Fallopian tube cancer
Fallopian tube cancer is rare. Only about 1 in 100 of all cancers of the female reproductive system (1%) are fallopian tube cancers.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
The fallopian tubes are part of a woman's reproductive system. This system is made up of the parts of the body involved in having sex, producing and fertilising eggs, carrying a baby and giving birth. It includes the ovaries, womb (uterus) and the vagina.
The two fallopian tubes come out from the sides of the womb. The tubes are very fine and about 10cm long. An egg is released from an ovary during the menstrual cycle every month. The egg moves through the fallopian tube and down to the womb.
This information is about primary fallopian tube cancer, which means the cancer first started to grow in this area. Sometimes cancers that start in other areas, such as the ovaries, womb or cervix, can spread to the fallopian tubes. This is known as a secondary fallopian tube cancer and is treated according to where it started (the primary cancer).
There are different types of fallopian tube cancer. The most common type is adenocarcinoma, which starts in the cells that form part of the lining of the fallopian tubes.
Causes of fallopian tube cancer
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The exact cause of fallopian tube cancer is not known. It’s more common in women in their 50s and 60s.
The only known risk factor is an inherited faulty gene. Our genes carry the information that’s passed on (inherited) from our parents. Doctors have identified two genes that may cause fallopian tube cancer. These are known as the BRCA genes.
Doctors think that a faulty BRCA gene may cause around 15% of fallopian tube cancers. 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 of these cancers.
We have more information about genetics and cancer.
Signs and symptoms of fallopian tube cancer
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Symptoms of fallopian tube cancer may include any or all of the following:
pain in the tummy (abdominal pain)
a swollen tummy (abdomen)
abnormal vaginal bleeding (bleeding after the menopause or in between periods)
watery discharge (that may be bloodstained) from the vagina.
These symptoms can be caused by other conditions but it’s important to have them checked by your doctor. You should always see your GP about abnormal vaginal bleeding.
How fallopian tube cancer is diagnosed
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Usually you begin by seeing your GP, who will examine you and may arrange for you to have some tests. Your GP may refer you immediately to a gynaecologist (a specialist in the female reproductive system).
The gynaecologist will do an internal vaginal examination to check for any lumps or swellings. You may also have an examination of your back passage (rectum). Your specialist will arrange for you to have some of the following tests.
You will usually have a blood test to check your general health and how well organs such as your kidneys and liver are working.
You may have a blood test to check if you have higher than normal levels of a protein called CA125. CA125 is a protein that most women have in their blood. A raised level of CA125 is sometimes linked with fallopian tube cancer or ovarian cancer.
You may have an abdominal ultrasound or an internal vaginal ultrasound to check whether the fallopian tubes look enlarged or abnormal. For an abdominal ultrasound, you’ll be asked to drink plenty of fluids so that your bladder is full. This helps to give a clearer picture. Once you’re lying comfortably on your back a gel is spread on to your abdomen. A small device, which produces sound waves, is then moved over the area. The sound waves are converted into a picture by a computer.
If you have an internal ultrasound scan, a probe with a rounded end is put into your vagina. Although this type of scan may sound uncomfortable, many women find it more comfortable than having an abdominal ultrasound, as you won’t need to have a full bladder.
CT (computerised tomography) scan
This is a series of x-rays that builds up a three-dimensional picture of the inside of the body. The scan is painless and takes about 10-30 minutes.
Most people who have a CT scan are given a drink and/or injection to allow particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. Before having the injection or drink, it's important to tell your doctor and the person doing the test if you’re allergic to iodine or have asthma.
Just before the scan begins, you may be asked to place a tampon into your vagina. This will ensure that the best possible picture is produced from the scan. Once you are lying in a comfortable position, the scan will be taken.
You will probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan, because the scanner is a powerful magnet. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins.
Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This can help the images from the scan to show up more clearly. You’ll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. The scan is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones, and you can hear, and speak to, the person operating the scanner.
Abdominal fluid aspiration
If you have a build-up of fluid in the tummy (abdomen) a sample of the fluid can be taken to check for any cancer cells.
The doctor will use a local anaesthetic to numb the area before passing a small needle through the skin. Some fluid is drawn off into a syringe and sent to a laboratory to be examined.
Sometimes the sample of fluid is taken while you are having an ultrasound scan. The scan helps guide the doctor to the fluid.
This is a small operation that allows the doctor to look at the fallopian tubes and the surrounding area. The operation is done under a general anaesthetic and will mean a short stay in hospital.
The doctor makes a small cut (about 1cm in length) in the lower abdomen. A thin fibre-optic tube (laparoscope) is then inserted. The doctor can examine the fallopian tubes by looking through the laparoscope. A small sample of tissue is removed (a biopsy) and is later examined for cancer cells.
During the operation, carbon dioxide gas is passed into the tummy (abdomen) and this can cause wind and/or shoulder pains for several days. You can often ease this pain by walking around or by taking sips of peppermint water.
An operation to examine the inside of the abdomen usually has to be done before a diagnosis of fallopian tube cancer can be confirmed. This operation is called a laparotomy. During the procedure the surgeon removes a small piece of tissue. This tissue is then examined to see if it contains cancer cells.
Staging for fallopian tube cancer
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The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors decide on the most appropriate treatment.
Fallopian tube cancer is staged according to the FIGO system. This system gives a number between 1 and 4 to the cancer, depending on how widespread it has become. For example, stage 1 cancer means that one or both fallopian tubes are affected by the cancer, while stage 4 means that the cancer has spread to other organs. A letter ‘a’, ‘b’ or ‘c’ can also sometimes be added after the number to give more detail on how the tumour has spread within the fallopian tube.
