Primary carcinoma of the fallopian tube is very rare. The incidence of tubal carcinoma is less than 0.5 percent of gynecological malignancies.
Predisposing factors are: Infertility, nulliparity and family history of ovarian cancer. Women with BRCA1 or BRCA2 mutations are at high risk.
Pathology : The site is usually in the ampullary part and the mucosa is commonly affected. The fimbrial end usually gets blocked resulting in hydrosalpinx or hematosalpinx. It is mostly unilateral (80%).
Microscopic appearance: It is mostly adenocarcinoma (papillary serous) 90%.
Spread: Apart from direct spread, the lymphatic spread to the regional lymph glands (paraaortic) usually occurs. Blood borne spread to distant organs can occur in late stages. Choriocarcinoma can occur in the fallopian tube following ectopic pregnancy or tubal hydatidiform mole.
CLINICAL FEATURES: Patient profile — The patients are usually post-menopausal and nulliparous. History of infertility and pelvic infection may be there.
Bimanual examination reveals a unilateral mass which may be tender. If reduced in size on compression, along with a watery discharge through the cervix, it is very much suspicious.
- Most often accidentally discovered on laparotomy and histologic examination of the excised tube.
− Persistent postmenopausal bleeding with uterine pathology being excluded by curettage.
− Persistent positive Papanicolaou smear with a negative cervical and endometrial pathology.
− Serum CA 125 is elevated in most cases (85%).
- Laparoscopy: In cases of persistent postmenopausal bleeding with a negative uterine pathology.
- Ultrasound can help in the preoperative diagnosis.
A fluid filled sausage shaped mass separate from the uterus and ovary is seen. Ascites may be present.
HOMOEOPATHIC MANAGEMENT OF CARCINOMA OF FALLOPIAN TUBES: -
There are many medicines which may prove effective such as: -