Fallopian Tube Cancer

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.

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.

Because fallopian tube cancer is such a rare type of cancer, it can prove to be difficult to diagnose.  Women usually don’t realise that they have fallopian tube cancer until the middle of a surgery planned to treat some other illness. However, there are several specific tests to diagnose the condition:

• 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 is performed. It involves the use of high-frequency sound waves to create images of organs and systems within the body. The test is effective while detecting abnormalities in the fallopian tubes.
• CT Scan – The Computed tomography takes pictures of the inside of the body and are recreated in the computer with the help of an X-ray machine. 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.

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.

The treatment options are recommended after thorough analysis of several factors such as:

1. Stage of Cancer
2. Patient’s preference
3. Age of the person

The various treatment options include:

Surgery – Operating on the tumours generally works best when combined with chemotherapy. The surgical options are –
a) Cyto-reductive/debulking surgery – The procedure is performed especially when the cancer has turned 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 treating through chemo drugs involving two methods 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. Patient can receive a single drug at a time or combination of multiple drugs at the same time. The procedure can give side effects such as fatigue, nausea, vomiting, hair loss, risk of infection, hair loss, diarrhoea and loss of appetite. 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 & neo-adjuvant chemotherapy.
The adjuvant chemotherapy is prescribed after the surgery is performed. The objective is to terminate the remaining cancer cells in the fallopian tubes or nearby areas and prevent any recurrence.
Neo-adjuvant chemotherapy is performed 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 a relatively easier removal of the tumour during surgery.

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