Fallopian Tube Cancer Treatment in Delhi, India

Fallopian tube cancer is a rare form of gynaecological cancer that begins in the fallopian tubes, the narrow ducts that connect the ovaries to the uterus. It occurs when abnormal cells grow uncontrollably in the tube lining, forming a tumour that can spread to nearby organs. This cancer is closely linked to genetic mutations, particularly BRCA1 and BRCA2, which also increase the risk of ovarian and breast cancer.

Although uncommon, fallopian tube cancer shares similarities with ovarian cancer in how it develops and spreads. Early symptoms, such as abnormal vaginal bleeding, pelvic pain, and bloating, are often mild or mistaken for other conditions, leading to delayed diagnosis. The cancer can spread through the fallopian tubes to the ovaries, uterus, or abdominal cavity. Early detection improves treatment options, making regular check-ups and awareness of symptoms important.

The exact cause of fallopian tube cancer is not fully understood, but it develops when healthy cells in the fallopian tube lining undergo genetic changes that cause them to grow uncontrollably. These abnormal cells can form tumours and, if left untreated, spread to nearby tissues and other parts of the body. Although the precise triggers for these changes are unclear, certain factors have been linked to an increased risk of developing this rare cancer.

Genetic Factors

• BRCA1 and BRCA2 mutations: These inherited gene mutations are strongly associated with fallopian tube cancer. Women with these mutations are at a higher risk of developing breast, ovarian, and fallopian tube cancers.
• Family history: A strong family history of ovarian, breast, or fallopian tube cancer can increase the likelihood of developing the condition. The risk is particularly high if close relatives, such as a mother or sister, have had these cancers.
• Lynch syndrome: This inherited condition, also known as hereditary nonpolyposis colorectal cancer (HNPCC), raises the risk of several cancers, including those affecting the female reproductive system.

Hormonal and Reproductive Factors

• Prolonged exposure to oestrogen: Early menstruation (before age 12) and late menopause (after age 55) lead to longer exposure to oestrogen, which may increase the risk of certain gynaecological cancers, including fallopian tube cancer.
• Never having been pregnant: Pregnancy and breastfeeding may provide some protective effects against gynaecological cancers by reducing the number of ovulation cycles, lowering exposure to hormones that could contribute to cancer development.

Age and Medical Conditions

• Postmenopausal status: The majority of fallopian tube cancer cases are diagnosed in women over 50, with most occurring after menopause.
• Endometriosis: This condition, where tissue similar to the lining of the uterus grows outside the uterus, has been linked to an increased risk of ovarian and fallopian tube cancer.
• Pelvic inflammatory disease (PID): Long-term inflammation of the reproductive organs due to infections such as chlamydia or gonorrhoea may play a role in cancer development.

Other Possible Risk Factors

• Lifestyle factors: Smoking and obesity have been associated with an increased risk of several cancers, including those affecting the female reproductive system.
• Prior radiation exposure: Although rare, previous radiation therapy to the pelvic area may contribute to a higher risk of fallopian tube cancer.

Fallopian tube cancer is a rare condition that can be difficult to detect in its early stages. Symptoms often develop gradually and may be mistaken for more common gynaecological conditions, such as ovarian cysts, fibroids, or infections. Because early signs can be subtle, paying attention to persistent or unusual changes in the body is important for early detection and timely medical care.

Common Symptoms

• Unexplained vaginal bleeding: Unexplained bleeding, particularly after menopause, is one of the most noticeable signs. In premenopausal women, it may appear as irregular periods or spotting between cycles.
• Abnormal vaginal discharge: A persistent watery or blood-tinged discharge may occur without an infection or other identifiable cause. This symptom is often overlooked but can indicate an issue in the reproductive system.
• Pelvic or abdominal pain: Discomfort or a dull ache in the lower abdomen or pelvis that does not go away with time. Some women describe it as a persistent, cramping sensation.
• Bloating or a feeling of fullness: A constant sensation of pressure, swelling, or bloating in the lower abdomen, sometimes leading to loss of appetite.
• Frequent urination: An increased need to urinate or a feeling of urgency, even if the bladder is not full. This can happen due to pressure from a growing tumour affecting surrounding organs.

Less Common Symptoms

• Lower back pain: A dull or aching pain that extends from the lower abdomen to the lower back, which may worsen over time.
• Unintentional weight loss: A noticeable decrease in weight without changes in diet or activity levels. This can occur as the body reacts to the cancer or due to loss of appetite.
• Fatigue: Persistent tiredness or lack of energy that does not improve with rest, which can result from the body’s response to cancer.
• Swelling in the lower abdomen: A noticeable increase in abdominal size or swelling, which can occur as the tumour grows or fluid builds up in the abdomen (ascites).

