CANCER OF THE FALLOPIAN TUBE
The fallopian tube is the least common site of gynecologic cancer in females, accounting for fewer than 1,000 new cases each year. Histologically, these tumors resemble papillary serous carcinoma of the ovary in more than 90% of cases. Diagnostic criteria for primary fallopian tube carcinoma include the following:
• The main tumor is in the tube and arises from the endosalpinx.
• The pattern histologically reproduces the epithelium of the mucosa and usually shows a papillary pattern.
• If the wall is involved, the transition between benign and malignant tubal epithelium should be demonstrable.
• The ovaries and endometrium are either normal or contain less tumor than the tubes.
The major concern is to distinguish these cancers from primary ovarian cancers. The staging system used for fallopian tube cancer is modified from the staging system for ovarian cancer because there is no FIGO-established official staging system for fallopian tube cancer.
Fallopian tube cancer and ovarian cancer spread in a similar manner. The classic triad of colicky pain, abnormal bleeding, and leukorrhea is rarely seen in its entirety; the most common symptom is abnormal vaginal bleeding. Pain, however, is reported frequently as an early symptom.
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The therapy of fallopian tube cancer is similar to the therapy of ovarian cancer; the most important initial therapy is effective cytoreductive surgery. As in ovarian cancer, residual disease is a good predictor of survival rates. The adjuvant therapy of choice is chemotherapy with platinum-based multidrug therapy, followed by a second-look laparotomy and second-line therapy as necessary. There are no reports of the use of paclitaxel in fallopian tube cancer, but one would surmise that this drug will have a significant role in the therapy of the disease.