Fallopian Tube Cancer

Fallopian tube cancer, also called tubal cancer, is a rare cancer that develops in the fallopian tubes. These are two slender tubes that connect the ovaries to the uterus. In some cases, the cancer begins at the end of the fallopian tube near the ovary and then spreads to the ovary.

Fallopian tube cancer is closely related to ovarian epithelial cancer. The two cancers share many features and are often staged and treated in much the same way. Because early fallopian tube cancer may cause few or no symptoms, it can be hard to find before it spreads.

Types & Stages

Most fallopian tube cancers are epithelial cancers, which means they begin in the lining of the tube. The two main types are:

• Serous adenocarcinoma is the most common type of fallopian tube cancer. It starts in the cells that line the inside of the fallopian tube. Many high-grade serous cancers of the ovary and peritoneum are now thought to begin in the fallopian tubes.
   
• Endometrioid adenocarcinoma also begins in the lining of the fallopian tube. It is less common than serous adenocarcinoma.

Rarer types of fallopian tube cancer include leiomyosarcoma, which forms in the smooth muscle of the tube, and transitional cell carcinoma, which forms in other cells inside the tube.

Because fallopian tube cancer is so similar to ovarian cancer, it uses the same staging system as ovarian, fallopian tube and primary peritoneal cancer:

• Stage I means the cancer is found only in one or both fallopian tubes or ovaries.
   
• Stage II means the cancer has spread to nearby pelvic organs or tissues, such as the uterus or other parts of the pelvis.
   
• Stage III means the cancer has spread to the lining of the abdomen beyond the pelvis or to nearby lymph nodes.
   
• Stage IV means the cancer has spread to distant parts of the body, such as the inside of the liver or spleen, the lungs or the fluid around the lungs.

Your care team will use the cancer type, stage, tumor grade and your overall health to recommend a treatment plan.

Signs & Symptoms

Fallopian tube cancer often causes no symptoms in its early stages. When symptoms do appear, they can be mild or similar to other common conditions, which can make this cancer hard to spot early.

Visit a doctor if you are experiencing any of these symptoms:

• Pelvic or abdominal pain
• Bloating or swelling in the abdomen
• Vaginal bleeding that is not related to your periods, or unusual vaginal discharge
• Feeling full quickly when eating
• Trouble eating or loss of appetite
• Urinary urgency or needing to urinate more often
• Unexplained fatigue
• A lump or mass in the pelvic are

Many of these symptoms can be caused by conditions that are not cancer. Still, it is important to pay attention to your body. If these symptoms are new, last more than a few weeks or are unusual for you, talk with a healthcare provider.

Diagnosis

Tests and procedures used to diagnose fallopian tube cancer may include:

• Pelvic exam. During a pelvic exam, your doctor checks the reproductive organs. The doctor inserts two gloved fingers of one hand into the vagina while pressing on the abdomen with the other hand to feel the uterus, ovaries and fallopian tubes. A device called a speculum is also inserted into the vagina. The speculum opens the vaginal canal so your doctor can look for signs of cancer or other problems.
   
• Imaging tests. Imaging tests may include a pelvic ultrasound, MRI or CT scan. Your doctor may also use a transvaginal ultrasound. During this test, a wand-like device called a transducer is inserted into the vagina. The transducer uses sound waves to create images of the uterus, ovaries and nearby tissues. Imaging can help your doctor look for signs of cancer and rule out other causes for your symptoms.
   
• CA-125 blood test. This blood test checks the level of CA-125, a protein that can be higher in people with some gynecologic cancers. A raised CA-125 level may mean you need more tests, but it can also be caused by conditions that are not cancer. On its own, a CA-125 test cannot diagnose fallopian tube cancer.
   
• Biopsy. A biopsy removes a small sample of tissue from the fallopian tube so it can be examined under a microscope by a pathologist. This is the only way to be sure whether cancer is present. Because of where the fallopian tubes are located, a biopsy usually requires surgery.

Treatment

Treatment for fallopian tube cancer depends on the stage of cancer, whether it has spread, tumor features, your overall health and your personal goals. Because it behaves like ovarian cancer, it is treated in a similar way. Your care team can help explain the benefits and risks of each option.

