Uterine tube cancer in the practice of an obstetrician-gynecologist

Abstract

Fallopian tube cancer (FTC) is an actual problem in oncology. Despite the low frequency of FTC, it is quite easy to confuse it with other malignant diseases of the female genital organs, namely, ovarian and endometrial cancer. It is quite difficult to diagnose FTC in time, since the absence of specific symptoms determines the detection of malignant tumors of fallopian tubes only during surgical interventions for benign gynecological pathology or in case of suspicion of ovarian or endometrial cancer. The final diagnosis and primary origin of the tumor can be established only by postoperative histological study.The article presents a review of the literature of scientometric databases on the etiology, diagnosis, and treatment of FTC. Based on the analysis of data from the scientific literature, the problem of FTC as a rare and deceptive malignant disease with a rather aggressive course is highlighted, which causes the formation of oncological awareness among obstetricians-gynecologists regarding this type of cancer.According to the literature, it is established that FTC is diagnosed very rarely. Among all cases of malignant tumors of the female genital organs, the frequency of FTC is only 0.14–1.8 %. It was also established that it is possible to diagnose FTC in a time only in 0–21 % of cases, according to other data– up to 10 %.Due to the aggressive course of tubal cancer, the five-year survival rate ranges from 22 till 57 %. Intraoperatively, it is possible to detect malignant tumors of the fallopian tubes only in 50 % of cases. The article provides data on the possible causes of development, clinical symptoms that can be manifested by FTC, as well as methods of diagnosis and treatment of this cancer.FTC is a very deceptive oncological pathology, which can be caused by chronic inflammatory changes in the fallopian tubes, infertility, fallopian tube endometriosis, and BRCA1 and BRCA2 mutations. First of all, obstetrician-gynecologists should pay attention on abnormal uterine bleeding in the patient, purulent-bloody discharge, pain in the lower abdomen, the phenomenon of “watery tubal discharge”, since these pathological manifestations are typical for FTC. The tumor marker CA-125 and β-subunit of hCG have important meaning, the levels of which are increased by FTC.Significant similarity of clinical symptoms with ovarian and endometrial cancer leads to significant errors in establishing the correct diagnosis. Since malignant tumors of the fallopian tubes can metastasize to groups of lymphatic lymph nodes that are completely atypical for them, it is also necessary to carry out a differential diagnosis with breast cancer, because FTC can manifest itself in the form of axillary lymphadenopathy, and with stomach cancer, in which an isolated increase of the left supraclavicular lymph node (Virchow’s metastasis) can also be observed, which is also characteristic of fallopian tube carcinomas.