Fallopian tube cancer

The fallopian tubes are two fine tubes that are part of a woman’s reproductive system. They link the ovaries to either side of the womb (uterus).

Symptoms of fallopian tube cancer may include:

  • pain in the tummy
  • a swollen tummy or fluid in the tummy
  • abnormal bleeding from the vagina (bleeding after the menopause or in between periods)
  • watery discharge (that may be bloodstained) from the vagina.

You might have scans, including an ultrasound, CT or MRI scan to diagnose fallopian tube cancer. Doctors may also need to collect tissue samples (biopsy) from the affected area. A biopsy can be taken in different ways.

The main treatment is often surgery. You will usually have chemotherapy after surgery, but sometimes you will have it before surgery. Radiotherapy is only occasionally used, usually to help control symptoms.

If you are still having periods, removing the ovaries will bring on an early menopause and you will become infertile (not able to become pregnant). You may find it helpful to talk things over with those close to you.

What is fallopian tube cancer?

Fallopian tube cancer is similar to ovarian cancer and is treated in the same way. It is best to read this information along with our general information on ovarian cancer which has more about the tests and treatments mentioned here.

If you’d like to order booklets or have any questions, contact our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm. Or you can order information online at be.macmillan.org.uk.


The fallopian tubes

The fallopian tubes are two fine tubes that link the ovaries to either side of the womb (uterus). They are part of a woman's reproductive system, which is made up of the ovaries, fallopian tubes, womb, cervix and vagina.

Each month, in women of childbearing age, one of the ovaries produces an egg (ovulation). The egg travels down the fallopian tube to the womb. If the egg isn’t fertilised by a sperm, it is shed, along with the lining of the womb, as part of the monthly period.

The fallopian tubes and their surrounding structures
The fallopian tubes and their surrounding structures

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Causes and risk factors for fallopian tube cancer

The exact cause of fallopian tube cancer is not known. It is more common in women who have been through the menopause (change of life).

Inherited risk

About 15% of fallopian tube cancers are thought to be due to an inherited change (mutation) in a gene. The inherited genes are BRCA1 and BRCA2. If a family has the BRCA1 or BRCA2 gene, several relatives on the same side of the family have usually had ovarian cancer or breast cancer. They may also have been diagnosed at a particularly young age.

Your GP can refer you to a family cancer clinic if two or more of your close relatives (your mother, sisters, or daughters) have had ovarian cancer or breast cancer.

We have more information on cancer and genetics.


Symptoms of fallopian tube cancer

Symptoms of fallopian tube cancer may include:

  • pain in the tummy
  • a swollen tummy or fluid in the tummy
  • abnormal bleeding from the vagina (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.


Diagnosing fallopian tube cancer

At the hospital you will see a doctor who is a specialist in women’s health (a gynaecologist). They will ask you about your symptoms and general health. They will carry out some tests and talk to you about any other tests you may need. You may see a specialist nurse before or after you have your tests.

There are several tests that may be used to diagnose fallopian tube cancer.

Internal (vaginal) examination

Your doctor will do an internal examination to check for any lumps or swelling in the ovaries or womb. It takes about five minutes and shouldn’t be painful but may be uncomfortable. You can ask for a female doctor to examine you if you prefer.

You lie on a couch, with your feet drawn up and knees apart. The doctor places one or two gloved fingers into your vagina and gently presses on your lower tummy with their other hand. They may put a speculum (which holds the vaginal walls apart) into the vagina to check that your cervix looks normal.

Blood tests

You will usually have a blood test to check for raised levels of a protein called CA125. The level of this protein may be higher in women with fallopian tube cancer or ovarian cancer. But it can also be raised by non-cancerous conditions.

You will also have blood tests to check your general health.

Ultrasound scan

This test uses sound waves to build up a picture of the organs inside the tummy (abdomen) and pelvis. A computer converts the sound waves into pictures that you can see on a screen. There are two types of ultrasound that can be used:

Pelvic ultrasound

You will be asked to drink plenty of fluids before this ultrasound so that your bladder is full. This helps to give a clearer picture. The person doing the scan spreads a gel on to your tummy (abdomen). They then gently go over the area with a small handheld device, which produces the sound waves.

