Cancer of the fallopian tube is one of the rarest malignant neoplasms that affects the female reproductive organs. It comes in several types and because its symptoms appear late, it is difficult to diagnose. What are the causes and symptoms of fallopian tube cancer? What is the treatment and what is the prognosis?
Cancer of the fallopian tube(Latincarcinoma oviducti , carcinoma of the fallopian tube) is a rare malignant neoplasm - one of the rarest types of cancer female reproductive system, the incidence is 0.14-1.8% and the incidence is approximately 3.6 / 1,000,000 women. It is most often diagnosed in the 4th to 6th. decade of life - the average age of onset is 55 (17-88 years).
Malignant neoplasm of the fallopian tube grows, as its name suggests, in the fallopian tube - the organ that connects the ovary with the uterine cavity, and is also involved in the transport of the egg, where fertilization occurs most often.
Fallopian tube cancer: causes
Since this cancer is very rare, its causes are not fully known. They are influenced by genetic, hormonal and reproductive factors as in ovarian cancer.
Known risk factors include BRCA1 and BRCA2 mutations - they increase the risk of its occurrence up to 120 times and 10 years earlier than in the rest of the population.
In addition, women who have never given birth, breastfed or took contraceptives have a greater risk of developing the disease.
Primary infertility is found in 70% of cases of this cancer.
No significant influence of smoking, weight, race, education, endometriosis, pelvic inflammatory disease history has been confirmed.
In 10-27% of cases, fallopian tube cancer is bilateral. According to the fallopian theory of ovarian cancer formation, it is considered to be a precursor of poorly differentiated serous cancer of the peritoneum, ovary and fallopian tube.
Fallopian tube cancer: types
The most common type of fallopian tube cancer is papillary adenocarcinoma.
Other types of crayfish:
- endometrioid cancer
- light cell
- from transitional epithelium
- slime,
- mixed
are very rare. More often than the primary tumor of the fallopian tube, there is an infiltration of the fallopian tube by ovarian cancer or a neoplastic process of the endometrium,metastasis of gastrointestinal neoplasms and breast cancer.
This cancer can spread through intraperitoneal spreading, the path of lymphatic vessels, blood vessels or local infiltration.
Fallopian tube cancer: symptoms
Unfortunately, in the early stages of development, this neoplasm is usually asymptomatic, similar to ovarian cancer. Only in the subsequent stages of advancement can clinical symptoms be observed. The most common of them are:
- in approx. 50% of cases of abnormal vaginal bleeding - especially after menopause and between periods
- ascites
- feeling of fullness and heaviness in the abdomen
- urgent urgency
- constipation
- low fever
- weight reduction
- leg pain
- lower back pain
- pelvic pain
- pain during sexual intercourse
In less than 15% of primary neoplasms the characteristic Latzki triad occurs:
- heavy, watery vaginal discharge
- colic abdominal pain associated with bleeding and vaginal discharge
- palpable pelvic tumor palpable through the abdominal wall
Fallopian tube cancer: diagnosis
The diagnosis is based on a medical interview, risk factor assessment, gynecological examination with cytology.
The smear result may indicate the presence of neoplastic cells in up to 23% of fallopian tube tumors.
Therefore, the next step should be to execute:
- colposcopic test
- cervical canal biopsy
- abrasion of the uterine cavity (curettage)
In the case of a negative result of the histopathological examination of the material collected from the cervix and the uterine cavity, with an abnormal cytology result, the diagnostics should be extended.
The next step should be to perform imaging tests. The pelvic organs ultrasound is the first examination performed most often. The use of the Doppler method may be helpful. The differential diagnosis in the ultrasound image should include:
- abscess
- ovarian tumor
- ectopic pregnancy
Computed tomography, magnetic resonance, positron emission tomography and PET-CT will be more detailed tests that we perform in order to verify the diagnosis, assess the stage of the tumor, determine the operability criteria and to monitor the treatment.
We can also measure the serum level of the tumor marker CA-125. However, its increased concentration may also be during menstruation, pregnancy and accompany itbenign lesions of the ovaries. The CA125 assessment is helpful in establishing the diagnosis and in monitoring response to treatment and in post-treatment surveillance.
It is also possible to perform exploratory laparoscopy or laparotomy (open abdominal surgery), during which material for histopathological examination can be obtained.
The final diagnosis of primary fallopian tube cancer is usually established during surgery or after obtaining the final result of a histopathological examination. The rarity of this disease and the diagnostic difficulties of proliferative changes in the fallopian tube in the early phase of the disease make it difficult to make a proper preoperative diagnosis.
The stage of the cancer is determined according to the FIGO clinical classification - thanks to this, the prognosis, further management can be assessed, and the course of the disease can be compared to other cases.
Fallopian tube cancer: treatment
Surgical procedure is the basis of treatment of fallopian tube tumors. The extent of the surgery depends on the stage of the cancer, as well as on the woman's reproductive plans.
In the case of a low stage of the disease, a sparing operation is possible in a young woman who wants to preserve her fertility. However, in the remaining cases, a major operation is performed, during which the uterus with the fallopian tubes and ovaries, the greater net, pelvic and peraortic lymph nodes are removed, and a peritoneal biopsy is performed similarly to ovarian cancer. In the case of advanced disease, primary or secondary cytoreductive procedures are performed to remove as many neoplastic lesions as possible.
Chemotherapy is the treatment of choice in adjuvant therapy. The choice of drugs depends on the initial stage of the disease, the histological type of the tumor, the patient's age and her reproductive plans.
Radiotherapy is unlikely to be used in the treatment of this cancer.
Fallopian tube cancer: prognosis
Unfortunately, cancer recurrences may appear on average within 2-3 years after the end of treatment. Mainly located outside the pelvis: greater net, breast, pericardium.
The average five-year survival is approx. 44-59% of patients, it depends on the stage of the cancer.
Comparing primary fallopian tube cancer to ovarian cancer, the former has a greater tendency to invade retroperitoneal space and develop distant metastases.
However, it is diagnosed at an earlier stage of advancement, due to the symptoms it causes and forces the patient to undergo gynecological control,