Fallopian Tube Cancer

What is fallopian tube cancer?

Fallopian tube cancer forms in the ducts (tubes) that carry eggs from the ovaries to the uterus. They’re a part of the female reproductive system. Most females have two fallopian tubes, one on each side of the pelvis.

How common is fallopian tube cancer?

Fallopian tube cancer is the rarest cancer to affect the female reproductive system (gynecological cancer). Fewer than 1% of gynecological cancers start in the fallopian tubes.

What causes fallopian tube cancer?

For most people who have fallopian tube cancer, the cancer starts somewhere else in the body and then spreads to the fallopian tubes. Cancer that spreads is metastatic cancer.

When cancer originates in the fallopian tubes, 9 out of 10 times, it develops in gland cells (adenocarcinomas). The remaining fallopian tube cancers start in connective tissue (sarcomas).

Recent research indicates that the most common type of ovarian cancer (high-grade serous carcinoma or epithelial) may actually begin as fallopian tube cancer. The cancer develops at the end of a fallopian tube where eggs enter from an ovary. It then spreads to the surface of the ovary.

Fallopian tube cancer may account for up to 70% of all epithelial ovarian cancers. Most cancers in the ovaries, fallopian tubes and the peritoneum are grouped together for diagnosis, treatment and management.

What are the risk factors for fallopian tube cancer?

Factors that increase the chances of developing fallopian tube cancer include:

• Age (more than half of women who develop fallopian tube cancer or ovarian cancer are over 63).
• Changes (mutations) to the breast cancer (BRCA) gene.
• Early menstruation before age 12 or late menopause.
• Endometriosis.
• Ethnicity and origin (people living in North America or those of Northern European or Ashkenazi Jewish heritage are most at risk).
• Family history of breast cancer, ovarian cancer or fallopian tube cancer.
• Hormone replacement therapy after menopause.
• Infertility problems or having no pregnancies.
• Inherited conditions, such as Lynch syndrome and Peutz-Jeghers syndrome.
• Obesity (especially during early adulthood).

What are the symptoms of fallopian tube cancer?

Symptoms of fallopian tube cancer can be vague and easy to dismiss. You should see your healthcare provider anytime you notice a change in your health, especially if you have cancer risk factors.

Signs of fallopian tube cancer include:

• Abdominal pain or bloating.
• Abnormal menstruation.
• Chronic back pain.
• Constipation.
• Fatigue.
• Feeling full quickly.
• Frequent urination.
• Painful intercourse.
• Pelvic pain or mass.
• Upset stomach (indigestion).
• Watery or bloody vaginal discharge.

How is fallopian tube cancer diagnosed?

Fallopian tube cancer is difficult to detect in its early stage. It often spreads before diagnosis. Your healthcare provider may notice a lump or mass during a pelvic exam.

If you have symptoms, your provider may order one or more of these tests:

• Blood test: A CA-125 blood test measures the amount of cancer antigen 125 (CA-125). People with fallopian tube cancer or ovarian cancer may have higher levels of this protein in the blood. But you may have high levels of CA-125 due to other causes, especially if you are premenopausal.
• Imaging scans: You may get a transvaginal ultrasound, CT scan, MRI or positron emission tomography (PET) scan. These scans produce images of the fallopian tubes and ovaries and can show cysts and tumors.
• Paracentesis: When you have a buildup of peritoneal fluid in the abdomen (ascites), your provider uses a needle to sample the fluid. A lab tests the fluid for cancer cells.
• Biopsy: Your provider may do a biopsy to determine the stage of fallopian tube cancer.

How is fallopian tube cancer staged?

Healthcare providers use staging to describe cancer’s location and spread. This information helps providers select the most effective treatment.

Staging is often by surgery, or possibly by imaging (CT or PET) scans. Most often, a biopsy is part of surgery for fallopian tube cancer. Your surgeon removes the fallopian tube and nearby lymph nodes. An expert examines samples of tissue from the tube and lymph nodes to check for cancer cells.

Stages of fallopian tube cancer include:

• Stage 1: Cancer affects one fallopian tube or both tubes.
• Stage 2: Cancer affects a fallopian tube and nearby tissues in the pelvic region.
• Stage 3: Cancer has spread outside the pelvic region to affect lymph nodes or organs.
• Stage 4: Cancer affects the liver or distant organs like the lungs or brain.

How is fallopian tube cancer treated?

Treatments for fallopian tube cancer depend on the cancer stage. Treatments include:

• Surgery to remove the uterus (hysterectomy) and the fallopian tube and ovary (salpingo-oophorectomy).
• Chemotherapy to shrink the tumor before surgery or destroy lingering cancer cells after surgical treatment. Sometimes chemotherapy is delivered during surgery to allow a higher concentration of the drug in the abdomen. This is called heated (hyperthermic) intraoperative peritoneal chemotherapy.
• Targeted therapy to stop the growth of certain cancer cells with minimal damage to other, healthy cells.
• Clinical trials to try promising new therapies still in development.

What’s the prognosis for someone with fallopian tube cancer?

Survival rates for someone with fallopian tube cancer depend on the cancer stage and other factors, like a person’s age. The prognosis is best when providers catch the cancer early, before it spreads.

The five-year survival rates (odds of being alive five years after the initial diagnosis) are:

• Stage 1: 90% to 95%.
• Stage 2: 70% to 80%.
• Stage 3: 50% to 60%.
• Stage 4: 20%.

How can I prevent fallopian tube cancer?

If you have a family history of breast, ovarian or fallopian tube cancer, your healthcare provider may recommend a genetic test to check for changes to the BRCA gene. The test can show if you have a BRCA mutation or a syndrome that increases the risk of gynecological cancers.

If you have the mutation, a salpingo-oophorectomy surgery can lower cancer risk by as much as 96%. This is a prophylactic (preventive) procedure.

These steps may also reduce the risk of fallopian tube cancer:

• Breastfeed, if possible.
• Choose hormonal birth control options, such as the pill, a hormone-based IUD or an implant. However, if you have a BRCA gene mutation, talk with your provider about what’s right for you. These options may increase breast cancer risk in some people.
• Cut back on alcohol and quit smoking.
• Eat a healthy diet and stay physically active.
• Lose weight, if needed.
• Use nonhormonal treatments to manage menopause symptoms.

When should I call my doctor?

You should call your healthcare provider if you experience:

• Lump or mass in the pelvic area.
• Severe abdominal, pelvic or back pain that interferes with sleep or daily activities.
• Unexplained weight loss.
• Unusual vaginal discharge.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What is the cancer stage?
• What is the best treatment for me?
• What are the treatment risks and side effects?
• Should I (or my family members) get tested for BRCA gene mutations?
• What changes can I make to protect my health?
• Should I look out for signs of complications?