Carcinoma of the Fallopian Tube
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Direct answer
Carcinoma of the fallopian tube is a rare gynaecological malignancy, most often high-grade serous, that frequently arises in the fimbrial end of the tube. Its classic presentation is the Latzko triad of watery vaginal discharge, colicky pelvic pain and an adnexal mass. It is staged and treated in the same way as epithelial ovarian cancer, with surgery followed by platinum-based chemotherapy.
What you must remember
- Histology: High-grade serous carcinoma is the commonest type.
- Latzko triad: Watery or serosanguinous discharge, colicky pelvic pain and a pelvic mass, though patients often present with only some of these features.
- Precursor lesion: Serous tubal intraepithelial carcinoma (STIC) in the fimbriae, often found in tubes removed prophylactically from BRCA carriers.
- Origin: Many high-grade serous cancers once labelled ovarian are now thought to begin in the tube.
- Staging: The FIGO system used for epithelial ovarian cancer, based on surgical findings and histology.
- Standard surgery: Total hysterectomy, bilateral salpingo-oophorectomy, omentectomy and staging biopsies.
- Genetics: Germline BRCA testing is standard for serous cancers, and BRCA-mutated disease may respond to PARP inhibitor maintenance.
A pathway from suspicion to adjuvant therapy
A 55-year-old postmenopausal woman presents with watery discharge, pelvic pain and a 7 cm adnexal mass. Her management follows the epithelial ovarian cancer pathway, as the steps below show. Because tubal cancer is uncommon, it is easily overlooked, so the pathway begins with a high index of suspicion.
- Imaging and markers: Ultrasound or CT characterises the mass and any spread. CA-125 may be raised but is non-specific.
- Primary surgery: Total hysterectomy, bilateral salpingo-oophorectomy and omentectomy are performed, with peritoneal biopsies and washings for cytology.
- Staging: The tumour is staged by the FIGO system using operative findings, histology and lymph node assessment where feasible.
- Chemotherapy: Platinum and taxane chemotherapy is usual after surgery, with carboplatin and paclitaxel as the standard combination.
- Genetic and maintenance review: BRCA status guides the use of maintenance PARP inhibitor therapy where it is indicated.
Each step is documented carefully, because the operative stage determines the need for further treatment.
Where the exam tries to catch you
The tube is easy to forget in a pelvic mass, and the diagnosis is often delayed.
- Trap: Dismissing a tubal mass in a postmenopausal woman as a simple hydrosalpinx Correct: Such a mass must be treated as malignant until histology proves otherwise, and sampling and staging follow the ovarian pathway.
- Trap: Treating tubal cancer with a separate regimen from ovarian cancer Correct: Management follows epithelial ovarian cancer, and tubal cancer is not treated by a different protocol.
- Trap: Believing a normal CA-125 excludes the disease Correct: CA-125 can be normal in early disease, so imaging and surgical histology decide the diagnosis.
Frequently asked questions
What is the Latzko triad in carcinoma of the fallopian tube?
The Latzko triad is watery or serosanguinous vaginal discharge, colicky pelvic pain and an adnexal mass. It is the classic presentation of carcinoma of the fallopian tube, although many patients present with only some of these features. The triad is a useful prompt to consider the tube in any postmenopausal pelvic mass.
What is serous tubal intraepithelial carcinoma?
Serous tubal intraepithelial carcinoma is an in situ precursor lesion of high-grade serous carcinoma, usually found in the fimbriae of the fallopian tube. It is often discovered in tubes removed prophylactically from BRCA carriers. Its discovery supports the view that many serous ovarian cancers begin in the tube.
Which staging system is used for carcinoma of the fallopian tube?
Carcinoma of the fallopian tube is staged with the FIGO system used for epithelial ovarian cancer. Stage depends on surgical findings, histology and lymph node status. Staging determines whether further chemotherapy is needed after surgery.
Why is carcinoma of the fallopian tube managed like ovarian cancer?
Most fallopian tube cancers are high-grade serous, the same histological type that dominates ovarian cancer, so the same surgery and chemotherapy apply. Staging surgery, platinum-taxane chemotherapy and maintenance options follow the ovarian pathway. One set of protocols therefore covers both organs.
Which marker is commonly raised in carcinoma of the fallopian tube?
CA-125 is commonly raised in carcinoma of the fallopian tube, although it is not specific. A rise supports the diagnosis but does not confirm it, and a normal value does not exclude disease. Histology after surgery is the definitive investigation.