Fallopian tube cancer is a rare gynecological malignancy that originates in the fallopian tubes, which are the ducts connecting the ovaries to the uterus. While historically considered distinct, recent research suggests that many high-grade serous ovarian cancers, the most common type of ovarian cancer, may actually begin in the fimbriated end of the fallopian tubes. Understanding the diagnostic process for this cancer is important because early detection can significantly improve treatment outcomes.
Recognizing Potential Signs
The initial symptoms of fallopian tube cancer are often subtle and non-specific, making early identification challenging. These vague symptoms can include abdominal pain or pressure, a feeling of bloating, and changes in bowel or bladder habits, such as increased urinary frequency. Abnormal vaginal bleeding or a watery, blood-tinged discharge may also occur. Because these signs can be attributed to many less serious conditions, they frequently lead to a delayed diagnosis.
Initial Medical Evaluation and Imaging
When fallopian tube cancer is suspected, a medical evaluation begins with a physical examination, including a pelvic exam. This examination helps identify any masses or abnormalities in the pelvic region. Following the physical exam, imaging techniques are often employed to visualize the pelvic organs.
A transvaginal ultrasound is commonly performed first, using a small probe inserted into the vagina to create detailed images of the uterus, ovaries, and fallopian tubes. This can reveal a mass or fluid accumulation. Computed tomography (CT) scans may be used, providing cross-sectional images that can detect the spread of cancer to other abdominal organs or lymph nodes. Magnetic resonance imaging (MRI) offers even more detailed images of soft tissues, helping to further characterize any suspicious masses and determine their relationship to surrounding structures.
Laboratory Tests
Blood tests play a role in the diagnostic workup for fallopian tube cancer through biomarker measurement. The most commonly used marker is Cancer Antigen 125 (CA-125), a protein that can be elevated in the presence of various gynecological conditions, including fallopian tube cancer. It is not a definitive indicator of cancer, as levels can also rise due to non-cancerous conditions like menstruation, pregnancy, or benign ovarian cysts. Other blood tests assess overall health, kidney and liver function, or rule out other conditions with similar symptoms.
Confirming the Diagnosis
A definitive diagnosis of fallopian tube cancer requires a biopsy, requiring tissue samples for microscopic examination. Laparoscopy, a minimally invasive surgical procedure, uses a small incision for a camera-equipped tube to visualize pelvic organs and collect samples. For larger masses or suspected widespread disease, a laparotomy (an open surgical procedure involving a larger incision) may obtain tissue and assess cancer extent. If fluid has accumulated in the abdomen (ascites), a procedure called paracentesis can drain the fluid for analysis of cancer cells. Pathologists examine these tissue and fluid samples under a microscope to confirm the presence of malignant cells, identify the specific type of fallopian tube cancer, and determine its characteristics.
Determining the Cancer’s Extent
Once fallopian tube cancer is confirmed, its extent is determined through staging. Staging guides treatment decisions by identifying cancer spread within the body. Additional imaging, such as a positron emission tomography (PET) scan, may be utilized to detect cancer cells that have spread to distant sites. Surgical exploration is also frequently performed to visually assess the abdominal cavity and pelvis, allowing for the identification of any spread to nearby organs or lymph nodes. This comprehensive evaluation provides a complete picture of the cancer’s stage.