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread.
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes.
‘Local recurrence’ means the cancer has come back in the same area after treatment.
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
Treatment for fallopian tube cancer
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The main treatment for fallopian tube cancer is surgery. Both ovaries and fallopian tubes are removed (bilateral salpingo-oophorectomy) as well as the womb and the cervix. The tissue that supports nearby organs (called the omentum) and the lymph nodes in the pelvis may also be removed. Removal of all of the above is called a radical hysterectomy.
Before your operation
You are likely to have an electrocardiogram or ECG (heart tracing) scan. You’ll also have blood and urine tests, and your blood pressure will be checked. Some women may also have a chest x-ray or a heart scan (echocardiograph). These tests can be done the day before your operation or a few days or weeks beforehand at a pre-assessment clinic.
About the operation
The operation is carried out under a general anaesthetic. The surgeon usually makes a cut downwards from the belly button to the pubic hair. Sometimes they make a 10cm (4in) cut across your tummy (abdomen) just above the pubic hair instead.
The surgeon then removes the fallopian tubes, the ovaries and other organs through the cut in your abdomen. The muscles and tissues are repaired and the wound is closed with staples or a continuous stitch.
After your operation
You can expect to be in hospital for 3-7 days after your operation. You’ll be encouraged to start moving around as soon as possible. You will have been given support stockings to wear. These help prevent blood clots developing in the legs and you may be asked to wear them for up to six weeks after you go home.
It's normal to have some pain or discomfort for a few days, but this can be controlled effectively with painkillers. If the pain is not controlled, let your doctor or nurse know so that your painkillers can be changed.
It takes time to fully recover from this operation and you’re likely to feel tired for several weeks or more. It will also take a while for your tummy muscles (abdominal muscles) and skin to heal. So you will need to avoid strenuous activity or heavy lifting for at least 12 weeks. A little walk for a few minutes each day is a good idea to build up your strength. It’s usually safe to start gentle exercise, like swimming, about 6-8 weeks after your surgery.
You can read more about what to expect before and after your surgery in our section on having a hysterectomy.
Sex, menopause and fertility
Getting back to a normal sex life after a hysterectomy is perfectly safe and healthy. To allow the wound to heal properly, most women are advised to wait at least six weeks after their operation before having sexual intercourse.
Any sexual problems usually settle with time. If they don't improve, your doctor or specialist nurse will be able to give you advice. They may be able to arrange for you to have counselling, which is often helpful.
In women who are still having periods, removing the ovaries will bring on an early menopause, so you will become infertile. Your doctor or specialist nurse can give you more information on how menopausal symptoms can be managed.
Being told that you have cancer and that treatment will make you infertile can be very difficult. Whatever your situation, the loss of fertility can be overwhelming. Some women may find it helpful to talk things over with a trained counsellor.
Chemotherapy (anti-cancer drugs) is usually given after surgery if it wasn’t possible to remove all of the cancer. It’s also given if there’s a high risk that some cancer cells that are too small to be seen have been left behind. Sometimes chemotherapy is given before surgery to shrink the cancer and make it easier to do the operation.
The most commonly used drugs to treat fallopian tube cancer are:
The drugs are usually given by injection into a vein (intravenously). Chemotherapy can often be given to you as an outpatient but it will sometimes mean spending a few days in hospital.
Side effects of chemotherapy
Chemotherapy can cause side effects, but they can often be well controlled with medicines. Most of these side effects will disappear once your treatment is over.
Lowering the number of blood cells - The drugs temporarily reduce the number of normal cells in your blood. When this happens, you’re more likely to get an infection and may get tired easily. If you have any signs of infection you will be given antibiotics. Occasionally, people may need a blood transfusion if they become anaemic due to chemotherapy.
Feeling sick (nausea) and being sick (vomiting) - There are now very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. Your doctor will prescribe these for you.
Sore mouth and loss of appetite - Looking after your mouth by cleaning your teeth carefully and regularly using mouthwashes are important. Your nurse will show you how to do this properly. If you don’t feel like eating during treatment, try replacing some meals with nutritious drinks.
Hair loss - Some of the chemotherapy drugs used can make your hair fall out. If your hair does fall out, it will grow back over a period of 3-6 months, once the chemotherapy has finished.
Numbness or tingling in hands or feet - This is due to the effect of some chemotherapy drugs on nerves and is called peripheral neuropathy. Tell your doctor if you notice these symptoms.
Radiotherapy uses high-energy rays that destroy the cancer cells while doing as little harm as possible to normal cells. It is occasionally used to reduce symptoms if the cancer comes back after surgery and chemotherapy.
Occasionally doctors use hormonal drugs such as Tamoxifen, letrozole (Femara®) or megestrol acetate (Megace®) as part of the treatment for fallopian tube cancer.
Follow-up care for fallopian tube cancer
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After your treatment has finished, you will have regular check-ups and possibly scans or x-rays. Let your doctor or specialist nurse know as soon as possible if you have any problems, or notice any new symptoms in between appointments.
You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you information about counselling in your area.
This information has been compiled using information from a number of reliable sources, including:
Raghaven, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
Souhami, et al. Oxford Textbook of Oncology. 2nd edition. 2001. Oxford University Press.
Hoskin, et al. Principles & Practice of Gynecologic Oncology. 3rd edition. 2002. Lippencott Williams and Wilkins.
With thanks to Dr Susan Lalondrelle, Consultant Clinical Oncologist, who reviewed this information.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
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