The origin of primary ovarian cancer, based on advancing genetic investigations and correlation with histopathologic evidence is most likely meta- static primary fallopian tube cancer (PFTC). Thus, fallopian tube, ovarian, and primary peritoneal cancers are now grouped under the same umbrella for diagnosis, treatment, and management as ovarian cancers. The incidence of PFTC was stated to be 0.41/100,000 women (119). Bilateral involvement is found in 5% to 30% of patients, and one third of patients have LN metastasis at the time of staging. Route of spread is trans coelomic, lymphatic, and hematogenous.
Hu’s criteria were established to assist in the definitive diagnosis of PFTC (120).
This was further modified by Sedlis in 1978 (121) and the criteria are: a) the main tumor is in the tube and arises from the endosalpinx; b) the pattern histologically reproduces the epithelium of fallopian tube mucosa and shows a papillary pattern; c) the transition between benign and malignant tubal epithelium should be demonstrable; d) and the ovaries and endometrium are normal or contain less tumor than the tube.
There is often a triad of symptoms: pelvic pain, a pelvic mass, and watery vaginal discharge (hydrops tubae profluens). This occurs in 11% of patients. A pelvic mass is diagnosed in 12% to 66% of patients.
PRE-TREATMENT WORKUP
Workup includes a history and physical examination with lab tests. Tumor markers including a CA-125 are drawn. An abnormal Pap smear has been found to be positive in 18% to 60% of patients. Imaging with ultrasound, CT, or MRI can be helpful.
HISTOLOGY
Ninety percent of tumors are serious, but other subtypes are found including endometrioid, transitional and mixed mesodermal Müllerian tumors.
The fallopian tubes are a pair of slender tubes that connect the ovaries to the uterus. While fallopian tube cancer is rare, it can occur. The exact cause of fallopian tube cancer is not well understood, but certain risk factors have been identified. Here are the causes and symptoms of fallopian tube cancer:
Causes:
- Age: The risk increases with age, with most cases diagnosed in women over the age of 50.
- Family history: A family history of fallopian tube, ovarian, or breast cancer may increase the risk.
- Genetic mutations: Inherited gene mutations, such as mutations in the BRCA1 and BRCA2 genes, are associated with an increased risk of fallopian tube cancer.
- Personal history of cancer: Women who have had ovarian, breast, or endometrial cancer in the past may have a higher risk.
Symptoms:
- Abnormal vaginal bleeding: Unusual vaginal bleeding, such as postmenopausal bleeding or bleeding between periods, can be a symptom of fallopian tube cancer.
- Pelvic pain or discomfort: Persistent or recurrent pelvic pain, often described as a dull ache or pressure, may be a symptom of fallopian tube cancer.
- Abdominal bloating or swelling: Persistent bloating or swelling in the abdomen, sometimes accompanied by a feeling of fullness, can be a sign of fallopian tube cancer.
- Changes in bowel or bladder habits: Fallopian tube cancer can affect nearby organs, leading to changes in bowel or bladder habits, such as constipation, increased frequency of urination, or difficulty urinating.
- Unexplained weight loss: Significant, unexplained weight loss without any known cause may be a symptom of advanced fallopian tube cancer.
It is important to note that these symptoms can also be caused by other conditions, and the presence of these symptoms does not necessarily indicate fallopian tube cancer. However, if you experience persistent or concerning symptoms, it is important to consult a healthcare professional for evaluation and appropriate testing.
TREATMENT
Primary treatment is usually surgical to follow the general TOC protocols.
Surgery includes full staging with a TH-BSO,LND(if less than stage IIIC),omentectomy, peritoneal biopsies, and debulking to microscopic residual disease.
Chemotherapy follows the same principles as that of tubo-ovarian cancer with first-line platinum and paclitaxel-based combination regimens.
Treatment by stage and grade:
° Stage I grade 1: definitive surgery
° Stage I grade 2 or 3: surgery and adjuvant chemotherapy °
Stage II to IV: surgery and (neo) adjuvant chemotherapy
FOLLOW-UP
For nonseminomatous tumors, follow-up should occur every 3 months for the first 2 years, every 6 months up to 5 years.
For dysgerminomas, a 10Y follow-up is recommended. Serum hCG and AFP should be measured for all patients, even if not initially elevated. 10–20% of tumors relapse.
REFERENCES
- Diaz-Padilla I, Malpica AL, Minig L, et al. Ovarian low-grade serous carcinoma: a comprehensive update. Gynecol Oncol. August 2012;126(2):279-285.
- Previs R, Leath CA III, Coleman RL, et al. Evaluation of in vitro chemoresponse profiles in women with Type I and Type II epithelial ovarian cancers: an observational study ancillary analysis. Gynecol Oncol. August 2015;138(2):267-271.
- Grabowski JP, Harter P, Heitz F, et al. Operability and chemotherapy responsiveness in advanced low-grade serous ovarian cancer. An analysis of the AGO Study Group meta- database. Gynecol Oncol. March 2016;140(3):457-462.
