Fallopian+Tube

[]. || []. The fallopian tube is lined with ciliated columnar epithelium with secreting cells. There are hormonal fluctuations that change the epithelium, and this is where most malignancies originate. [3] || GX - Grade cannot be evaluated. G1 - Cell appearance is closely related to normal tissue (well differentiated). G2 – Cells appear somewhat abnormal (moderately diffentiated). G3 – Cell appearance is abnormal, almost unrecognizable (poorly differentiated). G4 – Cells do not look like normal cells (undifferentiated). || 0 || __** Description **__ Carcinoma in situ (limited to tubal mucosa) || Usually, these will subside within 2-4 weeks after the completion of treatment. 10-15% of patients may experience persistent bloating or diarrhea. [2] || Overall survival[3] __** Stage and 5 yr survival **__ 1= 65% 2= 50-60%  3-4= 10-20% || Chemotherapy;[3] Radiation therapy can be used in tubal cancer for palliative goals in post operative cases.[3] image of field set up: || 2. Lenhard RE, Osteen R, Gansler T. The American Cancer Society’s Clinical Oncology. Williston, VT: Blackwell Publishing, Inc; 2001. 3. Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. ||
 * **Epidemiolgy:** || In United States the Fallopian tube carcinomas comprise 1% of all gynecologic cancers.[1] The average annual incidence is 3.6 cases per million women.[1] The mortality/morbidity on average, the 5-year survival rate is 51%; the rate for stage I disease is 65%, stage II disease is 50-60%, and stage III and stage IV disease is 10-20%. The lesions is more common in whites.[1] And the Tumor incidence increases with age but peaks at 60-66 years. However, it is a very rare cancer.[1] ||
 * **Etiology:** || The exact cause of fallopian tube cancer is unknown. It’s more common in women in their 50s and 60s.[1] The only known risk factor is an inherited faulty gene. Our genes carry the information that’s passed on (inherited) from our parents.[1] Doctors have identified two genes that may cause fallopian tube cancer. These are known as the BRCA genes.[1] Doctors think that a faulty BRCA gene may cause around 15% of fallopian tube cancers.[1] The BRCA genes are also linked to breast and ovarian cancer. Your GP can refer you to a family cancer clinic if you have two or more close relatives (mother, sisters, daughters) with breast or ovarian cancer or one close relative with both cancers.[1] ||
 * **Signs & Symptoms:** || 12- 66% of fallopian tube cancers present with a pelvic mass which is the most common physical sign. The most common presenting symptom is unexpected spotting, (metrorrhagia). Vaginal discharge and pelvic pain are also common early symptoms . ||
 * **Diagnostic Procedures:** || The infrequency of fallopian tube cancers and vague signs and symptoms results in a slow and involved diagnosis, usually after surgical exploration. [2] Hysteroscopy, hysterosalpingography (Fig.1 a fluoroscopy study using contrast to evaluate the size, shape, and abnormality if any of the uterus), and ultrasound can be used for imaging studies. Transvaginal ultrasound is more accurate than pelvic ultrasound and can be effectively screened with CA125, which is a tumor marker for Fallopian tube cancers. CA125 may also be elevated with benign conditions like endometriosis, pelvic inflammatory disease, and pregnancy.
