Fallopian Tube Cancer

What is fallopian tube cancer?

Fallopian tube cancer forms in your fallopian tubes, the ducts that carry eggs from the ovaries to the uterus. Most fallopian tube cancer starts in the same tissue (epithelial tissue) and acts like ovarian cancer and primary peritoneal cancer. Healthcare providers diagnose, treat and manage these cancers similarly.

Fallopian tube cancer is curable if it’s treated early, when surgery removes all of the cancer cells. The challenge of this cancer is that it doesn’t often cause symptoms in the early stages, and it spreads fast. Most people aren’t diagnosed until fallopian tube cancer has spread and is harder to treat.

How common is the condition?

For years, medical experts thought of fallopian tube cancer as the rarest cancer that affects the female reproductive system (gynecological cancers). As few as 1% of gynecological cancers start in the cells lining your fallopian tubes.

But new research shows that the most common type of ovarian cancer — epithelial ovarian cancer — likely starts in the fallopian tube. It forms at the end of the tubes where eggs enter from your ovaries (fimbriae). It then spreads to the surface of your ovary and the rest of your pelvis and abdomen.

What are the symptoms of fallopian tube cancer?

Symptoms of fallopian tube cancer can be hard to notice and easy to ignore, especially in the early stages. You may not notice symptoms until the cancer has spread throughout your abdomen.

Signs and symptoms of fallopian tube cancer include:

• Pelvic pain or mass.
• Abdominal pain, swelling or bloating.
• Loss of appetite, feeling full quickly or nausea.
• Changes in your pooping habits, like constipation or diarrhea.
• Peeing more often (frequent urination).
• Abnormal periods or bleeding after menopause.
• Watery or bloody vaginal discharge.

You should see your healthcare provider anytime you notice a change in your health, especially if you have a family history of cancer or other risk factors.

What causes fallopian tube cancer?

Researchers aren’t sure what causes fallopian tube cancer. They do know that 90% of the time, it develops in glands that line your organs, including epithelial cells. These are the same type of cells where most ovarian cancers start. Most fallopian tube and ovarian tumors are high-grade serous tumors. This means they spread fast.

The remaining fallopian tube cancers start in connective tissue (sarcomas).

Risk factors

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

• Age: More than half of people with fallopian tube cancer or ovarian cancer are over 63.
• Ethnicity: People living in North America or those of Northern European or Ashkenazi Jewish descent are more likely to get fallopian tube cancer.
• Family history: Your risk is greater if you have a first-degree biological relative (mother, sister, daughter) who’s had breast cancer, ovarian cancer or fallopian tube cancer.
• Genetic mutations: Changes (mutations) to the breast cancer (BRCA) gene increase your risk.
• Health conditions: Inherited conditions such as Lynch syndrome and Peutz-Jeghers syndrome increase fallopian cancer risk. Endometriosis is also a risk factor.
• Pregnancy and childbirth history: You’re more likely to develop fallopian tube cancer if you’ve never been pregnant or if you had your first full-term pregnancy past age 35.
• Menstrual cycle history: Getting your first period before age 12 and going through menopause after age 51 are both risk factors.
• Obesity: Having a body mass index (BMI) above 30 (obesity) can increase your risk, especially if you had obesity during early adulthood.

How is fallopian tube cancer diagnosed?

Fallopian tube cancer doesn’t usually cause symptoms in the early stages, which means it often spreads before diagnosis. You may not know there’s an issue until a healthcare provider notices a lump or mass during a routine pelvic exam.

Your provider may order one or more of these tests to learn more about your condition:

• Blood tests: A CA-125 blood test measures the amount of cancer antigen 125 (CA-125). You may have higher levels of CA-125 if you have fallopian tube cancer. But you may have high levels for reasons unrelated to a fallopian tube cancer diagnosis, especially if you’re perimenopausal.
• Imaging tests: You may get a transvaginal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET) scan. These scans produce images of your fallopian tubes and ovaries and can show cysts and tumors.

