Fallopian Tubes are a part of the female reproductive system. The fallopian tubes are tubular structures which connect the upper, outer-most part of the uterus with the ovary, and provide a route for the female egg to undergo fertilisation.In women of reproductive age, an egg is released from one of the ovaries into the adjacent fallopian tube, once every month during ovulation.The tube’s job is to move the egg along its journey to the uterus by lining cells with small hair-like ciliary projections. In the uterus (also called the womb), the egg has to be fertilised by male sperm or removed during menstruation.The fallopian tubes are called so after a famous Italian physician named Gabriele Fallopio (1523–1562), who first described them. Three layers of the fallopian tube are:
- Internal mucosa (endosalpinx)
- Intermediate muscular layer (myosalpinx)
- Outer serosa, peritoneum of the broad ligament and uterus (mesosalpinx)
What are fallopian tube cancers ?
Fallopian Tube Cancers are basically tumours of the Fallopian Tube.
How is a fallopian tube cancer caused ?
As in many lower-tract gynaecological tumours, Human Papilloma Virus (HPV) infection plays a role in the aetiology of cancer. HPV can be spread from one person to another through either skin-to-skin contact or through unprotected sex. Having multiple sexually transmitted diseases (like Chlamydia) can contribute to the pathogenesis, as well. Women smokers are double likely to get fallopian tube cancer as women non-smokers. Tobacco by-products have been detected in the cervical mucus of women smokers.Being immunocompromised (such as having AIDS or HIV infection) also can predispose to HPV infection and thus cancer.
What are the types of fallopian tube cancer ?
There are several types of cancer that can initiate in the Fallopian Tube.
- Papillary serous adenocarcinomas: The vast majority (more than 95 per cent) of fallopian tube cancers are papillary adenocarcinomas. These adenocarcinomas arise from abnormal cells lining the fallopian tubes.
- Leiomyosarcomas and transitional cell carcinomas: Rarely, a few tumours can arise in the smooth muscle in the fallopian tubes. These are then called sarcomas or leiomyosarcomas. If they arise from the transitional lining of fallopian tubes, they are called transitional cell carcinomas.
What are the clinical features of fallopian tube cancers ?
Symptoms of endometrial cancers include vaginal bleeding or foul smelling, yellowish discharge. Bleeding or spotting after menopause can also be noted. Pain or a lump in the abdomen, lethargy, or weight loss can also occur.
How are fallopian tube cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Pelvic ultrasonography: Although the presence of the pelvic mass can thus be confirmed by pelvic ultrasonography, its origin cannot always be determined.
- Transvaginal ultrasonography: The role of transvaginal ultrasonography is becoming more established. A cog wheel-like appearance with polyploid tissue growing from the inner surface of the fallopian tube has been described suggestive of fallopian tube pathology.
- Cytology: Abnormal or atypical glandular cytology in the absence of any other cervical or endometrial pathology should raise the possibility of an ovarian or fallopian tube malignancy.
- Tumour markers: CA125 are proving to be of help in the diagnosis of fallopian tube cancer.
- Biopsy: A pathologist studies the removed tissue under a microscope and confirms the cancer.
- Imaging tests: To determine the exact extent of disease, additional tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These tests may include the following such as X- rays, CT Scan, MRI Scan or PET Scans.
How are fallopian tube cancers staged and graded ?
Grade and Stage describe the tumour, helping to provide guidance in choosing the best treatment option(s). Staging is a careful attempt to find out the extent of the cancer. Staging will define whether the cancer has invaded into adjacent structures, whether the disease has spread, and if so, to what parts of the body. The staging of fallopian tube cancer is surgical and based on that for ovarian cancer.
Staging
The following stages are used for cancer of the fallopian tube:
- Stage 1: Cancer is restricted only to one or both of the fallopian tubes. This is early stage.
- Stage 2: Fallopian Tube Cancer is found in either one or both fallopian tubes and/or has also spread to other organs in the pelvis like the uterus, ovaries and bladder.
- Stage 3: Cancer is present in one or both fallopian tubes and has extended outside the pelvis to other abdominal organs or to lymph nodes in the abdomen.
- Stage 4: Cancer is present in one or both fallopian tubes and has spread extra-abdominally or to the liver.
- Recurrent Cancer: If the cancer recurs after primary treatment, this is recurrent cancer.
Grading
Grade refers to the resemblance of cancer cells to normal cells. Low-grade tumours are better differentiated and grows relatively slowly while high-grade tumours grow faster and spread rapidly.
How are fallopian tube cancers treated ?
- Surgery : The current recommendation for surgery is to carry out a total abdominal hysterectomy (removal of uterus), bilateral salpingooophorectomy, omentectomy and lymphadenectomy.
- Chemotherapy : another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing. It appears that chemotherapy is most useful in advanced disease.
- Radiotherapy : there may still be a role of postoperative pelvic radiotherapy in patients who are staged accurately.
What is the care to be taken after the removal of a fallopian tube cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