Fallopian tube cancer is rare and can be difficult to detect in its early stages. Symptoms often resemble those of ovarian or other gynaecological conditions, leading to delays in diagnosis. At Max Hospital, a thorough evaluation using clinical assessments, imaging tests, and laboratory investigations helps in detecting the condition as early as possible.

Initial Assessment

Diagnosis begins with a detailed evaluation to understand symptoms and assess potential risk factors.

• Medical history and symptom review: Doctors ask about abnormal bleeding, pelvic pain, bloating, or other persistent symptoms. Family history of ovarian, fallopian tube, or breast cancer is also considered, as genetic factors can increase risk.
• Pelvic examination: A physical examination is performed to check for lumps, tenderness, or any abnormalities in the reproductive organs. The doctor may also examine the abdomen for swelling or fluid buildup.

Imaging Tests

Imaging tests help in identifying abnormalities and assessing the extent of the disease.

• Ultrasound
• A transvaginal ultrasound involves inserting a small probe into the vagina to obtain clearer images of the fallopian tubes and nearby structures.
• An abdominal ultrasound is performed externally by moving a probe over the lower abdomen to detect any unusual masses.

• CT scan (Computed Tomography): A detailed imaging technique that provides cross-sectional views of the abdomen and pelvis, helping to identify tumour size and spread.
• MRI (Magnetic Resonance Imaging): MRI Scan produces highly detailed images of soft tissues, offering better visualisation of the reproductive organs. This helps in distinguishing between benign and cancerous growths.
• PET-CT scan (Positron Emission Tomography): Uses a special dye with radioactive tracers to detect areas of increased metabolic activity, which can indicate the presence of cancerous cells. This is useful in assessing cancer spread beyond the fallopian tubes.

Laboratory Tests

Blood tests may provide clues about cancer presence and help in monitoring its progression.

• CA-125 blood test: Measures levels of the CA-125 protein, which is often elevated in gynaecological cancers, including fallopian tube cancer. While this test alone is not definitive, consistently high levels may indicate further testing is needed.
• Genetic testing: For individuals with a strong family history of ovarian, breast, or fallopian tube cancer, genetic testing for BRCA1, BRCA2, and Lynch syndrome mutations can help determine inherited risk.

Confirmatory Diagnosis

A biopsy is necessary to confirm the presence of cancer cells.

• Laparoscopy: A minimally invasive procedure where a thin tube with a camera is inserted through a small incision in the abdomen. This allows doctors to closely examine the fallopian tubes and obtain tissue samples for testing.
• Surgical biopsy: In cases where imaging and laparoscopy suggest cancer, a more extensive biopsy may be performed through surgery to collect a larger tissue sample. The sample is then analysed under a microscope to determine if cancer is present.

Early and precise diagnosis is essential for effective treatment.

Fallopian tube cancer is staged based on how far the cancer has spread. Staging helps guide treatment decisions and predict outcomes.

• Stage I: Cancer is limited to the fallopian tubes.
• Stage IA: Cancer is in one fallopian tube without spreading to its outer surface.
• Stage IB: Cancer is in both fallopian tubes without spreading beyond them.
• Stage IC: Cancer is in one or both fallopian tubes and has spread to the outer surface or caused fluid build-up in the abdomen.
• Stage II: Cancer has spread beyond the fallopian tubes to nearby pelvic organs.
• Stage IIA: Cancer has reached the ovaries or uterus.
• Stage IIB: Cancer has spread to other pelvic structures such as the bladder or rectum.
• Stage III: Cancer has spread beyond the pelvis to the abdomen or nearby lymph nodes.
• Stage IIIA: Microscopic cancer cells are found in the abdominal lining or lymph nodes.
• Stage IIIB: Tumours larger than 2 cm are present in the abdomen but have not reached the liver or spleen.
• Stage IIIC: Cancer has spread to lymph nodes or the surface of the liver or spleen.
• Stage IV: Cancer has spread to distant organs beyond the abdomen.
• Stage IVA: Cancer cells are found in fluid around the lungs (pleural effusion).
• Stage IVB: Cancer has spread to distant organs such as the liver, lungs, or bones.

Earlier stages generally have better treatment outcomes, while later stages may require more aggressive treatment approaches.

