Where does the tumor come from?
The fallopian tube connects the uterine cavity with the abdominal cavity and ends with fimbriae at the ovary. It is in this terminal part that the first changes in the epithelium most often occur, which over time turn into serous carcinoma of a high degree of malignancy. The tumor grows inside the tube, blocks its lumen, and the accumulated fluid periodically pours into the uterus and out - hence the characteristic watery discharge. The cells then spread throughout the abdominal cavity, settling on the peritoneum and omentum, which determines the stage and extent of the operation.
- High-grade serous carcinoma—main type
- Beginning of growth in the fringed section of the tube
- Precancerous changes in the tubal epithelium
- Distribution throughout the peritoneum and omentum
- Damage to the pelvic and para-aortic lymph nodes
- Association with ovarian and peritoneal tumors
Who's at risk
The main known factor is inherited mutations of the BRCA1 and BRCA2 genes, which increase the risk of breast, ovarian and fallopian tube cancer. Therefore, women with such mutations and with several cases of these diseases in the family are recommended genetic counseling and discussion of preventive measures. Additional factors are associated with a long continuous ovulatory period: early onset of menstruation, late menopause, lack of pregnancy and breastfeeding. Chronic inflammatory diseases of the tubes were previously considered a risk factor, but there is no convincing evidence of this association.
- BRCA1 and BRCA2 gene mutations
- Cancer of the ovary, tube or breast in close relatives
- Lynch syndrome
- Lack of childbirth and breastfeeding
- Early menarche and late menopause
- Age over 50
Symptoms
The combination of three signs is considered classic: watery or sanguineous discharge, pain in the lower abdomen and a palpable formation in the pelvis, but this picture is not completely found in everyone. A characteristic feature is an attack of cramping pain, which ends with copious discharge and relief, because the contents of the tube are poured into the uterus. As the tumor spreads, bloating, enlargement of the abdomen due to fluid in the abdominal cavity, a feeling of early satiety, weakness, and weight loss appear. In some women, the first manifestations appear already at a late stage.
- Copious watery discharge
- Bloody discharge during menopause
- Cramping pain in the lower abdomen
- Pain relief after discharge
- Education in the pelvis
- Abdominal enlargement, bloating
- Weakness, loss of appetite, weight loss
Diagnostics
The examination begins with an examination by a gynecologist and a transvaginal ultrasound, in which the tube looks dilated, with a dense component and blood flow in it. The picture is complemented by CA-125 tumor markers and special malignancy risk indices, taking into account age and ultrasound data. To assess the spread, CT or MRI of the pelvis and abdominal cavity is prescribed. An important detail: a biopsy is usually not performed before surgery to avoid dispersing tumor cells. The diagnosis is confirmed morphologically after removal, and genetic testing is recommended for all patients.
- Examination by a gynecologist
- Transvaginal ultrasound with blood flow assessment
- CA-125 tumor markers and additional indicators
- MSCT of the abdomen and pelvis
- MRI of the pelvis with an unclear picture
- Aspirate or biopsy of the uterine mucosa to exclude pathology
- Histological examination after surgery
- Genetic testing for BRCA mutations
Treatment
The basis of treatment is an operation in which the uterus with appendages, the greater omentum and all visible foci of the tumor are removed, and an audit of the abdominal cavity is performed to determine the stage. The more completely the tumor is removed, the better the result of subsequent treatment. Almost all patients are prescribed platinum-based chemotherapy; in some cases it is performed before surgery to reduce the volume of the tumor. When BRCA mutations are detected, maintenance targeted therapy is used. After treatment, the woman is observed by a gynecological oncologist with examinations, ultrasound and CA-125 monitoring.
- Removal of the uterus with appendages and greater omentum
- Maximum complete removal of tumor foci
- Staging with abdominal exploration
- Chemotherapy with platinum drugs
- Chemotherapy before surgery for large tumor volumes
- Maintenance targeted therapy for BRCA mutations
- Surveillance with control SA-125
- Genetic counseling for relatives
