Obstetrics and Gynecology Board Review Pearls of Wisdom

464 Obstetrics and Gynecology Board Review •••

❍ What percentage of patients with fallopian tube malignancies present with the classic triad of symptoms?
Less than 15%; however, >50% present with vaginal discharge or bleeding and about 60% have a pelvic mass.

❍ How often is bilateral involvement found in adenocarcinoma of the fallopian tube?
Dependent on the stage of the tumor at the time of diagnosis. For stage I, II, and in situ lesions, the incidence is
approximately 7%. In stage III and IV disease, however, bilateral involvement is seen in as many as 30%.

❍ Describe the staging system for fallopian tube tumors.
Although there are several staging systems for tubal cancers, the most widely used is that of the International
Federation of Gynecologists and Obstetricians (FIGO). It is similar to that used to stage ovarian malignancies.

Stage 0 Carcinoma in situ (limited to the tubal mucosa)

Stage I

Stage IA

Stage IB

Stage IC

Growth limited to the fallopian tubes

Growth limited to one tube with extension into submucosa and/or muscularis, but not

penetrating the serosal surface. No ascites

Growth limited to both tubes with extension into submucosa and/or muscularis, but not

penetrating the serosal surface. No ascites

Tumor either IA or IB but with extension through or onto tubal serosa or ascites containing

malignant cells or with positive peritoneal washings

Stage II

Stage IIA

Stage IIB

Stage IIC

Growth involving one or both fallopian tubes with pelvic extension

Extension and/or metastasis to uterus and/or ovaries

Extension to other pelvic tissues

Tumor either IIA or IIB but with ascites containing malignant cells or with positive peritoneal

washings.

Stage III

Stage IIIA

Stage IIIB

Stage IIIC

Tumor involving one or both fallopian tubes with peritoneal implants outside pelvis and/or

positive retroperitoneal or inguinal adenopathy. Superficial liver metastasis included

Tumor grossly limited to true pelvis with negative nodes but with histologically confirmed

microscopic seeding of abdominal peritoneal surfaces

Tumor involving one or both tubes with negative nodes but histologically confirmed implants

of 2 cm or less on abdominal peritoneal surfaces

Abdominal implants of >2 cm in diameter and/or positive retroperitoneal or inguinal nodes

Stage IV Growth involving one or both fallopian tubes with distant metastases

Includes parenchymal liver metastasis and cytologically confirmed malignant pleural effusions

❍ Based on the surgical findings at the time of laparotomy, how common are the four stages?
Stage I disease accounts for about 29% of all fallopian tube malignancies, stage II for about 23%, stage III 39%,
and stage IV for 7%.

❍ What is the 5-year survival for patients with adenocarcinoma of the fallopian tube?
Overall 5-year survival is approximately 56%, but is dependent on the stage at the time of diagnosis. The
associated 5-year survival by stage is as follows: Stage I 81%, stage II 67%, stage III 41%, and stage IV 41%.