Treatment for fallopian tube cancer depends on factors such as the stage of cancer, overall health, and response to initial therapy. A combination of surgery, chemotherapy, and in some cases, radiation or targeted therapy, is used to treat the condition. At Max Hospital, a multidisciplinary team of oncologists, gynaecologists, and specialised surgeons work together to create a treatment plan that focuses on removing cancer, preventing its spread, and improving quality of life.

Surgical Treatment

Surgery is the main treatment for fallopian tube cancer, aiming to remove as much of the cancer as possible. The type of surgery performed depends on how far the cancer has spread.

• Salpingo-oophorectomy: Involves the removal of one or both fallopian tubes and ovaries. This is often performed if cancer is detected early and confined to these structures.
• Total hysterectomy with bilateral salpingo-oophorectomy: If the cancer has spread beyond the fallopian tubes, the uterus, cervix, both fallopian tubes, and ovaries may be removed to reduce the risk of recurrence.
• Lymph node dissection: Nearby lymph nodes are removed and examined to determine whether the cancer has spread. This helps in staging the disease and planning further treatment.
• Omentectomy: The omentum, a fatty tissue covering the abdominal organs, may also be removed, as fallopian tube cancer can spread there.
• Cytoreductive or debulking surgery: If the cancer has spread extensively, the goal is to remove as much of the tumour as possible before starting chemotherapy. This improves treatment effectiveness.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells or prevent their growth. It is often used after surgery to target remaining cancer cells or before surgery to shrink tumours.

• Neoadjuvant chemotherapy: Given before surgery to shrink tumours, making surgical removal easier and more effective.
• Adjuvant chemotherapy: Administered after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.
• Combination chemotherapy: Most commonly involves platinum-based drugs such as carboplatin and paclitaxel, which are effective in treating gynaecological cancers.
• Intraperitoneal chemotherapy: In some cases, chemotherapy drugs may be delivered directly into the abdominal cavity for better local control of the disease.

Radiation Therapy

Radiation therapy is not commonly used for fallopian tube cancer but may be recommended in certain cases, particularly when surgery and chemotherapy are not suitable options. It involves using high-energy rays to destroy cancer cells and shrink tumours.

• External beam radiation: Targets specific areas where cancer remains or has spread.
• Palliative radiation: Used to relieve symptoms such as pain or discomfort caused by advanced-stage cancer.

Targeted Therapy

Targeted therapy focuses on specific genetic changes in cancer cells, helping to block their growth. This approach is particularly useful for individuals who do not respond well to chemotherapy.

• PARP inhibitors: These drugs block an enzyme that cancer cells use to repair themselves. They are often used in individuals with BRCA gene mutations.
• Angiogenesis inhibitors: These drugs prevent the formation of new blood vessels that supply tumours, helping to slow cancer progression.

Hormonal Therapy

Some fallopian tube cancers are hormone-sensitive, meaning they grow in response to oestrogen. In such cases, hormonal therapy may be recommended to block or reduce hormone levels.

• Oestrogen receptor blockers: Prevent oestrogen from binding to cancer cells, slowing tumour growth.
• Aromatase inhibitors: Reduce the amount of oestrogen produced in the body, limiting its effect on cancer cells.

After treatment, regular follow-ups are essential to monitor recovery, detect any recurrence, and manage side effects.

• Routine imaging tests: CT scans, MRIs, or ultrasounds are conducted periodically to check for signs of cancer recurrence.
• Blood tests: CA-125 levels may be monitored to detect changes that could indicate recurrence.
• Supportive care: Management of chemotherapy side effects such as nausea, fatigue, and neuropathy.
• Counselling and rehabilitation: Emotional and psychological support, along with physical therapy if needed, to aid in recovery.

Fallopian tube cancer can lead to several complications, affecting overall health and quality of life. Timely intervention helps manage these complications, improving recovery and comfort.

Fallopian tube cancer can lead to various complications that affect overall health and well-being. Max Hospital provides specialised care to manage these issues effectively.

• Cancer Spread (Metastasis): Cancer may spread to nearby or distant organs, causing pain, weight loss, and breathing difficulties. Treatment options include surgery, chemotherapy, and targeted therapy.
• Bowel Obstruction: Tumours pressing on the intestines can lead to nausea, vomiting, and constipation. Treatment may involve surgery, stenting, dietary changes, and medications.
• Fluid Build-Up (Ascites and Pleural Effusion): Fluid accumulation in the abdomen or around the lungs can cause bloating and breathing difficulties. Procedures like fluid drainage, diuretics, and chemotherapy help manage this condition.
• Lymphoedema (Swelling in the Legs or Lower Body): Cancer treatment can affect lymphatic drainage, leading to swelling. Compression therapy, physiotherapy, and skin care help reduce discomfort.
• Severe Pain and Nerve Damage: Cancer or its treatment may cause chronic pain and nerve damage. Pain relief options include medications, physiotherapy, and nerve block procedures.
• Emotional and Psychological Challenges: Anxiety and emotional distress are common with cancer. Counselling, support groups, and rehabilitation programmes provide necessary support.

