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Tubal Cancer - General
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Contents
IncidenceCarcinoma of the fallopian tube is uncommon and accounts for only 0.3% of all cancers of the female genital tract (1). More commonly the fallopian tubes are involved secondarily from other tumour sites including ovary, endometrium, gastrointestinal tract and breast. Clinical FeaturesThere are no known predisposing factors. Tubal cancers are more likely to occur in postmenopausal women with a mean age of 55-60 years (1). The classical triad of symptoms/signs include:
This triad of symptoms is seen in less than 15% of patients (1). Often, as with ovarian cancer, the presentation is non-specific. A pelvic mass is palpable in 60% of patients. It has been reported that approximately 10% of patients will have abnormal or adenocarcinomatous cells of cervical cytology (2). HistopathologyMacroscopically, in early stage disease, the involved tube may appear externally normal or only slightly swollen but more commonly it resembles a hydrosalpinx. The tube is usually filled with friable tissue with areas of necrosis. The tumour is bilateral in 20% of cases (3). Histologically, almost all cancers are epithelial in origin and are usually papillary adenocarcinomas. They closely resemble serous adenocarcinoma of the ovary. Other tumours of the fallopian tubes have been reported including sarcomas (3). SpreadThe fallopian tubes have a rich lymphatic drainage and spread to the paraaortic and pelvic nodes is common. However, spread is principally by transcelomic exfoliation of cells that implant throughout the peritoneal cavity (2,3). StageStaging of fallopian tube cancer is surgical / pathological and based on the FIGO staging classification (2). Stage 0 Carcinoma in situ (limited to tubal mucosa) Stage I Growth limited to the Fallopian tubes Ia Growth is limited to one tube, with extension into the submucosa and/or muscularis, but not penetrating the serosal surface; no ascites Ib Growth is limited to both tubes, with extension into the sub-mucosa and/or muscularis but not penetrating the serosal surface; no ascites IcTumour either Stage Ia or Ib, but with tumour extension through or onto the tubal serosa, or with ascites present containing malignant cells, or with positive peritoneal washings Stage II Growth involving one or both Fallopian tubes with pelvic extension IIa Extension and/or metastasis into the uterus and/or ovaries IIb Extension into other pelvic tissues IIc Tumour either Stage IIa or IIb and with ascites present containing malignant ells or with positive peritoneal washings Stage III Tumour involves one or both Fallopian tubes, with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastasis equals Stage III. Tumour appears limited to the true pelvis, but with histologically-proven malignant extension to the small bowel or omentum. IIIa Tumour is grossly limited to the true pelvis, with negative nodes, but with histologically-confirmed microscopic seeding of abdominal peritoneal surfaces. IIIb Tumour involving one or both tubes, with histologically-confirmed implants of abdominal peritoneal surfaces, none exceeding 2 dm in diameter. Lymph nodes are negative IIIc Abdominal implants > 2 dm in diameter and/or positive retroperitoneal or inguinal nodes. Stage IV Growth involving one or both Fallopian tubes with distant metastases. If pleural effusion is present, there must be positive cytology to be Stage IV. Parenchymal liver metastases equals Stage IV. Frequency of presentation according to stage(4): Stage 1 37% Stage 2 20% Stage 3 31% Stage 4 10% In comparison to ovarian cancer, patients tend to present at an earlier stage which is believed to be as a consequence of earlier occurrence of symptoms. Dr Geoffrey Otton
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