A Rare Case Of Fallopian Tube Cancer

Laparotomy was done on 18.02.05 after stabilizing
the patient with 2 units of pre-operative blood
transfusion. On opening the abdomen, a hugely
distended growth was seen to arise from left
fallopian tube. The growth appeared haemorrhagic,
adherent to the gut, omentum and the posterior
surface of the uterus. The peritoneal fluid after
saline wash was collected for cytology. Liver,
undersurface of the diaphragm, paracolic gutters,
peritoneum, gut, omentum and para-aortic space
were explored and found free of any metastasis. The
pouch-of-douglas (POD) when approached was
found to have metastatic deposits. Total abdominal
hysterectomy with bilateral salpingo-oophorectomy
and infra-colic omentectomy was done after
releasing all adhesions. The metastatic deposits in
the POD was removed partially with as much
debulking as possible because of its friable nature
and gross adhesions. The patient had an uneventful
postoperative period. The histopathology report of
the mass confirmed papillary adenocarcinoma of the
left fallopian tube, the nodule in POD revealed
metastases and peritoneal wash had malignant cells.
The patient was referred for chemotherapy but did
not turn up. She returned after 7 months with
bleeding per vagina from a metastatic growth at
vaginal vault. The mass regressed with 6 cycles of
chemotherapy with cisplatin and cyclophosphamide.
The patient remains asymptomatic and is still under
follow-up.

Discussion:

Cancer of the fallopian tube may be either primary
or secondary. Most tumours involving the fallopian
tube are metastatic (80%), mainly from ovarian
cancer as well as from endometrial and
gastrointestinal tumours.(2) Primary
adenocarcinoma of fallopian tube is usually
unilateral. The fallopian tube cancer is extremely
rare and comprises only 0.3-0.5% of all
gynaecological malignancies. The aetiolgy of the
disease remains unknown. Many of the patients are
nulliparous and infertile. Fallopian tube carcinoma
may remain asymptomatic in early stage of the
disease. The usual presenting symptom is
perimenopausal or postmenopausal bleeding per
vagina seen in about 50% of the patients. The
patient may also complain of continuous watery or
amber coloured vaginal discharge and lower
abdominal pain.

The most common finding on physical examination
is a palpable pelvic or abdominal mass that occa-
sionally has a characteristic sausage shape. The triad
of pain, menorrhagia and leucorrhoea with an ad-
nexal mass are considered pathognomonic of tubal
cancer. Ascites is rarely present. Preoperative diag-
nosis of fallopian tube carcinoma is seldom made
prior to surgery. It is suspected in fewer than 5% of
cases preoperatively. Primary ovarian neoplasm is
the most common preoperative diagnosis made in
these patients.

Ultrasound, both abdominal and vaginal, is accurate
to diagnose fallopian tube pathology when it
demonstrates a cystic and solid mass in the adnexal
region in the presence of an identifiable separate ip-
silateral ovary. Computed tomography may be help-
ful for localising distant spread to other intra ab-
dominal or retro peritoneal structures. The Interna-
tional Federation of Gynaecology and Obstetrics
(FIGO) has formulated a surgico-pathological staging
system and is essentially based on tumour penetra-
tion through the layers of tube.

The definitive treatment is exploratory laparotomy
to confirm the diagnosis, and staging the disease, to
remove the primary tumour along with total abdom-
inal hysterectomy and bilateral salpingo-ophorecto-
my and resection of pelvic metastases. It appears
that cisplatinum based chemotherapy improve long
term survival in patients with advanced disease as in
this case. Its benefit as adjuvant therapy for early
stage disease has not been defined. The role of sec-
ond look surgery is controversial. The prognostic
factor that directly correlates with survival is stage
of the disease at the time of surgery.

Conclusion:

Fallopian tube cancer is a very rare type of virulent
genital cancer which is difficult to diagnose early
and carries a poor prognosis. Thus pre-operative di-
agnosis of fallopian tube carcinoma is seldom made
and most of the time the diagnosis is made on the
operating table. This case was a stage IIC primary fal-
lopian tube cancer. The 5-year survival of stage II
disease reported in one report of FIGO published in
19983 were 52%. Chemotherapy with cisplatin con-
taining regime improve the long-term survival.

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