There is no guaranteed way to prevent fallopian tube cancer, but certain measures may help lower the risk:

• Regular Health Check-ups: Routine gynaecological exams and screenings can help detect early signs of abnormalities.
• Genetic Testing and Counselling: Individuals with a family history of ovarian or breast cancer may consider genetic testing for BRCA1 and BRCA2 mutations.
• Risk-Reducing Surgery: In high-risk cases, preventive removal of the fallopian tubes and ovaries (salpingo-oophorectomy) may be an option.
• Healthy Lifestyle Choices: Maintaining a balanced diet, staying physically active, and avoiding smoking can support overall health.
• Managing Hormonal Factors: Some studies suggest that long-term use of oral contraceptives may reduce the risk of ovarian and fallopian tube cancer, but medical advice is necessary before considering this option.

Regular medical check-ups and early detection play a key role in reducing risks and improving outcomes.

1. Can fallopian tube cancer be detected in a routine gynaecological exam?

A routine gynaecological exam may not always detect fallopian tube cancer, as it is a rare condition with symptoms that can be mistaken for other issues. However, if abnormalities are found during a pelvic exam, further tests such as ultrasound, CT scans, or blood tests (like CA-125) may be recommended for diagnosis.

2. Does fallopian tube cancer affect fertility?

Yes, fallopian tube cancer can affect fertility, especially if treatment involves the removal of one or both fallopian tubes, ovaries, or the uterus. In cases where only one tube is affected and removed, natural conception may still be possible. Fertility preservation options such as egg or embryo freezing may be considered before treatment.

3. Are there any early warning signs that are often overlooked?

Yes, early symptoms of fallopian tube cancer are often vague and mistaken for other conditions. These may include:

• Persistent bloating or abdominal discomfort
• Unusual vaginal discharge, sometimes watery or blood-tinged
• Pelvic pain that does not go away
• Feeling full quickly after eating
• Unexplained weight loss

Because these symptoms can be linked to other health issues, they may not always raise immediate concerns.

4. What is the difference between fallopian tube cancer and ovarian cancer?

Both cancers are part of the same group of gynaecological cancers and share similar symptoms. The key differences include:

• Origin: Fallopian tube cancer starts in the fallopian tubes, whereas ovarian cancer begins in the ovaries.
• Spread: Some research suggests that many ovarian cancers may actually originate in the fallopian tubes before spreading.
• Rarity: Fallopian tube cancer is much rarer than ovarian cancer.

Despite these differences, both conditions are often treated in similar ways.

5. Can fallopian tube cancer return after treatment?

Yes, like many cancers, fallopian tube cancer can return, especially if diagnosed at a later stage. The risk of recurrence depends on factors such as the stage at diagnosis, the response to initial treatment, and overall health. Regular follow-ups, imaging tests, and blood tests can help monitor for any signs of recurrence.

6. How does menopause affect the risk of developing fallopian tube cancer?

The risk of fallopian tube cancer increases after menopause, particularly in women over the age of 50. Hormonal changes and a history of hormone replacement therapy (HRT) may contribute to this risk. Women with BRCA1 or BRCA2 gene mutations also have a higher likelihood of developing the condition after menopause.

7. Are there any dietary or lifestyle changes that can help during or after treatment?

Certain lifestyle changes may support overall health during and after treatment:

• Healthy diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain energy levels.
• Hydration: Staying well-hydrated can support digestion and recovery.
• Physical activity: Gentle exercise can help improve strength, reduce fatigue, and boost mood.
• Managing stress: Meditation, yoga, or counselling can provide emotional support during treatment.
• Avoiding tobacco and alcohol: Reducing or eliminating smoking and alcohol consumption may lower the risk of complications.

A healthcare provider can offer guidance on specific lifestyle changes based on individual health needs.

Reviewed By Dr. Kanika Batra Modi, Principal Consultant, Surgical Oncology, Cancer Care / Gynecologic Oncology, Robotic Surgery on 17 March 2025.