Fallopian+Tube


 * Epidemiology: || Carcinomas of the fallopian tubes are rare, making up only 0.15% to 1.80% of all gynecologic malignancies. There is a 14% higher incidence in whites than in blacks. Most occurrences are in the fifth and sixth decades of life. 1 ||
 * Etiology: || The rarity of fallopian tube carcinomas makes it difficult to establish causative factors of the disease. 1 ||
 * Signs & Symptoms: || Most patients with fallopian tube carcinoma present with the early clinical symptoms of vaginal bleeding, vaginal discharge, and pelvic pain. Metrorrhagia (intermenstrual bleeding) is the most common presenting symptom. The most common physical sign is a pelvic mass, which occurs in 12% to 66% of patients. 1 ||
 * Diagnostic Procedures: || * Because of the rarity of primary malignancies of the fallopian tube and nonspecific presenting signs and symptoms, it has been difficult to diagnose most cases before surgical exploration. This frequently leads to a delay in correct diagnosis that may range from 2 months to more than 12 months.
 * Papanicolaou smears and endometrial sampling have produced unsatisfactory results in diagnosis of fallopian carcinomas.
 * Hysteroscopy and hysterosalpingography can diagnose abnormal masses of the fallopian tube in a nonspecific fashion. Their use may cause intraperitoneal tumor seeding if the ampulla is patent.
 * Transvaginal ultrasonography provides more accurate assessment of adnexal pathology than pelvic ultrasound alone.
 * CA 125, a tumor marker, may be elevated in fallopian tube malignancies; however, serum antigen levels are elevated in benign as well as malignant conditions, including endometriosis, pelvic inflammatory disease, and early pregnancy.
 * Reports suggest that screeing with CA 125 would be more effective if used in combination with transvaginal sonography. 1 ||
 * Histology: || Majority are papillary serous adenocarcinoma. Rare histological subtypes include endometrioid, clear cell, transitional cell, squamous cell, malignant mixed müllerian tumors, and leiomyosarcoma. 1 ||
 * Lymph Node Drainage: || Lymph Node Drainage of Fallopian Tube 6

The most common node of metastic spread is the periaortic lymph nodes and are involved 10% to 20% of the time in local disease and 80% of the time in advanced diseases.  1 || Becacause of the high frequency of synchronous and metachronous involvement of both ovaries, the uterus, fallopian tubes, total abdominal hysterectomy and bilateral salpingo-oophorectomy has been accepted as the routine surgical procedure in ovarian cancer. 1 ||
 * Metastatic Spread: || Similar to ovarian cancer. The most common node of metastic spread is the periaortic lymph nodes and are involved 10% to 20% of the time in local disease and 80% of the time in advanced diseases. They extend locally to adjacent structures to involve the peritoneum, omentum, bowel, and ovaries at early stages. 70% of patients are present with disease confined to the pelvis. These tumors disseminate intraperitoneally paraaortic spread may precede intraabdominal dissemination through early lymphatic and vascular invasion. Distance metastases to the liver and lung are uncommon.
 * Grading: || **GX:** The tumor grade cannot be evaluated.
 * G1:** The tumor cells are well differentiated.
 * G2:** The tumor cells are moderately differentiated.
 * G3:** The tumor cells are poorly differentiated.
 * G4:** The tumor cells are undifferentiated. 5 ||
 * Staging: || FALLOPIAN TUBE STAGING FIGO SYSTEM 1

|| •Reported complications of radiation therapy have been small in number and minor in severity. •Major treatment sequelae related to bowel and bladder complications can be successfully minimized by proper treatmen planning and shielding of vital structures during treatment. •Patients who have undergone multiple surgical explorations or have concomitant medical problems (e.g. obesity, diabetes, hypertension) are at increased risk for development of complications in any treatment regimen. •Extensive disease involving bowel, bladder and other abdominal organs also can add to treatment morbidity. 1 || •negative peritoneal cytology •no residual disease at primary cytoreductive surgery •disease limited to the pelvis •abnormal vaginal bleeding as a presenting symptom •negative second look laparotomy
 * Radiation Side Effects: || Sequelae of Treatment
 * Prognosis: || Good prognostic factors are as follows:

