Treatment Protocols for Fallopian Tube Cancer

Introduction:

Fallopian tube cancer origins in the cells of the fallopian tubes. The cancer cells can grow and multiply and destroy nearby structures. It can also spread to other parts of the body (metastasis). Cancer can begin from any of the different types of cells present in the fallopian tubes. Fallopian tube cancer commonly starts in glandular cells. They are the cells present in the lining of the fallopian tube. Cancer occurring in the lining of the fallopian tube is called adenocarcinoma of the fallopian tube, and it is similar to serous carcinoma of the ovary.

Many serous carcinomas, which were previously thought of as ovarian cancers, are later identified to originate from cells of the nearby fallopian tube. Later they have implanted and grown on the ovary. Rare types of fallopian tube cancer can also develop. These include clear cell carcinoma, squamous cell carcinoma (SCC), adenosquamous carcinoma, endometrioid carcinoma, and sarcoma are rare types of fallopian tumors. It is hard to identify the origin of fallopian tube cancer. Ovarian cancers can also spread to the fallopian tubes and multiply to form tumors there. Ovarian and fallopian tube cancer treatments are similar.

What Is the Treatment for Fallopian Tube Cancer?

Fallopian tube cancer treatment depends on the stage of cancer, medical history, current health condition, treatment goals, and other factors. The main aim of fallopian tube cancer treatment is to get rid of cancer with lesser side effects. The following treatment is commonly recommended for the fallopian tube cancer patient:

1) Surgery -

The first line of treatment for fallopian tube cancer will mostly be surgery. The surgeon will remove abnormal-looking tissue during surgery. And the samples are later analyzed in the laboratory to find out if the cancer has spread. This is called surgical staging. There are different methods of surgery like the following:

• Salpingo-Oophorectomy - The salpingo-oophorectomy is often done during the early stage of fallopian tube cancer. In this procedure, the fallopian tube, along with the ovaries, are removed. The surgery may involve the removal of one or both ovaries and fallopian tubes.

• Total Hysterectomy and Bilateral Salpingo-Oophorectomy - This is the most common surgery done for fallopian tube cancer. During this surgery, the ovaries, uterus, and fallopian tubes are removed. The surgeons may also remove the nearby lymph nodes and any other tissues if it has an abnormal appearance during the surgery.

• Surgical Debulking - This surgery is done during the late stage of fallopian tube cancer. During this surgery, surgeons try to remove most of the abnormally looking tissues as possible from the abdomen and pelvis. Additional surgeries may be performed to relieve the symptoms of the patient.

2) Chemotherapy -

In chemotherapy, anticancer drugs are used to destroy cancer cells. Usually, chemotherapy is given following surgery for fallopian tube cancer. Chemotherapy may be given intravenously (IV) (into a vein) or intraperitoneal (IP) (into the abdomen) chemotherapy. When drugs are administered through IP chemotherapy, the drugs circulate and treat cancer throughout the abdomen as well as these drugs are also absorbed into the bloodstream. When cancer has spread inside the abdomen, and only minimal cancer is left after surgery, then IP chemotherapy is considered. The drugs are injected directly into the abdomen during IP chemotherapy through a port (a small medical appliance installed beneath the skin). The port is installed during fallopian tube cancer surgery or during a separate surgery. The port helps in the safe delivery of the drug with a minimal spill into the surrounding tissue.

Chemotherapy can also be administrated to control the symptoms of late fallopian tube cancer or relieve pain. Carboplatin and Paclitaxel are the common chemotherapy drug combination used in the treatment of fallopian tube cancer. Cisplatin, Pegylated Liposomal Doxorubicin, and Topotecan are a few other drugs used to treat fallopian tube cancer.

3) Targeted therapy -

In targeted therapy, drugs are used to target specific molecules in cancer cells. These molecules send signals that specific cells grow or multiply. When these molecules are targeted using the drugs, they stop the growth and spread of cancer cells. This therapy is also known as molecular targeted therapy. The following targeted therapy is used to control the growth of late fallopian tube cancer.

• Bevacizumab - This drug is often given in combination with drugs such as Carboplatin, Taxane drug, or other chemotherapy drugs during the diagnosis or recurrence. It is administrated intravenously for two to three weeks. In recurrent cancer cases, Bevacizumab is often given in combination with chemotherapy drugs to help the chemotherapy drugs work better.

• Olaparib - It can be given in patients with a BRCA1 or BRCA2 gene mutation. It is usually taken twice a day orally. It can also be given as maintenance therapy for patients with advanced, recurrent ovarian cancer.

• Niraparib - This drug is used as a maintenance drug in patients with recurrent fallopian tube cancer.

4) Radiational Therapy -

High-energy rays or particles are used in this therapy to destroy cancer cells. Radiation therapy is not often used to treat fallopian tube cancer. They are used in the following conditions:

• If chemotherapy is not possible due to older age and health problems.

• To control the symptoms of severe fallopian tube cancer or relieve pain.

• To treat metastatic cancer or small areas of recurrent that are causing symptoms.

Side effects of radiation therapy will depend mainly on the total dose of radiation, the specific area or organs being treated, the size of the area being treated, and the treatment schedule.

Follow-up care:

Regular follow-up visits are important after cancer treatment, especially during the first five years after treatment. The follow-up helps the healthcare team to monitor the progress and recovery from treatment. And it is important to consult a doctor immediately if any symptoms arise and not to wait till the next appointment. Follow-up visits are usually scheduled like the following:

• Every three to four months for the first two to three years after completing initial treatment.

• Every four to six months for the next three years.

• Later once a year.

Conclusion:

Fallopian tube carcinoma is a rare cancer of the female genital tract. Ovarian cancer and fallopian cancer have similar characteristics. So, evaluation of the history and a proper diagnosis are important for treating fallopian tube cancer. There are several treatment options available for depending on the stage of cancer, medical history, current health condition. Also, follow-up after treatment is mandatory.