Fallopian Tube Cancer
Fallopian tube cancer also called tubal cancer is a rare form of a malignant tumour that develops in the fallopian tube. Although originate at the fallopian tube, if left untreated fallopian tube cancer can spread into your lower abdomen (pelvis) and stomach areas; this condition is called fallopian tube cancer.
The fallopian tubes are two narrow ducts that extend from the ovaries to the uterus, measuring ten to fourteen cm long and three to eight millimetres in diameter. They play an important role in the female genital tract. At each ovulation, the ovary releases one egg; that egg is captured by the infundibulum of the fallopian tube which is transported to the uterus by a group of hair-like structures (cilia) that form the tubal mucosa. If fertilization occurs, the embryo thus formed is propelled by the cilia in the uterine cavity.
Cancer of the fallopian tubes is the rarest of all gynaecological cancers, representing approximately 1-2% of all gynaecological cancers worldwide. In the United States, the incidence of fallopian tube cancer was estimated at 0.41 per 100,000 women from 1998 to 2003. The highest incidence was found in white, non-Hispanic women and women aged 60–79.
Fallopian tube cancer occurs when there is abnormal cell proliferation in the fallopian tube due to certain pathogenic factors, which allow them to divide indefinitely to form a malignant growth. In the early stage of tubal cancer, the cancerous cells are confined inside the tube. Over time, cells migrate from their original place and form a new tumour in other tissues or organs known as the metastatic fallopian tube cancer.
In most cases, fallopian tube cancer is a metastasis cancer which comes from another malignant tumour that started elsewhere in the body, mainly the ovaries, endometrium, GI tract, peritoneum, or the breasts.
3. Risk Factors
Risk factors for fallopian tube cancer are not well known. However, sex, age, race, pelvic inflammatory disease, and certain chronic diseases such as TB are etiological factors suspected in the development of a tumour. In addition, fallopian cancer is sometimes found in patients that have a history of infertility. Some identified risk factors include:
- Age – cancer of the fallopian tubes is rare thus it affects mostly women aged between 60-79 years.
- Race – the highest incidence of fallopian tube cancer is found in white, non-Hispanic women.
- Menopause – Although fallopian tube cancer can affect younger women, it is more common among post menopause women.
- Personal/family history – A factor likely to develop the fallopian tube cancer is a history of ovarian cancer in your immediate family; this risk is even higher if you have a personal history of cancer the ovary (ovarian cancer).
- Genetic –Pieces of new studies shows that mutation in a human gene called BRCA1 can be associated with a significant increase in the risk of breast cancer and others cancer of which fallopian tube cancer is no exception.
You can have fallopian tube cancer for a long period without experiencing any symptoms and silently damaging your tube. When symptoms finally emerge, they may be taken for those of other medical conditions.
In general, if you have fallopian tube cancer you will experience:
- Presence of pelvic mass or lump.
- A sensation of pressure in the abdomen.
- White, clear or pinkish vaginal discharge.
- General malaise.
- Abdominal pain
- Bleeding after menopause.
- The fact that cancer can remain asymptomatically for years, the tumour can grow significantly in volume or spread to other tissues before it is diagnosed. Cancer can spread by direct extension or through the lymphatic circulation to form metastasis in other organs such as the pelvis and stomach.
- To avoid complications, if you experience symptoms related to fallopian cancer, consult your doctor immediately. These symptoms may not necessarily mean fallopian cancer. It is best to see a doctor.
The fact that symptoms of fallopian tube cancer do not manifest at the beginning of the disease, the diagnosis is often late. In addition, because of the proximity of the uterus and ovary, the diagnosis is very difficult to confirm by a simple pelvic exam; specific exams are needed along with the pelvic exam.
- Pelvic Examination– Your physician will ask you a question about the symptoms you experience. He or she will perform a pelvic examination on your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for abnormalities.
- Your doctor can also perform a Pap test and imaging techniques to rule out the presence of an ovarian or uterus cancer; these two often present symptoms similar to tubal cancer. Other tests that can be done to confirm with certainty the cancer are CA 125 blood test, gynaecological ultrasound, CT scan, MRI of the pelvis, and a biopsy.
- CA 125 blood test– Your doctor may take samples of your blood to perform a CA 125 blood test. CA 125 is a protein which is considered as a tumour marker; it is often elevated in women with ovarian cancer. Most of the times, this testing is recommended in the fallopian tube cancer diagnosis to rule out other gynaecological cancers such as ovarian cancer.
- Gynecology Ultrasound– this painless, non-invasive and safe diagnostic technique allows your physician to examine your pelvic organs, uterus, ovaries, fallopian tubes, and bladder. If you experience pelvic or abdominal pain, irregular bleeding and/or heavy menstrual bleeding, You will likely be recommended to undergo an ultrasound. Your physician may also recommend this test if pelvic or abdominal abnormalities have been found during the physical exam.
- CT scan– A CT-scan is a medical technique involving the use of special x-ray machine with sophisticated computers to create a three-dimensional picture of the tissues of your body; your pelvic area in the diagnosis of fallopian tube cancer. However, excessive use of CT scan can lead to health problems. The magnetic resonance imaging (MRI) is non-radiating and may represent an alternative for some applications of CT scan, but cannot replace the CT imaging.