 * **Histology:** || [[image:uwlmedicaldosimetry2012/FTpic.jpg width="131" height="98" caption="Histology of fallopian tube cancer"]]
 * **Lymph node drainage:** || The main lymphatic drainage from the fallopian tube is into the ovarian vein and lymphatics, and it will end up in the paraaortic and iliac nodes. [3] ||
 * **Metastatic spread:** || Common sites of fallopian tube tumors are in the ampula, infundibulum, and the lumen. The spread extends to the local structures such as the peritoneum, omentum, bowel, and the ovaries. Metastatic spread is similar to ovarian cancer, however, paraaortic spread may come before the intraabdominal spread with early lymphatic and vascular invasion. Distant metastases to the lung and liver are uncommon. [3] ||
 * **Grading:** || Grade describes how closely cancer cells resemble normal tissue through microscopic examination. Tumor grading is based on the degree of differentiation of the malignant cells, nuclear features, and an estimate of growth rate as indicated by the mitotic rate. [2]
 * **Staging:** || Staging classification done by the International Federation of Gynecology and Obstetrics (FIGO) is the most commonly used system [3]: ||  ||   ||
 * __** Stage **__
 * I || Growth limited to the fallopian tubes ||
 * IA || Growth limited to one tube with extension into the submucosa and/or muscularis but no penetrating the serosal surface; no ascites ||
 * IB || Growth limited to both tubes with extension into the submucosa and/or muscularis but not penetrating the serosal surface; no ascites ||
 * IC || Tumor either stage IA or IB with tumor extension through or onto the tubal serosa; or with ascites present containing malignant cells or positive peritoneal washings ||
 * II || Growth involving one or both fallopian tubes with pelvic extension ||
 * IIA || Extension and/or metastasis to the uterus and/or ovaries ||
 * IIB || Extension to other pelvic tissues ||
 * IIC || Tumor either IIA or IIB with ascites present containing malignant cells or with positive peritoneal washings ||
 * III || Tumor 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; tumor appears limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum ||
 * IIIA || Tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces ||
 * IIIB || Tumor involving one or both tubes with histologically confirmed implants of abdominal peritoneal surfaces, none >2 cm in diameter; lymph nodes are negative ||
 * IIIC || Abdominal implants >2 cm in diameter and/or positive retroperitoneal or inguinal nodes ||
 * IV || Growth involving one or both fallopian tubes with distant metastasis; if pleural effusion is present, there must be positive cytology to be stage IV; parenchymal liver metastases equal stage IV ||  ||
 * **Radiation side effects:** || Acute effects may include:
 * Fatigue
 * Diarrhea
 * Nausea
 * Dermatitis
 * Dysuria [2]
 * **Prognosis:** || Factors that influence the prognosis of ovarian cancer are: [3]
 * Age.
 * Stage at presentation.
 * Presence of ascites. (fluid buildup in peritoneal cavity)
 * Amount of tumor presence after surgical resection and debulking.
 * Aggressiveness of tumor cell type.
 * Age and tumor volume +2cm decrease survival rate.
 * Results of second look laparotomy. (negative increases survival of 5yr)
 * Regional nodal involvement and nearby organ involvement greatly influence prognosis.
 * Invasion of the tubal wall.
 * Depth of invasion within the tube.
 * Results of pelvic lymph node sampling at time of surgery. (due to early nodal involvement)
 * **Treatments:** || Surgery is the treatment of choice due to the benefits of tumor debluking and need to sample lymph nodes in the region and evaluation of nearby structures and organ in the area.[3]
 * Resection of fallopian tube (if tumor has not invaded beyond the mucosa) and in most cases contra lateral fallopian tube.
 * Total hysterectomy, omentectomy, bilateral salpingectomy,
 * Sampling of peritoneal washings, diaphragm, bladder, and bowel.
 * Nodal sampling to evaluate for disease spread.
 * Post operative chemotherapy with paclitaxel and platinum compound similar to the treatment of ovarian cancer.
 * The uses of cisplatin, doxorubicin and cyclophosphamide have been used in a clinical trial with 53% positive response. (small sample size was used)
 * Fields are similar to those used in ovarian cancer techniques. (whole abdomen)
 * Best results are seen with 50Gy in 5 to 6 weeks
 * The para-arotic lymph chains should be treated due to the spread in early stage cases.
 * Phosphorus -32 intraperitoneal (15-20 mCi).
 * **TD 5/5:** || * TD 5/5
 * Organ 1/3 2/3 3/3
 * Lung 4500cGy 3000cGy 1750cGy
 * Liver 5000cGy 3500cGy 3000cGy
 * Spinal cord 5000cGy (5cm) 5000cGy(10cm)4700cGy(20cm)
 * Bone marrow 3000cGy
 * Stomach 6000cGy 5500cGy 5000cGy
 * Rectum 6000cGy
 * Bladder 8000cGy 6500cGy
 * Kidney 5000cGy 3000cGy 2300cGy
 * Small bowel 5000cGy 4000cGy ||
 * **References:** || 1.Gor H.B. Malignant Lesions of the Fallopian Tube and Broad Ligament Clincal Presentation. Medscape. February 11, 2011. Available at: [|http://emedicine.medscape.com/article/273332-clinical#showall]. Accessed on: June 20, 2012.

Back to Week 5