Fallopian tube cancer is a malignant tumor lesion of the fallopian tube of a primary, secondary or metastatic nature. With cancer of the fallopian tube, abdominal pain, the release of serous or purulent whites, an increase in the volume of the abdomen due to ascites, a violation of the general condition are noted. Diagnosis is carried out on the basis of gynecological examination, ultrasound, aspirate examination and scrapings from the uterine cavity. The optimal tactic is a combined treatment – a panhysterectomy with a postoperative course of radiation and chemotherapy.
General information
In gynecology, cancer of the fallopian tube is relatively rare, in 0.11–1.18% of cases from malignant neoplasms of female reproductive organs. Usually the disease is detected in patients after 50 years. The tumor process is more often unilateral and affects the ampoule of the fallopian tube. Less often, cancer of the fallopian tube is bilateral.
Causes
There is no clearly defined opinion on the causes of the development of uterine tube cancer in modern gynecology yet. Among the predisposing factors are repeatedly transferred inflammation of the appendages (salpingitis, adnexitis), age over 45-50 years. In the anamnesis, patients often have an absence of childbirth or infertility associated with amenorrhea or anovulatory cycles. In recent years, the theory of viral etiology in the development has been considered, in particular the role of type II herpes virus and human papillomavirus.
As the tumor grows, the fallopian tube is stretched and deformed, which acquires a retort-like, ovoid or other irregular shape. The tumor, as a rule, has the appearance of cauliflower with a finely rounded, finely wrinkled surface, grayish or pinkish-white color. Hemorrhages, necrosis, impaired patency develop inside the fallopian tube; rupture of the stretched walls of the tube is possible. The outer surface of the affected fallopian tube acquires a gray-bluish or dark purple color due to pronounced dyscirculatory disorders.
When the ampullary hole of the pipe is sealed, a picture of hydro-, hemato- or pyosalpinx develops. In the case of an open opening of the ampoule, tumor masses can protrude into the abdominal cavity in the form of separate tumor nodes or warty growths. As a result of perifocal inflammation in cancer of the fallopian tube, adhesions with the omentum, uterus, intestinal loops are formed.
Tumor dissemination in uterine tube cancer can occur by lymphogenic, hematogenic and implantation methods. The lymphogenic pathway of metastasis is observed more often, due to the abundant supply of the phalopian tube with lymphatic vessels. Metastases are most often found in the inguinal, lumbar and supraclavicular lymph nodes. A single blood supply network of the internal genitals provides secondary damage to the ovaries, uterus and its ligamentous apparatus, vagina. By implantation, cancer of the fallopian tube can diseminate along the serous cover of the visceral and parietal peritoneum, involving the omentum, intestines, adrenal gland, liver, spleen, etc. in the generalized process. organs.
Classification
A malignant process in the fallopian tube may develop initially (primary cancer of the fallopian tube) or be a consequence of the spread of cancer of the uterus or ovaries (secondary cancer). There is also metastasis to the fallopian tubes of breast cancer, stomach, intestines (metastatic cancer). According to histological type, disease is more often represented by adenocarcinoma (serous, endometrioid, mucinous, light cell, transitional cell, undifferentiated).
For the staging of this pathology in gynecology, 2 classifications have been adopted – TNM and FIGO. The TNM classification is based on determining the prevalence of the primary tumor (T), the involvement of regional lymph nodes (N) and the presence of distant metastases (M).
Stage 0 (Tis) is preinvasive fallopian tube cancer (in situ).