To make a diagnosis, your provider will need to remove fluid or tissue so a pathologist can test for cancer cells in a lab. Procedures include:

• Exploratory surgery: Surgery allows your provider direct access to your organs, so they can check for suspicious-looking tissue. They may remove all or part of your fallopian tubes, ovaries and nearby lymph nodes for testing. Procedures include laparotomy (open surgery), laparoscopy (minimally invasive surgery) or robotic surgery.
• Paracentesis: Your provider uses a needle to collect a sample of fluid that’s built up in your abdomen (ascites) for testing.
• Biopsy: A biopsy removes a tissue sample from a tumor for testing. This procedure can be performed under ultrasound or computed tomography (CT) scan guidance.

How is fallopian tube cancer staged?

Imaging scans and procedures that remove and test tissue allow providers to stage fallopian tube cancer. Cancer staging describes where fallopian tube cancer is located and how much it’s spread (metastasized). Staging helps your provider plan treatments and determine your prognosis.

Stages of fallopian tube cancer include:

• Stage 1: Cancer affects one fallopian tube or both.
• Stage 2: Cancer affects one fallopian tube or both and nearby tissues in your pelvis.
• Stage 3: Cancer has spread outside your pelvis to lymph nodes or nearby organs.
• Stage 4: Cancer has spread to your liver or distant organs like your lungs or brain.

You may also hear your provider describe your cancer as:

• Local: Hasn’t spread beyond your fallopian tubes.
• Regional: Has spread to nearby abdominal organs or lymph nodes.
• Distant: Has spread to distant organs.

Your provider can help you understand these classifications and how they affect your health outlook.

How is fallopian tube cancer treated?

Your treatment will depend on the cancer stage. Treatments include:

• Surgery: Exploratory surgery to diagnose fallopian tube cancer is often also the first stage of treatment. Most people have surgery to remove their uterus (hysterectomy), both fallopian tubes (salpingectomy) and ovaries (oophorectomy). You may need to have other organs removed, too, to increase your chances of survival and improve your quality of life. Depending on your age and diagnosis, your provider may be able to remove only the tumor. That way, you still may be able to have children.
• Chemotherapy: You may need chemotherapy to shrink the tumor before surgery or destroy lingering cancer cells after surgery. Sometimes, providers give chemotherapy treatment during surgery to allow more concentrated chemotherapy drugs in your abdomen. This is called heated (hyperthermic) intraoperative peritoneal chemotherapy.
• Targeted therapy: Targeted therapy stops the growth of certain cancer cells with minimal damage to healthy cells. Your provider may recommend targeted therapy drugs if you have a BRCA genetic mutation.
• Immunotherapy: If you have cancer cells with a specific genetic mutation (such as Lynch syndrome), your provider may consider immunotherapy drugs.
• Clinical trials: Your provider may recommend you take part in a study to try promising new cancer treatments.
• Palliative care: Palliative care can help you manage cancer symptoms and treatment side effects.

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 BRCA test. The test can show if you have a BRCA mutation or a syndrome that increases your risk of gynecological cancers.

If you have the mutation, removing your ovaries and fallopian tubes (a salpingo-oophorectomy) can lower cancer risk by as much as 96%. This is a prophylactic (preventive) procedure.

To reduce your risk of fallopian tube cancer, you can also:

• Choose hormonal birth control options, such as the pill or an implant. (But 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.)
• Have a tubal ligation or removal of your fallopian tubes.
• Use non-hormonal treatments to manage menopause symptoms.
• Cut back on how much alcohol you consume and quit smoking if you do.
• Eat a healthy diet and stay physically active.
• Strive to reach a healthy weight for you.
• Breastfeed, if possible.

What can I expect if I have fallopian tube cancer?

About 80% of people experience remission (no signs or symptoms of fallopian tube cancer) after treatment. Early-stage cancers return (recur) 25% of the time. Advanced-stage cancers return up to 80% of the time.

You’ll need to see your healthcare provider regularly, especially within the first five years, to check for recurrent cancer. You’ll likely need lifelong checkups if you were treated for advanced cancer.

Talk to your provider about any new symptoms you’re experiencing during these visits. In addition to striving to keep you cancer-free, your healthcare provider can offer resources and advice to help you manage lasting side effects or locate support groups for people living with a cancer diagnosis.

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

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

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

• Local: 94%.
• Regional: 53%.
• Distant: 44%.

When should I call my healthcare provider?

You should call your healthcare provider if you have:

• A lump or mass in your 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 healthcare provider?

You may want to ask your healthcare provider:

• What’s the cancer stage?
• What’s 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?