Poor prognostic factors are as follows: •advanced stage of the disease •absence of fimbriated end closure in stage I disease •presence of a TP53 mutation

•The presence or absence of invasion of tubal wall, the depth of invasion when present and the location of the tumor within the tube (ie. fimbriated or nonfimbriated) are prognostic variables. •The presence of ascites and the patient's age do not seem to affect prognosis because the prognosis depends on the location of the tumor within the fallopian tube and depth of invasion of tumor. 4

Fallopian Tube Cancer Overall Survival Table 4

|| -Treatment of choice is surgical resection as soon as possible after initial diagnosis. Surgical resection should be extensive, including a total abdominal hysterectomy, omentectomy, bilateral salpingectomy, sampling of peritoneal washings, diaphragm, bladder, and bowel. Lymph node sampling is also recommended. Every effort should be made for as complete a surgical resection as possible. -Conservative surgical treatment (unilateral salpingectomy only) is satisfactory if the tumor does not invade beyond the mucosa; however, most times some form of adjuvant treatment for sterilization of microscopic or residual disease is required. 1 
 * Treatments: || Surgery:

Chemotherapy: -A combination of paclitaxel plus a platinum compound is often used post-operatively. -Good response rates have been reoported with a cisplatin-based combination. -"In the only prospective trial to date, 18 patients receiving at least 6 to 12 cycles of cisplatin, doxorubicin, and cyclophosphamide achieved response rates of 53%." <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1 <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif;">

Radiation Therapy: -Used post-operatively for recurrent or disseminated tumors. -Techniques used are similar to those used for ovarian cancer. - External beam (whole abdomen). -Phosphorus 32 (intraperitoneal administration). -Dose: greater than 50Gy in 5-6 weeks. -Some advocate irradiation to the abdomen, para-aortics, and pelvis. <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1 <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif;">


 * The post-operative use of chemotherapy and radiation therapy has shown responses when used together or separately. <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1 <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif;"> ||
 * TD5/5: || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">TD 5/5 Table for OAR in the abdominal-pelvic portal. <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">2 <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">* <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">3 <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;"> || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;"> || <span style="font-family: Arial,Helvetica,sans-serif;">**References **1. Chao KS, Perez CA, Brady LW. //<span style="font-family: Arial,Helvetica,sans-serif;">Radiation Oncology - Management Decisions. // <span style="font-family: Arial,Helvetica,sans-serif;"> 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 2002: 531-535. 2. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991; 21: 109-122. 3. Rembert J, Hsu I. Ovarian Cancer. In: Hansen EK, Roach M. //<span style="font-family: Arial,Helvetica,sans-serif;">Handbook of Evidence-based Radiation Oncology, //<span style="font-family: Arial,Helvetica,sans-serif;"> 1st ed. New York: Springer, 2007: 358-367. 4. eMedicine. Malignant Lesions of Fallopian Tube and Broad Ligament. []. Accessed February 1, 2010. 5. Washington CM, Leaver D, eds. //<span style="font-family: Arial,Helvetica,sans-serif;">Principles and Practice of Radiation Therapy, 2 // <span style="font-family: Arial,Helvetica,sans-serif;">nd ed: Philadelphia: Mosby Inc, 2004: 780-787. 6. Lenards, N. //<span style="font-family: Arial,Helvetica,sans-serif;">Clinical Oncology for Medical Dosimetrists: Ovary. // <span style="font-family: Arial,Helvetica,sans-serif;"> Course content - Ovary, Slide 7
 * Planning Photos: || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Treatment portal for abdominal-pelvic radiation therapy. Parallel opposed anterior and posterior fields are used to encompass the entire peritoneum. Some authors have recommended using techniques similar to those used in the treatment of ovarian carcinoma. <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1

Bridget - <span style="color: #00ff00; font-family: Arial,Helvetica,sans-serif;">Green <span style="font-family: Arial,Helvetica,sans-serif;"> Ginnie - <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Blue <span style="font-family: Arial,Helvetica,sans-serif;"> Sheri - <span style="color: #800000; font-family: Arial,Helvetica,sans-serif;">Brown <span style="font-family: Arial,Helvetica,sans-serif;">Zach - <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">Purple <span style="font-family: Arial,Helvetica,sans-serif;">