Primary fallopian tube cancer is rare. The average age of patients with this cancer is 50 to 60 yr. Risk factors are not well defined; however, chronic salpingitis or other inflammatory disease (such as TB) are possible etiologic factors. Patients sometimes have a remote history of infertility.

More than 95% of fallopian tube cancers are papillary serous adenocarcinomas; a few are sarcomas. The spread pattern is similar to that of ovarian cancer. Fallopian tube cancer may spread by direct extension, by peritoneal seeding, or through the lymphatics. Staging is similar to that for ovarian cancer (

see Table 241-7).

Symptoms, Signs, and Diagnosis
Most patients present with an adnexal mass or vague abdominal or pelvic complaints, such as abdominal discomfort, bloating, or pain. Fewer than 1/3 of patients present with hydrops tubae profluens-a triad of pelvic pain, copious watery discharge, and adnexal mass.
Diagnosis and treatment are surgical. The treatment of choice consists of exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and surgical staging, which includes washings from the pelvis, abdominal gutters, and diaphragmatic recesses. Multiple pelvic and abdominal peritoneal biopsies, omentectomy, and pelvic and para-aortic lymph node dissection should also be performed. Cytoreductive surgery is indicated for advanced-stage disease.

Postoperative therapy, identical to that for ovarian cancer, is usually necessary. External beam radiation therapy to the pelvis and abdomen is useful in selected patients.