MEDICAL TREATMENT :
Staging: Although the fallopian tubes are derived from the same embryonic structure as the uterus, histologically and clinically, malignant lesions of the fallopian tubes behave like ovarian tumors. Unlike ovarian tumors, 50% of fallopian tube tumors are stage I and II, whereas more than 50% of ovarian malignancies are usually in stage III and IV. Fallopian tube carcinomas have a predilection for metastasis to retroperitoneal lymph nodes in contrast to intraperitoneal spread of ovarian carcinomas.
International Federation of Gynecology and Obstetrics (FIGO) fallopian tube cancer staging is as follows:
Stage 0 - CA in situ (limited to tubal mucosa)
Stage I - Growth limited to the fallopian tubes
Stage Ia - Growth limited to 1 tube, with extension into the submucosa and/or muscularis but not penetrating the serosal surface; no ascites
Stage Ib - Growth limited to both tubes with extension into the submucosa and/or muscularis but not penetrating the serosal surface; no ascites
Stage Ic - Tumor stage 1a or 1b but with tumor extension through or onto the tubal serosa, or with ascites present containing malignant cells, or with positive peritoneal washings
Stage II - Growth involving 1 or both fallopian tubes with pelvic extension
Stage IIa - Extension and/or metastasis to the uterus and/or ovaries
Stage IIb - Extension to other pelvic tissues
Stage IIc - Tumor stage IIa or IIb, with ascites present containing malignant cells, or with positive peritoneal washings
Stage III - Tumor involving 1 or both fallopian tubes, with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes; superficial liver metastasis equals stage III; tumor appears limited to true pelvis but has histologically proven malignant extension to the small bowel or omentum
Stage IIIa - Tumor grossly limited to the true pelvis, with negative nodes but with histologically confirmed microscopic seeding or abdominal peritoneal surfaces
Stage IIIb - Tumor involving 1 or both fallopian tubes, with histologically confirmed implants on abdominal peritoneal surfaces, none exceeding 2 cm in diameter; lymph node findings negative
Stage IIIc - Abdominal implants larger than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
Stage IV - Growth involving 1 or both fallopian tubes, with distant metastases; if pleural effusion is present, positive cytology results necessary to be stage IV; parenchymal liver metastases equal stage IV
Staging for fallopian tube CA is via the surgical pathological system. Operative findings designating stage are determined before tumor debulking.
Modified FIGO staging for fallopian tube CA is as follows:
Stage 0 - CA in situ (limited to tubal epithelium)
Stage I - Growth limited to tube
Stage IA - Growth limited to 1 fallopian tube, without extension through or onto serosa, ascites containing malignant cells, or positive peritoneal washings
Stage IA to 0b - Growth limited to 1 fallopian tube, with no extension into lamina propria
Stage IA to 1b - Growth limited to 1 fallopian tube, with extension into lamina propria but no extension into muscularis
Stage IA to 2b - Growth limited to 1 fallopian tube, with extension into muscularis
Stage IB - Growth limited to both fallopian tubes, without extension through or onto serosa, ascites containing malignant cells, or positive peritoneal washings
Stage IB to 0b - Growth limited to both fallopian tubes, with no extension into lamina propria
Stage IB to 1b - Growth limited to both fallopian tubes, with extension into lamina propria, but not extension into muscularis
Stage IB to 2b - Growth limited to both fallopian tubes, with extension into muscularis
Stage IC - Tumor either stage IA or IB, but with extension through or onto tubal serosa, with ascites containing malignant cells, or with positive peritoneal washings
Stage I(F) - Tumor limited to fimbriated end of fallopian tube(s), without invasion of tubal wall
Stage II - Tumor involving 1 or both fallopian tubes, with pelvic extension
Stage IIA - Extension and/or metastasis to uterus and/or ovaries
Stage IIB - Extension to other pelvic tissues
Stage IIC - Tumor either stage IIA or IIB, with ascites containing malignant cells or with positive peritoneal washings
Stage III - Tumor involving 1 or both fallopian tubes, with peritoneal implants outside pelvis, including superficial liver metastasis, and/or positive retroperitoneal or inguinal nodes; tumor limited to pelvis except for histologically proven extension to small bowel or omentum
Stage IIIA - Tumor grossly limited to pelvis, with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces
Stage IIIB - Tumor involves 1 or both fallopian tubes, with grossly visible histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; lymph node findings negative
Stage IIIC - Abdominal implants larger than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
Stage IV - Growth involving 1 or both fallopian tubes, with distant metastases, including parenchymal liver metastases; if pleural effusion present, fluid must be positive cytologically for malignant cells
Modification in terminology - Modifications to accommodate subsets of tumor that otherwise cannot be assigned a stage or to distinguish among subsets that may differ in their associated prognosis
DRUG TREATMENT: Medical care depends on frozen section and pathology results, as follows:
Stage 0 - CA in situ
Negative cytology results - No further treatment
Positive cytology results - Intraperitoneal phosphorous P 32 (32P) or short-term cisplatin therapy
Stage I
Negative cytology results - No treatment or short-term cisplatin therapy
Positive cytology results - Intraperitoneal 32P or short-term cisplatin therapy
Stage II-IV
Bulky residual disease or positive nodes - Cisplatin-containing regimens
No residual disease, negative nodes - Short-term cisplatin or intraperitoneal 32P therapy
Residual disease in pelvis - Cisplatin regimen or whole-abdomen radiation with pelvic boost; however, as with ovarian malignancy, patients with fallopian tube malignancy also have an increase in the 5-year survival rate with Taxol and cisplatin therapy
Various chemotherapy cycles are as follows:
Cyclophosphamide, doxorubicin, and cisplatin
Cyclophosphamide and cisplatin
Taxol and cisplatin
Topotecan alone - Used for first-line chemotherapy and can be used for recurrent disease
Treatment of broad ligament malignancy is similar to that for fallopian tube malignancy except in young patients, in whom wide local excision can be adequate.
Surgical Care: Surgical care includes (1) total abdominal hysterectomy with bilateral salpingo-oophorectomy, (2) omentectomy and peritoneal washing, and (3) selective pelvic and para-aortic lymphadenectomy.