

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide.  Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same 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 they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

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. 

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. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may restart normal sexual activity within a few weeks after treatment if they feel ready. Most side effects go away soon after treatment is finished. 

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. 

In a 2010 study, adding the targeted therapy drug bevacizumab (Avastin) to chemotherapy and keeping patients on the drug after chemotherapy ends increased the amount of time it takes for advanced fallopian tube cancer and other cancers of a woman’s reproductive system to grow and spread. Talk with your doctor about possible side effects for bevacizumab and how they could be managed if this treatment is added to your care plan.

Palliative/supportive care

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem, so it is addressed as quickly as possible. 

Recurrent fallopian tube cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. 

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. 

Metastatic fallopian tube cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Supportive care to help relieve symptoms and side effects will be an important part of the treatment plan.

For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Coping with Side Effects

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for fallopian tube cancer are described in detail within the Treatment section. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with fallopian tube cancer. 

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. 

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care.

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.

Follow-up care is very important for women who have finished fallopian tube cancer treatment. Although there are no specific guidelines for follow-up care after treatment for fallopian tube cancer, your plan may include x-rays, CT scans, ultrasound studies, and/or MRI scans. Tell your doctor about any new symptoms. 

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.

Latest Research

Doctors are working to learn more about fallopian tube cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

New treatments. Researchers continue to look for better treatments, including different combinations of the treatment options (surgery, radiation therapy, chemotherapy, and targeted therapy) described in Treatment.

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.

Genetic research. 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.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of gynecologic cancers, including fallopian tube cancer, to improve patients’ comfort and quality of life.

 

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