Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.

Treatment for fallopian tube cancer depends on:

• the type of fallopian tube cancer
• where it is in the body
• whether the cancer has spread, and where it has spread to
• your general health
• your personal preferences.

Treatment options can include surgery, chemotherapy, radiation therapy and targeted therapy.

Surgery

Fallopian tube cancer is usually treated with surgery to remove the uterus, cervix, fallopian tubes or ovaries, and sometimes also lymph nodes as well. Your doctor will discuss what type of surgery might be best for you.

Bilateral salpingo-oophorectomy

A total hysterectomy is the surgical removal of the uterus and cervix. Your doctor may also remove part of your vagina, called a radical hysterectomy. In most cases, the fallopian tubes and ovaries are also removed – this is called a bilateral salpingo-oophorectomy. The ovaries are removed either because the cancer may have spread to the ovaries, or because the ovaries produce oestrogen, a hormone that may cause the cancer to grow.

The operation can be either:

• open surgery, where a large cut is made in your belly
• laparoscopic surgery (also called keyhole surgery), where several small cuts are made in your belly and a thin telescope is used to see inside. Your uterus and any other organs will be taken out through your vagina.

Surgery can affect your ability to have children (see Effects of treatment on fertility).

Lymph node removal

Lymph nodes (also called lymph glands) are small, bean-shaped organs that are part of the lymphatic system in your body. There are major lymph nodes in the neck, armpits, groin and abdomen. The lymphatic system is an important part of the immune system.

If fallopian tube cancer has spread into the muscular wall of the uterus, this increases the risk that it will spread to other areas near the uterus and to the pelvic lymph nodes. Your doctor may discuss the need to remove some of the lymph nodes in your pelvic region, to make sure the cancer doesn’t spread further. Surgically removing your lymph nodes is called a lymphadenectomy.

Lymph node removal is not recommended for all women. If cancer is found in the lymph nodes, your doctor may advise more therapy, called adjuvant therapy.

Chemotherapy

Different chemotherapy options are used to treat different types and stages of fallopian tube cancer^[1] . Sometimes more than one type of chemotherapy treatment may be used. Chemotherapy can cause side effects which depend on the type and number of chemotherapy agents used.

Chemotherapy can be given at various times including before surgery (neoadjuvant chemotherapy) to shrink the tumour, or after surgery (adjuvant chemotherapy) to reduce the risk of the cancer coming back. It can be used as a main treatment for cancer that has spread to distant parts of the body to improve symptoms and prolong life.

Chemotherapy will usually be given after surgery for fallopian tube cancer. This may be given directly into the belly (called intraperitoneal chemotherapy).

Treatment options for fallopian tube cancers are similar to those of ovarian cancer.

For further information regarding chemotherapy, see Chemotherapy.

Targeted therapy

Targeted therapies may be given for fallopian tube cancer.

Bevacizumab may be used for people with stage 3 or 4 fallopian tube cancer.^[2] Bevacizumab is a monoclonal antibody, which is a type of immunotherapy. It works by blocking the action of a growth factor called VEGF (vascular endothelial growth factor).

It may be used on its own^[3] or in combination with chemotherapy.^[4]

PARP inhibitors may be used for people with advanced or recurrent fallopian tube cancer. These are medicines that block DNA repair and can cause cancer cells to die. Examples of these medicines are olaparib, rucaparib and niraparib.^[5]

Radiation therapy

In some cases of fallopian tube cancer, radiation therapy to the abdomen and pelvis may be given after chemotherapy.

Follow-up

It is important that patients have proper follow-up care after treatment for fallopian tube cancer

Recurrent or advanced disease

Recurrent fallopian tube cancer is cancer that has recurred (come back) after it has been treated.

Recurrence is when the cancer comes back in the same part of the body. Secondary cancer is when the cancer spreads to another part of the body.

Fallopian tube cancer may come back in the fallopian tubes or in other parts of the body.

The most common treatment for recurrent fallopian tube cancer is chemotherapy and targeted therapy.^[6]