Vaginal ultrasound

The tip of an ultrasound probe (the size of a tampon) is gently inserted into your vagina. The probe produces sound waves. Although this may sound uncomfortable, you may find it easier than a pelvic ultrasound, as you don’t need a full bladder.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes about 10-30 minutes. CT scans use a small amount of radiation, which would be very unlikely to harm you or anyone you come into contact with. You'll be asked to not eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

MRI (magnetic resonance imaging) scan

This test uses magnetism 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 it is safe for you to have the MRI scan. Before the scan, you will be asked to remove metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones.

Removing fluid from the tummy

If you have a build-up of fluid in the tummy (called ascites) your doctor may take a sample to check for cancer cells. They numb the skin over the area first with a local anaesthetic. The doctor then passes a needle through the skin into the fluid and draws some into a syringe.

If you have a lot of fluid it can be uncomfortable so your doctor may remove it by putting a short tube (a cannula) into the tummy (abdomen). The tube attaches to a bag that collects the fluid as it drains.

We have more information about ascites.

Laparoscopy

Sometimes, you need a simple operation called a laparoscopy (keyhole surgery) to see inside the tummy (abdomen). While you are under general anaesthetic, the surgeon makes a small cut (about 1cm in length) in the lower abdomen. They put a thin tube with a light and camera (called a laparoscope) through the cut and use this to look at the fallopian tubes. The surgeon may take a small sample of tissue (a biopsy) from areas that don’t look normal. A pathologist (a doctor who specialises in analysing cells) then looks at the tissue under the microscope for signs of cancer.

During the operation, the surgeon pumps some carbon dioxide gas into the tummy. This helps them to see clearly and to move the laparoscope around safely. You may have wind and/or shoulder pains for several days after because of the gas. If you’re uncomfortable your nurse will give you painkillers and advice to help.

Guided biopsy

You may have a sample of tissue (biopsy) removed from the tumour using a CT scan to guide the surgeon to the right place. The doctor numbs the skin over the area using a local anaesthetic injection. You may also be given a sedative to help you relax.

They pass a needle through the skin of your tummy. A CT scan guides them to the right place. They take a biopsy from the tumour which they check for cancer cells.


Staging and grade

The stage of a cancer describes how far it has grown and whether it has spread to other organs.  Knowing the stage helps your doctor to advise you on the best treatment for your situation.

Fallopian tube cancer is staged in the same way as ovarian cancer using the FIGO staging system.

This system uses a number between 1 and 4 to describe how far the cancer has spread. For example, stage 1 means that the cancer is in one or both fallopian tubes, while stage 4 is when the cancer has spread to organs outside the pelvis. A letter is also added after the number to give more detail on how the cancer has spread.

You can read more about staging in our information on cancer of the ovary.  While reading, you can replace ‘ovary’ with ‘fallopian tube’ for information about staging for your situation.

Grading

Grading is about how the cancer cells look under the microscope compared with normal cells. Knowing the grade helps your doctor decide on the best treatment for you.

  • Low-grade (grade 1)
    The cells look similar to normal cells and usually grow slowly and are less likely to spread.
  • Moderate-grade or intermediate-grade (grade 2)
    The cells look more abnormal and are slightly faster-growing.
  • High-grade (grade 3)
    The cells look very different from normal cells and may grow more quickly.

Other terms used

  • ‘Early’ or ‘local’ may be used to describe a cancer that has not 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

Fallopian tube cancer is usually treated in a similar way to ovarian cancer. You can read more about the treatments in our information on ovarian cancer.

Your treatment will depend on the stage and grade of the cancer and your general health. Your specialist doctor or nurse will advise you of the best treatment options for your situation and explain the advantages and disadvantages.

A team of specialists will meet to discuss and decide on the best treatment for you. This multidisciplinary team (MDT) will include:

  • a surgeon who specialises in gynaecological cancers (a gynaecological oncologist)
  • a cancer doctor (oncologist) who specialises in cancer treatments for gynaecological cancers
  • a gynae-oncology nurse specialist
  • a radiologist (a doctor who analyses x-rays and scans)
  • pathologists (who advise on the type and extent of the cancer).

The main treatment is often surgery. You will usually have chemotherapy after surgery, but sometimes you will have it before surgery. Radiotherapy is only occasionally used, usually to help control symptoms.


Surgery

Radical hysterectomy

The surgeon removes the ovaries and fallopian tubes, as well as the womb and the cervix. They may also remove the tissue that supports nearby organs (called the omentum) and lymph nodes in the pelvis. Lymph nodes (sometimes called glands) are part of your body’s immune system that protects you from infection and disease.