Stage I (T1) – cancer does not spread beyond the fallopian tube (tubes):
- IA (T1a) – cancer is localized in one fallopian tube; serous membrane does not germinate; ascites is absent;
- IB (T1b) – cancer is localized in both fallopian tubes; serous membrane does not germinate; ascites is absent;
- IC (T1c) – cancer is limited to one or both tubes; infiltrates the serous cover; atypical cells are detected in ascitic effusion or flushing waters from the abdominal cavity
Stage II (T2) – cancer spreads to one or two fallopian tubes, as well as pelvic organs:
- IIA (T2a) – the spread of the tumor to the uterus or ovaries
- IIB (T2b) – spread of the tumor to other pelvic structures
- IIC (T2c) – involvement of pelvic organs with the presence of atypical cells in ascitic effusion or flushing waters from the abdominal cavity
Stage III (T3) – cancer affects the fallopian tube (tubes), spreads through the peritoneum beyond the pelvis, metastasizes to regional lymph nodes:
- IIIA (T3a) – microscopic foci of metastasis along the peritoneum outside the pelvis are detected
- IIIB (T3b) – foci of metastasis along the peritoneum less than 2 cm in the maximum dimension
- IIIC (T3c / N1) – foci of metastasis more than 2 cm, metastases to regional (inguinal, paraaortic) lymph nodes
Stage IVB (M1) – there are distant metastases of fallopian tube cancer, except for peritoneal metastases.
Symptoms of fallopian tube cancer
Cancer of the fallopian tube often manifests itself at an early stage. Since there is an anatomical communication between the fallopian tube and the uterus, the products of tumor decay and blood enter the vagina through the cavity and cervix, manifesting pathological secretions.
Discharge from the genital tract can be serous, serous-purulent or serous-bloody. Acyclic bleeding often occurs in patients of reproductive age or spotting of varying intensity against the background of menopause. The separate diagnostic curettage carried out in these cases does not always reveal tumor cells in the scrapings, which delays the diagnosis.
A pathognomonic sign of fallopian tube cancer is “intermittent dropsy” – the periodic release of abundant whites, coinciding with a decrease in the size of the sac formation of appendages. With cancer of the fallopian tube, pain occurs early on the side of the lesion: first of a transient cramping nature, and then permanent. Intoxication, temperature reactions, weakness, ascites, metastatic enlargement of cervical and supraclavicular lymph nodes, cachexia are noted in advanced cancer of the fallopian tube.
Diagnostics
It is extremely difficult to conduct an informative preoperative diagnosis of fallopian tube cancer. Cancer must be differentiated from pyosalpinx, salpigitis, tuberculosis of the fallopian tube, ectopic pregnancy, cancer of the uterus and ovaries. It is possible to suspect cancer of the fallopian tube by persistent lymphorrhea with an admixture of blood, tubar colic, bleeding.
A vaginal gynecological examination reveals a one- or two-sided sac tumor located along the body of the uterus or in the Douglas space. The palpable tube is usually irregular retort-shaped or ovoid in shape with areas of uneven consistency.
Examination of secretions and scrapings of the cervical canal and endometrium, as well as aspirates from the uterine cavity, in some cases, allows identifying atypical cells. If uterine tube cancer is suspected, the tumor-associated marker CA-125 is detected in the blood, but its increase is also observed in endometriosis and ovarian tumors.
Among the instrumental techniques for cancer of the fallopian tube, transvaginal or transabdominal sonography (ultrasound) is most often performed, which reveals deformed tube walls, papillary growths, a tumor of a cystic or solid structure. Additional diagnostic information can be obtained during abdominal ultrasound, abdominal X-ray, pelvic CT, diagnostic laparoscopy, laparoscopic echography.
Treatment
With cancer of the fallopian tube, as a rule, they are not limited to tubectomy only. The first stage of treatment is surgical removal of the uterus with adnexectomy (pangisterectomy) with removal of the large omentum (omentectomy), biopsy of the iliac, paraaortic lymph nodes and peritoneum, taking flushes from the pelvic peritoneum of the pelvis. During hysterectomy, an urgent histological examination of the removed tissues is performed.
In the future, in almost all cases, polychemotherapy with platinum derivatives, radiation therapy for the pelvic region and the paraaortic zone are prescribed. Combined treatment can increase the five-year survival rate and the duration of the relapse-free period.
Prevention and prognosis
Prevention is reduced to timely treatment of appendage inflammation, regular oncogynecological screening, observation of a gynecologist and oncogynecologist. Survival rates after treatment vary greatly depending on the stage of cancer. With the first stage of this disease, the survival rate is 65-75%, II stage — 30-50%, III stage — 14%, IV stage – 0%.
The prognosis improves with timely combination therapy. The prospects for survival worsen with low-grade adenocarcinoma, the spread of cancer beyond the fallopian tube.
