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types of cancer

Fallopian Tube Cancer

Overview

Fallopian Tube Cancer connects a woman’s ovaries to her uterus. It plays a key role during human reproduction by carrying the egg to the uterus. The Fallopian tube is also known as the oviduct or uterine tube, it has finger-like branches, called the fimbriae that reach out into the pelvic cavity and pick the egg from the ovary.

This organ, shaped like a slender tube is rarely susceptible to cancer with just 1% of all reproductive cancers in women attributed to fallopian tube cancer. Women who are between the age group of 50-60 are more likely to suffer from this type of cancer. The cancer forms in the tissue lining of the fallopian tubes. At times, they begin at the end of the fallopian tube near the ovary and spread to the ovary itself.

Symptoms

Detection of Fallopian tube cancer is difficult in the early stages since the symptoms remain vague until the cancer has advanced. It is important to note that the symptoms are non-specific and the cause of a particular symptom may be attributed to a different medical condition altogether and not necessarily cancer.

The symptoms include:

  • Fatigue
  • Frequent urination
  • Pain the pelvis or abdomen
  • Difficulty in eating and feeling full quickly
  • Bloating of the Abdomen & Pelvis
  • An upset stomach
  • Indigestion & Constipation
  • Back pain
  • Pain during sexual intercourse
  • Menstrual irregularities
  • Vaginal discharge which may be transparent, white or have a tinge of blood.
  • Causes

    Fallopian tube cancer is one of the rarest cancers amongst all gynaecological cancers. There is no certain cause that can explain its occurrence. However, some of the possible risk factors observed are:

  • Ageing
  • Hereditary (in case a close relative has a history of ovarian or breast cancer)
  • If the patient has never given birth
  • If the patient has never breastfed her child
  • If the patient has never used birth control pills
  • Infertility.
  • It is also observed that 10-15% of fallopian tube cancers occur due to genetic mutation. A normal woman has an average risk of 1-2% in her lifetime to get fallopian cancer whereas women who have mutation of the BRCA1 & BRCA2 genes have around 40% risk in their lifetime to get the cancer. The BRCA genes aid in the production of the BRCA proteins which help repair damaged DNA or destroy cells if DNA cannot be repaired. It is said that mutations in the BRCA are connected to the fallopian tube cancer.

    Diagnosis

    Because fallopian tube cancer is such a rare type of cancer, it can prove to be difficult to diagnose. Reports suggest that fallopian cancers are generally detected in their advanced stages when they have spread to nearby organs, especially the abdomen. Therefore, it is important to visit the physician in case of the any of the already-discussed symptoms are witnessed. Below are the tests and diagnostic procedures used to detect fallopian cancers:

  • Pelvic Exam – This involves a physical exam to find any abnormality in the pelvis.
  • CA125 Test – The human blood contains a protein called CA125. The protein level in the blood tends to increase during pregnancy, menstruation, gynaecological diseases and also during cancer. A test is conducted to check the CA125 protein levels in the body as part of the check-up.
  • Ultrasound – An ultrasound of the pelvis helps in detecting abnormalities in the fallopian tubes.
  • Computed Tomography (CT) Scan – The computed tomography system takes pictures of the inside of the body from different angles using X-rays. These images are then used to recreate 3-dimensional images with the help of the computer. These newly created images show if there are any abnormalities or tumours in the examined area. During the CT scan of the fallopian tube, a special dye may be injected into a vein or swallowed to get a clearer picture of the organ.

  • These procedures helps in confirming and staging the fallopian cancers. A Fallopian tube cancer can be divided into 4 stages.

    Stage I – In the early stage, the cancer is limited to just the 2 Fallopian tubes.

    Stage II – During second stage, the cancer would have spread to pelvis, uterus or ovaries.

    Stage III – Here the cancer spreads to the lymph nodes, intestine, peritoneum (located outside the pelvis) or the retroperitoneal lymph nodes. There are possibilities where it could touch the outer layer of the liver or spleen. Stage IV – In the final stage (also known as end stage fallopian tube cancer), the cancer spreads to the other distant parts of the body (called distant metastasis) and beyond the abdomen and pelvis region. This includes presence of cancer cells in the fluid within the pleural cavity (known as pleural cavity). In such advanced cases, the cancer can penetrate inside the liver, lungs or lymph nodes outside the abdomen.

    Treatment

    The treatment options are recommended after a thorough analysis of various factors such as the stage of cancer, patient’s preference and the age of the patient. Fallopian cancers are treated using one or a combination of the following treatment modalities:

    Surgery:
    Operating on the tumours generally works best when combined with chemotherapy. The surgical options are:

    a) A salpingo-oophorectomy: This procedure is performed in the early stages of fallopian cancers and it involves the removal of the ovary and fallopian tube either on one side (unilateral) or both sides (bilateral).

    b) A total hysterectomy and bilateral salpingo-oophorectomy: This treatment plan involves the removal of the fallopian tubes, ovaries and the entire uterus including the surrounding lymph nodes and tissues that may appear abnormal at that time. This is the most commonly used surgical treatment plan for fallopian cancer.

    c) Cytoreductive/debulking surgery: The procedure is performed in the advanced stages, especially when the cancer has become metastatic. It involves removing tissue from nearby organs such as liver, spleen and colon apart from the fallopian tubes (the point of origin). In this surgery, there are cases where the chemotherapy is performed to reduce the size of the tumour before the actual surgery is performed. This is known as neoadjuvant chemotherapy. Loss of ovaries eliminates the body’s tendency to produce sex hormones, resulting in early menopause.

    Chemotherapy:
    The procedure involves destroying cancer cells using chemo drugs in two ways namely intravenous (IV) tube (which is placed into a vein using a needle) or in a pill/capsule that is swallowed orally. The chemotherapy regimen usually consists of a set number of cycles given in a finite period of time. Patients can receive a single drug at a time or combination of multiple drugs at the same time.

    During treatment of the fallopian tubes with chemotherapy, there are possibilities where the patient may lose their ability to conceive a child resulting in early menopause. Based on the complexity of the cancer, there are two other options under chemotherapy which are adjuvant & neoadjuvant chemotherapy. Adjuvant chemotherapy is prescribed after the surgery is performed.

    The objective is to kill the remaining cancer cells in the fallopian tubes or nearby areas and thereby prevent any recurrence. Neoadjuvant chemotherapy is delivered before the surgery. In certain cases, it is often difficult to operate on tumours which are big in size. This type of chemotherapy helps in reducing the size of the tumour thereby facilitating relatively easier removal of the tumour during surgery.

    Radiation Therapy: This therapy involves the usage of high-energy rays or particles to destroy cancer cells. Although rarely used to treat fallopian tube cancer, it is usually recommended for older patients who cannot have chemotherapy.

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