View source for Medicine:Fallopian tube cancer

'''Primary fallopian tube cancer''' ('''PFTC'''), often just '''tubal cancer''', is a malignant [[Medicine:Neoplasm|neoplasm]] that originates from the [[Medicine:Fallopian tube|fallopian tube]].<ref>{{Cite journal|last1=Horng|first1=Huann-Cheng|last2=Teng|first2=Sen-Wen|last3=Huang|first3=Ben-Shian|last4=Sun|first4=Hsu-Dong|last5=Yen|first5=Ming-Shyen|last6=Wang|first6=Peng-Hui|last7=Tsui|first7=Kuan-Hao|last8=Wen|first8=Kuo-Chang|last9=Chen|first9=Yi-Jen|date=September 2014|title=Primary fallopian tube cancer: domestic data and up-to-date review|journal=Taiwanese Journal of Obstetrics & Gynecology|volume=53|issue=3|pages=287–292|doi=10.1016/j.tjog.2014.07.003|issn=1875-6263|pmid=25286779|doi-access=free}}</ref>
==Signs and symptoms==
The internal location of the fallopian tubes makes it difficult to reach an early diagnosis. Symptoms are nonspecific, and may consist of pain and [[Medicine:Vaginal discharge|vaginal discharge]] or  bleeding. A pelvic mass may be detected on a routine gynecologic examination.

Vaginal discharge in fallopian tube carcinoma results from ''intermittent hydrosalphinx'', also known as ''hydrops tubae profluens''.<ref>{{cite journal | pmid = 13899814 | volume=18 | title=Hydrops tubae profluens--symptom in tubal carcinoma |date=November 1961 |vauthors=GOLDMAN JA, GANS B, ECKERLING B | journal=Obstet Gynecol | pages=631–4}}</ref>

==Pathology==
The most common cancer type within this disease is adenocarcinoma; in the largest series of 3,051 cases as reported by Stewart et al. 88% of cases fell into this category.<ref name=stewart/> According to their study, half of the cases were poorly differentiated, 89% unilateral, and the distribution showed a third each with local disease only, with regional disease only, and with distant extensions. Rarer forms of tubal neoplasm include [[Medicine:Leiomyosarcoma|leiomyosarcoma]], and transitional cell carcinoma.

As the tumor is often enmeshed with the adjacent [[Biology:Ovary|ovary]], it may be the pathologist and not the surgeon who determines that the lesion is indeed tubal in origin.

Secondary tubal cancer usually originates from cancer of the ovaries, the endometrium, the GI tract, the peritoneum, and the breast.

==Diagnosis==
A pelvic examination may detect an [[Medicine:Adnexal mass|adnexal mass]]. A CA-125 blood test is a nonspecific test that tends to be elevated in patients with tubal cancer. More specific tests are a gynecologic ultrasound examination, a [[CT scan]], or an MRI of the [[Biology:Pelvis|pelvis]].
Occasionally, an early fallopian tube cancer may be detected by chance during pelvic surgery.

===Staging===
International Federation of Gynecology and Obstetrics (FIGO) staging is done at the time of surgery:
:Stage 0: Carcinoma in situ
:Stage I: Growth limited to fallopian tubes
:Stage II: Growth involving one or both fallopian tubes with extension to pelvis
:Stage III: Tumor involving one or both fallopian tubes with spread outside pelvis
:Stage IV: Growth involving one or more fallopian tubes with distant [[Medicine:Metastasis|metastases]]