Treatment may include:

• Total hysterectomy with bilateral salpingo-oophorectomy. This surgery removes the uterus and cervix along with both fallopian tubes and both ovaries. It is sometimes called a TH/BSO. The most common approach, a total abdominal hysterectomy, can be done through a traditional open incision or through a minimally invasive approach.
   
• Unilateral salpingo-oophorectomy. In select cases, such as very early cancer in a younger person who wishes to preserve fertility, surgery may remove only one ovary and one fallopian tube.
   
• Minimally invasive laparoscopy. When appropriate, the surgeon may use a laparoscope, a thin, lighted tube with a small video camera at its tip. The camera projects images onto a screen, allowing tissues to be removed through very small incisions in the abdomen.
   
• Debulking surgery. In this procedure, a surgical incision in the abdominal wall, called a laparotomy, is used to remove as much of the tumor as safely possible. Removing as much cancer as possible can help other treatments work better.
   
• Platinum-based chemotherapy. Chemotherapy that includes a platinum-based medicine is the standard treatment after surgery. It uses medicines to kill cancer cells or slow their growth. Chemotherapy may be given before surgery to shrink tumors, after surgery to treat any remaining cancer cells or for cancer that returns.
   
• Targeted therapy. Targeted therapy uses medicines that focus on specific features of cancer cells. Tumor testing can help show whether targeted therapy may be an option.
   
• PARP inhibitors. These targeted medicines may help certain cancers, especially those with BRCA gene changes or other features that affect DNA repair. They are often used as maintenance therapy after chemotherapy in select cases.
   
• Bevacizumab. This targeted medicine works by limiting the blood supply that tumors need to grow. It may be added to chemotherapy or used as maintenance therapy in some advanced or recurrent cases.
   
• Immunotherapy. Immunotherapy helps the immune system recognize and attack cancer cells. It may be an option for some advanced or recurrent cancers with certain tumor features.

Clinical trials may also be available. These research studies test new treatments or new ways to use current treatments. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of fallopian tube cancer is not always known. It begins when cells in the fallopian tube develop changes in their DNA that cause them to grow out of control. Because it is closely related to ovarian cancer, it shares many of the same risk factors.

Factors that may increase the risk include:

• Older age. The risk increases as you get older, and it is more common after menopause.
   
• Family history. Having a close blood relative with ovarian, fallopian tube, primary peritoneal or breast cancer may increase risk.
   
• Inherited gene changes. Changes in the BRCA1 and BRCA2 genes can raise the risk of fallopian tube cancer.
   
• Lynch syndrome. This inherited condition, also called hereditary nonpolyposis colorectal cancer, can increase the risk of several cancers, including those of the reproductive organs.
   
• Endometriosis. Endometriosis, a condition in which tissue similar to the lining of the uterus grows outside the uterus, may increase the risk of certain related cancers.
   
• Hormone therapy after menopause. Some forms of hormone therapy used after menopause may increase risk, especially when used for a long time.
   
• Obesity. Having obesity may increase the risk of developing this cancer and can affect overall health.

Having one or more risk factors does not mean you will develop fallopian tube cancer, and some people with the disease have no known risk factors. Talk with your healthcare provider about your personal risk.

Screening

There is no recommended routine screening test for fallopian tube cancer for people at average risk who do not have symptoms.

Tests such as CA-125 blood tests and transvaginal ultrasound have not been shown to reliably find this cancer early in people without symptoms, and they can lead to extra testing without lowering the risk of dying from the disease.

People at higher risk, such as those with BRCA gene changes, Lynch syndrome or a strong family history of ovarian, breast or related cancers, should talk with a healthcare provider or genetic counselor. In some high-risk situations, doctors may discuss closer monitoring, genetic testing or risk-reducing options, such as surgery to remove the fallopian tubes and ovaries.

If you have symptoms that are new, persistent or unusual for you, do not wait for a screening test. Talk with a healthcare provider about your symptoms and whether further evaluation is needed.

This information is for general education only and is not a substitute for medical advice. Please consult a qualified healthcare provider for diagnosis, treatment recommendations and guidance based on your personal health history.