If the cancer has spread to other areas in the pelvis or tummy (abdomen), the surgeon will try to remove as much of it as possible.

Before your operation

You will have blood and urine tests, and your blood pressure will be checked. Some women may also have tests on their heart and a chest x-ray before surgery. You usually have these done a few days or weeks before your operation at a pre-assessment clinic.

After your operation

You can expect to be in hospital for 3–7 days after your operation. You will be encouraged to start moving around as soon as possible. You will have been given support stockings to wear to help prevent blood clots developing in the legs.

It is 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 are 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 short walk for a few minutes each day is a good way to build up your strength.

You can read more about what to expect before and after your surgery in our information on ovarian cancer and on having a hysterectomy.


Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given after surgery if there is a risk that some cancer cells, too small to be seen, have been left behind. You also have chemotherapy if it wasn’t possible to remove all of the cancer. Some women have chemotherapy before surgery to shrink the cancer and make it easier to do the operation. Chemotherapy is also used to treat fallopian tube cancer that comes back. 

The chemotherapy drug most commonly used is carboplatin. You have it on its own or in combination with the chemotherapy drug paclitaxel (Taxol®).

We have fact sheets about carboplatin, and about the combination of carboplatin and paclitaxel chemotherapy.

Other drugs that can also be used are:

You usually have chemotherapy as an outpatient in a chemotherapy day unit.  Usually, a nurse will give it to you as a drip (infusion) into a vein.

Side effects of chemotherapy

Chemotherapy can cause side effects, but they can often be well controlled with medicines. Your doctor or nurse will explain what to expect. Let them know about any side effects you have. There are different ways to manage or treat side effects. Most side effects will disappear once your treatment is over.

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Lowering the number of blood cells

The drugs temporarily reduce the number of normal cells in your blood. When this happens, you are 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 feeling sick (nausea) and being sick (vomiting). Your doctor will prescribe these for you. 

Sore mouth and loss of appetite

It is important to look after your mouth by cleaning your teeth carefully and using mouthwashes regularly. Your nurse will show you how to do this properly. If you do not feel like eating during treatment, try replacing some meals with nutritious drinks. 

Hair loss

Some chemotherapy drugs 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. It is called peripheral neuropathy. Tell your doctor if you notice these symptoms.  

We have more information on peripheral neuropathy.


Radiotherapy

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 and other treatments are not suitable.

We have more information on radiotherapy.


Hormonal therapy

Occasionally, hormonal therapy drugs such as tamoxifen or an aromatase inhibitor drug may be used if tests show the cancer cells are sensitive to hormones. This is more usually used to treat fallopian tube cancer that has come back.

We have more information about hormonal therapy.


Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. Research into treatments for fallopian tube cancer is ongoing. Your specialist may invite you to take part in a treatment research trial. You can decide not to take part or to withdraw from a trial at any stage. You will still receive the best standard treatment available.

We have more information about clinical trials.


Sex, menopause and fertility

Your doctor may advise you to wait at least six weeks after the operation before having sex so that your wound heals properly. After this time, getting back to a sex life is safe and healthy.

Any sexual difficulties may settle with time. If they don’t, tell your doctor or specialist nurse so they can give you advice. They may be able to arrange for you to have counselling or see another specialist for more support.

If you are still having periods, removing the ovaries will bring on an early menopause and you will become infertile (not able to become pregnant). Your doctor or specialist nurse can give you more information on how menopausal symptoms can be managed.

It can be hard to cope with becoming menopausal or losing your fertility because of treatment. It may seem especially difficult when you are already coping with cancer.

Some women find it helpful to talk things over with their partner, family or friends. Others may prefer to talk to a counsellor. Your GP or specialist doctor can arrange this. Many hospitals also have specialist nurses who can offer support, and fertility clinics usually have a counsellor you can talk to.

Talking to other women in a similar position may help you feel less alone. Our online community is a good place to talk to other women who may be in a similar situation. You can also talk things over with our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm.

We have more information for women on sexuality and cancer and on cancer treatment and fertility.


Follow-up

After your treatment has finished, you will have regular check-ups and may have scans or x-rays. If you have any problems or notice any new symptoms between these appointments let your doctor know as soon as possible.


Your feelings

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 there if you need it. Our cancer support specialists can give you information about counselling in your area.

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