Fallopian-Tube Tumor

Fallopian-tube tumors are very rare, benign even rarer than malignant. Benign histologic types are diverse; adenomatoid tumor is relatively common; others such as papilloma, hemangioma, leiomyoma and lipoma are extremely rare. Because tumors are small and asymptomatic, pre-operative diagnosis is difficult; prognosis is good. Malignant tumors are primary or secondary; the vast majority are secondary cancer, accounting for 80-90% of fallopian-tube malignancies. Primary foci are mostly in ovary and uterine body; may also metastasize from contralateral tube, cervical cancer, rectal cancer or breast cancer. Spread is mainly lymphatic. Symptoms, signs and treatment depend on the primary focus; prognosis is poor. Primary fallopian-tube cancer has mean onset age 55, mostly 45-60. Early stage may be asymptomatic; in symptomatic patients the main manifestation is profuse vaginal discharge — watery yellow or pale bloody fluid, intermittent, sometimes with lower-abdominal pain and lumbar soreness; occasionally tenesmus, dysuria or frequency. Pelvic exam may reveal a thickened tube or mass on one/both sides; early stage may only show thickening. Diagnosis is difficult: when a patient reports recurrent vaginal watery/bloody discharge, especially postmenopausal nulliparous woman, with negative diagnostic curettage and cervical biopsy, fallopian-tube cancer should be suspected.

Common Symptoms

Lower-abdominal mass; ascites; abdominal pain; black watery vaginal discharge; irregular vaginal bleeding

Causes and Pathogenesis

Etiology unknown. 70% have chronic salpingitis, 50% have infertility history; the contralateral tube in unilateral tubal cancer often shows inflammatory changes on pathology — suggesting chronic inflammation may be a trigger. Chronic salpingitis is common but tubal cancer is rare, so inflammation is not the only trigger. Two-thirds are unilateral, favoring ampulla or fimbria; lesion starts in endometrium, serosa is rough, often adherent to surrounding tissue; tube is dilated like hydrosalpinx, lumen contains papillary tissue and turbid fluid; microscopy shows adenocarcinoma. Pathology: 1. Gross: lesion commonest in ampulla, next fimbrial end; mostly unilateral, bilateral 10%-26%. Early tubal cancer may look normal, usually shows thickened irregular or sausage-shaped tube; cross-section shows cauliflower-like tissue or necrotic mass in lumen. Fimbrial end is often sealed by adhesions; lumen may contain fluid, blood or pus. 2. Microscopy: vast majority (90%) are papillary adenocarcinoma; 50% are serous carcinoma, mostly poorly differentiated; others such as endometrioid, clear-cell, squamous, adenoacanthoma, adenosquamous and mucinous carcinoma are rare. Tubal adenocarcinoma histologic grades: Grade I papillary, well-differentiated, mainly papillary structure, low malignancy; Grade II papilloalveolar, papillary structure still present but poor differentiation, marked atypia with small alveoli/glands; Grade III alveolar-medullary, poorly differentiated, high malignancy, many mitoses, solid sheets/nests, sometimes alveolar structure. Risk factors: 1. Age — benign tumors in reproductive-age women; malignant in elderly; some special types favor adolescent/young females. 2. Childbearing — some gynecologic tumors relate to early childbearing, dense births, multiparity. 3. Sexual hygiene — unclean sex causes female genital infections: vaginitis, cervicitis, cervical erosion, salpingitis; these are important factors for vulvar, vaginal, cervical and tubal cancer. 4. Endocrine — female genital organs are main targets of female hormones; tumors are closely related to endocrine. Some women self-medicate with estrogen-containing drugs/supplements/cosmetics without doctor guidance, raising endogenous estrogen; long-term high estrogen stimulation is one cause of tubal and ovarian cancer. 5. Unhealthy lifestyle — smoking, especially heavy smoking, may be an important cause of cervical and tubal cancer. Epidemiologically, smokers have 2-fold risk vs non-smokers.

Treatment

Drug therapy, supportive therapy

Preventive Measures

1. Avoid unclean sex and improper sexual relations; reduce inflammatory infections. 2. No intercourse during treatment; spouse should be examined if needed. 3. Care for local lesions: keep clean and dry to prevent secondary infection.

Department to Visit

It is recommended to visit the Surgical Oncology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.