==Treatment==
The initial approach to tubal cancer is generally surgical, and similar to that of ovarian cancer. As the lesion will spread first to the adjacent [[Biology:Uterus|uterus]] and ovary, a total abdominal [[Biology:Hysterectomy|hysterectomy]] is an essential part of this approach, removing the ovaries, the tubes, and the uterus with the cervix. Also, [[Medicine:Peritoneal washing|peritoneal washing]]s are taken, the omentum is removed, and pelvic and paraaortic [[Biology:Lymph node|lymph node]]s are sampled. [[Medicine:Cancer staging|Staging]] at the time of surgery and pathological findings will determine further steps. In advanced cases when the cancer has spread to other organs and cannot be completely removed, cytoreductive surgery is used to lessen the tumor burden for subsequent treatments. Surgical treatments are typically followed by adjuvant, usually platinum-based, [[Medicine:Chemotherapy|chemotherapy]].<ref name=liapis>{{cite journal|vauthors=Liapis A, Bakalianou K, Mpotsa E, Salakos N, Fotiou S, Kondi-Paffiti A | title=Fallopian tube malignancies: A retrospective clinical pathological study of 17 cases.| journal=J Obstet Gynaecol |volume=28|issue=1|pages=93–5|year=2008 | pmid = 18259909|doi=10.1080/01443610701811894 | s2cid=5351886}}</ref><ref>{{cite journal| journal=Arch Gynecol Obstet | volume=264|title=Treatment of fallopian tube cancer. Review of the literature.| issue=1| pages=13–9| year=2000|vauthors=Takeshima N, Hasumi K | pmid = 10985612| doi=10.1007/pl00007475| s2cid=34114333}}</ref>
Radiation therapy has been applied with some success to patients with tubal cancer for palliative or curative indications.<ref>{{cite journal | journal= Radiother. Oncol. | volume= 10| title=Fallopian tube cancer: the role of radiation therapy. | issue= 4 | pages= 267–75 | year= 1987|vauthors=Schray MF, Podratz KC, Malkasian GD | pmid = 3444903 | doi=10.1016/s0167-8140(87)80032-4}}</ref>

==Prognosis==
Prognosis depends to a large degree on the stage of the condition. In 1991 it was reported that about half of the patients with advanced stage disease survived 5 years with a surgical approach followed by cisplatinum-based chemotherapy.<ref>{{cite journal   |vauthors=Barakat RR, Rubin SC, Saigo PE, etal | title=Cisplatin-based combination chemotherapy in carcinoma of the fallopian tube.  |journal=Gynecol Oncol | year=1991 | volume=42 | issue=2 | pages=156–160 | doi=10.1016/0090-8258(91)90337-5 | pmid=1894176 }}</ref>

==Frequency==
Tubal cancer is thought to be a relatively rare primary cancer among women, accounting for 1 to 2 percent of all gynecologic cancers,<ref name=ucsf>{{cite web|  url=http://www.ucsfhealth.org/adult/medical_services/cancer/pelvic/conditions/fallopian/signs.html | author=UCSF | title=Gynecologic Cancer: Fallopian Tube Cancer}} accessed 08-14-2008</ref> In the US, tubal cancer had an incidence of 0.41 per 100,000 women from 1998 to 2003.<ref name=stewart>{{cite journal|vauthors=Stewart SL, Wike JM, Foster SL, Michaud F | title=The incidence of primary fallopian tube cancer in the United States.| journal=Gynecol. Oncol. |volume=107|issue=3|pages=392–7|year=2007 | pmid = 17961642|doi=10.1016/j.ygyno.2007.09.018 |url=https://zenodo.org/record/1259469}}</ref>  Demographic distribution is similar to that of [[Medicine:Ovarian cancer|ovarian cancer]], and the highest incidence is found in white, non-Hispanic women aged 60–79.<ref name=stewart/> However, recent evidence suggests tubal cancer to be much more frequent .<ref name=piek>{{cite journal |vauthors=Piek JM, van Diest PJ, Verheijen RH |title=Ovarian carcinogenesis: an alternative hypothesis |journal=Adv. Exp. Med. Biol. |volume=622 |pages=[https://archive.org/details/ovariancancersta00geor/page/79 79–87] |year=2008 |pmid=18546620 |doi=10.1007/978-0-387-68969-2_7 |url=https://archive.org/details/ovariancancersta00geor/page/79 |series=Advances in Experimental Medicine and Biology |isbn=978-0-387-68966-1 |url-access=registration }}</ref>

Evidence is accumulating that individuals with mutations of [[Biology:BRCA1|BRCA1]] and [[Biology:BRCA2|BRCA2]] are at higher risk for the development of PFTC.<ref>[http://findarticles.com/p/articles/mi_m0CYD/is_8_37/ai_85591405 BRCA mutations link to tubal cancer], accessed 08-14-2008</ref><ref name="hereditary serous ovarian carcinogenesis">{{Cite thesis | url=http://dare.ubvu.vu.nl/handle/1871/9013 | title=Hereditary serous ovarian carcinogenesis, a hypothesis |type=PhD thesis | publisher=Vrije Universiteit Amsterdam| year=2004| last1=Piek| first1=J. M. J. |isbn=9064646406 |hdl=1871/9013}}</ref>

==See also==
[[Medicine:SEE-FIM Protocol|SEE-FIM Protocol]]

==References==
{{Reflist}}

== External links ==
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{{DEFAULTSORT:Fallopian Tube Cancer}}
[[Category:Rare cancers]]

{{Sourceattribution|Fallopian tube cancer}}