Fallopian+Tube


 * **Epidemiolgy:** || Jenn

Carcinomas of the fallopian tubes are rare. The incidence rate is 0.41 per 100,000 women from 1998 to 2003 in the United States, comprising 0.15% to 1.80% of all gynecologic malignancies. It is more likely to occur in woman ranging from the ages of 60 to 79. There is a higher incidence in white, non-hispanic women. 1 || The exact cause of fallopian tube cancer is not known. One known risk factor is an inherited faulty gene. The BRCA gene may cause around 15% of fallopian tube cancers. Some other risk factors may include age, postmenopausal women, and having a family history. 2 ||
 * **Etiology:** || Jenn
 * **Signs & Symptoms:** || Rachel
 * Most of the patients with fallopian tube carcinoma present with early clinical symptoms of vaginal bleeding, vaginal discharge, and pelvic pain. 3
 * The most common presenting symptom if metrorrhagia.
 * A pelvic mass is the most common physical sign, which occurs in 12% to 66% of patients. ||
 * **Diagnostic Procedures:** || Rachel
 * It has been difficult to diagnose most cases before surgical exploration. This usually leads to a delay in correct diagnosis that may range from 2 months to more than 12 months. 3
 * Endometrial sampling and papanicolaou smears have not produced good results in diagnosis of fallopian carcinomas.
 * Hysterosalpingography and hysteroscopy can diagnose abnormal masses of the fallopian tube in a nonspecific fashion. These methods can cause intraperitoneal tumor seeding if the ampulla is patent.
 * Transvaginal ultrsonography has shown to be more accurate than pelvic ultrasound alone.
 * CA 125 may be elevated in fallopian tube malignancies, however, serum antigen levels are elevated in benign conditions as well.
 * Reports suggest that the most effective screening would be a combination of monitoring CA 125 along with a transvaginal sonography. ||
 * **Histology:** || Brandon

Most of fallopian tube carcinomas are papillary serous adenocarcinomas. 4 However, there are some rare subtypes that are also associated with fallopian tube carcinomas such as: edometrioid, clear cell, transitional cell, squamous cell, and leiomyosarcoma. 4 The incidence between left and right fallopian tube tumors are the same. 4 Also, fallopian tube carcinomas tend to be more malignant than benign. 4 || The lymphatic drainage for fallopian tube carcinomas is very similar to ovarian tumors. 4 The veins and lymphatics of the fallopian tube drain into the ovarian vein and lymphatics. The most commonly involved lymphatics are the paraaortic lymph nodes as well as the iliac lymph nodes. 4 || Fallopian tube cancer has similar metastatic spread as other cancers of the female reproductive system. Of women who have fallopian tube metastatic spread, 80% are confined to the peritoneal cavity. 5 In some cases, the disease can spread to the contralateral fallopian tube as well. Lymphatic spread includes para-aortic and infundibulopelvic lymph nodes. 5 || Grading refers to the microscopic appearance of cancer cells as they compare to normal cells. The criteria for grading differs between cancers, however for fallopian tube cancer, the grades are noted as GX, G1, G2, G3, and G4. Grade X (GX) cancer cells cannot be identified under a microscope and represent cancer cells in their earliest stage. 6 Grade 1 cells are well differentiated meaning they closely resemble normal cells. 6 Grade 2 fallopian tube cancer have variable characteristics from normal cells but there is still some resemblance (moderately differentiated). 6 Cells that are almost completely abnormal are considered a poorly differentiated or grade 3 (G3) cancer. 6 Finally, grade 4 (G4) cells are completely undifferentiated and look completely abnormal. 6 || The TNM and International Federation of Gynecology and Obstetrics (FIGO) classification for staging fallopian tube cancer is as follows: 7 || Common side effects from treatment include 8,9 - Short term side effects: - Long term side effects: -Depends on age, stage at presentation, presence of ascites, amount of residual tumor after primary surgical resection and aggressiveness of treatment. 10 -Increasing age and residual tumor volume > 2cm after primary surgery result in decreased survival. -Presence of vascular or lymphatic invasion and stromal invasion are associated with a decreased 5 year survival rate. || -Primary treatment option: surgical resection as soon as possible after diagnosis. 10 -Total abdominal hysterectomy, omentectomy, bilateral salpingectomy, sampling of peritoneal washings, diaphragm, bladder and bowel. -Chemotherapy: used post-operative; results similar to ovarian cancer. -Radiation Therapy: post-operative for recurrent or disseminated tumors. -Whole abdomen external beam or Phosphorus 32 (intraperitoneal). -For best results, a total tumor dose > 50 Gy in 5-6 weeks is used. -Chemotherapy and radiation have both shown responses when used together or separately. || TD 5/5 Table for OAR in the abdomen-pelvic portal. 11
 * **Lymph node drainage:** || Brandon
 * **Metastatic spread:** || Ashley
 * **Grading:** || Ashley
 * **Staging:** || Amanuel
 * **Radiation side effects:** || Amanuel
 * Diarrhea
 * Irritable bladder/ radiation cystitis
 * Nausea
 * Fatigue
 * Vaginal Irritation, sometimes with discharge
 * <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Bowel changes
 * <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Frequent urination ||
 * **Prognosis:** || Lindsey
 * **Treatments:** || Lindsey
 * **TD 5/5:** || Kevin

||
 * **References:** || # Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2011: 603.
 * 1) Macmillan. Fallopian tube cancer. Available at: []. Accessed June 27, 2013.
 * 2) Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2011: 604.
 * 3) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2002: 531-533.
 * 4) Pectasides D, Pectasides E, Economopoulos T. Fallopian tube carcinoma: A review. //Oncol//. 2006;11(8):902-912.
 * 5) Fallopian Tube Cancer. Cancer.net Web site. []. Updated August 2012. Accessed June 24, 2013.
 * 6) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Szklaruk J, Tamm EP, Choi H, et al. MR Imaging of Common and Uncommon Large Pelvic Masses. RadioGraphics. 23, 403-424.
 * 7) <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Radiation therapy for ovarian cancer. American Cancer Society. <span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">[] <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">. Accessed June 25, 2013.
 * 8) <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Radiation therapy for ovarian cancer. Cancer Research UK. <span style="background-color: #ffffff; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">[] <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">. Accessed June 25. 2013.
 * 9) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2011: 605-606.
 * 10) 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. ||

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