Carcinoma of the Fallopian Tube

The fallopian tube is the least common site of cancer in the female genital tract, although its epithelial surface far exceeds that of the ovary, where epithelial cancer is 20 times more common. Approximately 300 new cases occur yearly; 90% are papillary serous adenocarcinomas, with the remainder being mixed mesodermal, endometroid, and transitional cell tumors. BRCA1 and -2 mutations are found in 7% of cases. The gross and microscopic characteristics and the spread of the tumor are similar to those of ovarian cancer but can be distinguished if the tumor arises from the endosalpinx where the tubal epithelium shows a transition between benign and malignant, and the ovaries and endometrium are normal or minimally involved. The differential diagnosis includes primary or metastatic ovarian cancer, chronic salpingitis, tuberculous salpingitis, salpingitis isthmica nodosa, and cautery artifact.

Unlike patients with ovarian cancer, patients often present with early symptoms, usually postmenopausal vaginal bleeding, pain, and leukorrhea. Surgical staging is similar to that used for ovarian cancer, and prognosis is related to stage and extent of residual disease. Patients with stages I and II disease are generally treated with surgery alone or with surgery and pelvic radiation therapy, although radiation therapy does not clearly improve 5-year survival (5-year survival stage I: 74 versus 75%, stage II: 43 versus 48%). Patients with stages III and IV disease are treated with the same chemotherapy regimens used in advanced ovarian carcinoma, and 5-year survival is similar (stage III - 20%, stage IV - 5%).