- MRI of the pelvis– This medical technique consists of applying a combination of electromagnetic waves at high frequency on your pelvic to produce detailed images. After injecting a contrast medium (or contrast agent) into your vein, this technique allows your health care provider to determine the chemical composition and the nature of biological tissues of your fallopian tube, and detect the presence of abnormalities such as a malignant tumour.
- Biopsy– To confirm accurately the presence of cancerous cells in your fallopian tube, your doctor will recommend a biopsy. In general, a pathologist will remove a small amount of tissue from the fallopian tube for laboratory analysis. The result will be interpreted by a doctor or a physician specialized in interpreting and diagnosing the changes caused by disease in tissues and body fluids.
Determining the stage of tubal cancer helps to choose the treatment most appropriate and effective to fight a tumour. In general, the stage of fallopian tube cancer is determined by the size of a tumour and degree of the cells within your body. Sometimes, to accurately determine the stage of a fallopian tube cancer, additional testing may be necessary.
The fallopian tube cancer stages include:
- Carcinoma in situ – Limited to the tubal mucosa.
- Stage I – At this early stage, the cancer is limited to the fallopian tubes.
- Stage II – Cancer has reached one or both fallopian tubes and has slightly spread to the pelvis.
- Stage III – Cancer has affected one or both fallopian tubes and has spread outside the pelvis.
- Stage IV – Cancer has reached one or both fallopian tubes, outside the pelvis, spread to distant organs such as pleura, peripheral lymph nodes, lungs, and skin.
- Recurrent – A fallopian tube cancer that has returned after treatment is considered as recurrent cancer. In general, recurrent cancers are more difficult to treat and survival chance is lower
Cancer treatment depends on the extent, stage, presence or absence of metastases. Your doctor will also consider your general health and age to recommend an appropriate therapy. Knowing these details, your oncologist will determine which treatment will be more appropriate and effective.
Most of the times, the treatment of fallopian tube cancer includes surgery, chemotherapy, and radiotherapy. If the cancer is diagnosed early, your health care provider will implore surgery alone or in combination with radiotherapy to treat it. In case of advanced cancer, the treatment will include chemotherapy.
Surgical intervention is often performed to treat tubal cancer. Type of surgery performed depends on the state of cancer and its location. Fallopian tube cancer tends to spread to the uterus and ovary; your surgeon can perform a total abdominal hysterectomy in order to remove the ovaries, tubes and the uterus along with the cervix.
If the cancer is aggressive or has spread to other organs and cannot be completely removed, a cytoreduction surgery combined with chemotherapy can be necessary. The goal of this therapy is to decrease the size of a tumour for subsequent treatments.
Chemotherapy is the use of powerful drugs to destroy cancer cells or prevent them from growing. Unlike surgery and radiotherapy, chemotherapy attack cells in your entire body. Most often, treatment consists of simultaneous administration of several chemotherapeutic agents (polychemotherapy).
Whatever agents and dosage administered, the drugs must be strong enough to destroy the cancer cells but not too powerful to destroy too many healthy cells. In most cases, the chemotherapy drugs will be given by intravenous injection approximately five times a week over a period of three months.
The chemotherapy drugs always cause side effects such as:
- Nausea and vomiting.
- Loss of appetite.
- Loss of hair loss.
- Low sex desire.
- Menstrual irregularity.
- Increased risk of infections.
Radiotherapy is a cancer treatment consists of using x rays to destroy cancer cells by preventing them from dividing. Unlike chemotherapy, radiation acts locally on the treated area. For women who have an advanced fallopian tube cancer, radiation may be used to shrink a tumour and make it possible to be removed surgically. Radiation therapy can also be used to relieve pain caused by cancer that has spread to other parts of the body.
The three most common side effects of radiotherapy include:
- nausea and vomiting
- skin redness and pain
9. Survival Rates.
Fallopian tube cancer prognosis depends greatly on the stage of a tumour when it was diagnosed. Your lifestyle also plays an important role in your chance of survival. If you were diagnosed with stage 0 or 1 fallopian tube cancer, your five-year survival rate can be up to 91%. But In advanced cancer, your 5-year survival rate drops considerably. In 1991, it was reported that about 50% of patients with advanced stage fallopian tube cancer that underwent a surgical approach followed by cisplatinum-based chemotherapy survived Five years.
The best way to prevent the onset of cancer is to live a healthy lifestyle. Your lifestyle, as well as your environment, is often the open door to cancer including fallopian tube cancer. Even if you are at low risk, you might have cancer if you continue to expose yourself to carcinogens.
Several factors can cause the formation of cancerous cells. Some risk factors such genetic and age is impossible to change. However, If you want to prevent cancers it is important to:
- Adopt a healthy diet: a diet containing 5 to 10 servings of fruits and vegetables a day may help prevent the occurrence of cancer
- Maintain a healthy weight.
- Reduce exposure to ultraviolet (UV) radiation.
- Exercise regularly.
- Practice safe sex.