31 Fallopian Tube
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SUMMARY OF CHANGES
• The definitions of TNM and Stage Grouping for this chapter have not changed from the Fifth Edition.
C57.0 Fallopian tube
ANATOMY
Primary Site. The fallopian tube extends from the posterior superior aspect of the uterine fundus laterally and anteriorly to the ovary. Its length is approxi- mately 10 cm. The medial end arises in the cornual portion of the uterine cavity, and the lateral end opens to the peritoneal cavity.
Carcinoma of the fallopian tube is almost always an adenocarcinoma arising from an in situ lesion of the tubal mucosa. It invades locally into the muscular wall of the tube and then into the peritubal soft tissue or adjacent organs such as the uterus or ovary, or through the serosa of the tube into the peritoneal cavity. Metastatic tumor implants can be found throughout the peritoneal cavity.
The tumor may obstruct the tubal lumen and present as a ruptured or unrup- tured hydrosalpinx or hematosalpinx.
Regional Nodes. Carcinoma of the fallopian tube can also metastasize to the regional lymph nodes (see Figure 30.1), which include:
Common iliac
Internal iliac (hypogastric) Obturator
Presacral Para-aortic Inguinal
Pelvic lymph nodes, NOS
Adequate evaluation of the regional lymph nodes usually includes aortic and pelvic nodes.
Distant Metastases. Surface implants within the pelvic cavity and the abdominal cavity are common, but these are classified as T2 and T3 disease, respectively. Parenchymal liver metastases and extraperitoneal sites, including lung and skeletal metastases, are M1 (see Figure 30.9).
DEFINITIONS Primary Tumor (T)
TNM FIGO
Categories Stages
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis 0 Carcinoma in situ (limited to tubal mucosa) T1 I Tumor limited to the fallopian tube(s)
T1a IA Tumor limited to one tube, without penetrating the serosal surface; no ascites (Figure 31.1)
T1b IB Tumor limited to both tubes, without penetrating the serosal surface; no ascites (Figure 31.2)
T1a TNM:
FIGO: IA
FIGURE 31.1. T1a is tumor limited to one fallopian tube, without penetrating the serosal surface; no ascites.
T1b TNM:
FIGO: IB
FIGURE 31.2. T1b is tumor limited to both tubes, without penetrating the serosal surface;
no ascites.
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T1c T1c
TNM:
FIGO: IC
TNM:
FIGO: IC
Ascites, peritoneal washing
FIGURE 31.3. Two views of T1c: tumor limited to one (left of dotted line) or both tubes with extension onto or through the tubal serosa, or with malignant cells in ascites or peritoneal washings (right of the dotted line).
T1c IC Tumor limited to one or both tubes with extension onto or through the tubal serosa, or with malignant cells in ascites or peritoneal washings (Figure 31.3)
T2 II Tumor involves one or both fallopian tubes with pelvic extension
T2a IIA Extension and/or metastasis to the uterus and/or ovaries (Figure 31.4)
T2b IIB Extension to other pelvic structures (Figure 31.5)
T2c IIC Pelvic extension with malignant cells in ascites or peritoneal washings (Figure 31.6)
T3 III Tumor involves one or both fallopian tubes, with peritoneal implants outside the pelvis
T3a IIIA Microscopic peritoneal metastasis outside the pelvis T3b IIIB Macroscopic peritoneal metastasis outside the pelvis 2 cm or
less in greatest dimension
T3c IIIC Peritoneal metastasis more than 2 cm in diameter Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 IIIC Regional lymph node metastasis Distant Metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 IV Distant metastasis (excludes metastasis within the peritoneal cavity)
T2a TNM:
FIGO: IIA
FIGURE 31.4. T2a is tumor involving one or both fallopian tubes with pelvic extension and/or metastasis to the uterus (shown) and/or ovaries.
T2b TNM:
FIGO: IIB
FIGURE 31.5. T2b is tumor with extension to other pelvic structures.
STAGE GROUPING (AJCC/UICC/FIGO)
0 Tis N0 M0
I T1 N0 M0
IA T1a N0 M0
IB T1b N0 M0
IC T1c N0 M0
II T2 N0 M0
IIA T2a N0 M0
IIB T2b N0 M0
IIC T2c N0 M0
III T3 N0 M0
IIIA T3a N0 M0
IIIB T3b N0 M0
IIIC T3c N0 M0
Any T N1 M0
IV Any T Any N M1
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T2c TNM:
FIGO: IIC
Ascites, peritoneal washing
FIGURE 31.6. T2c is pelvic extension with malignant cells in ascites or peritoneal washings.
