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What is the difference between fallopian tube cancer, peritoneal cancer and ovarian cancer?

Peritoneal, ovarian and fallopian tube cancers are all types of gynaecological cancers and treated in a similar way. Sometimes patients get confused and are keen to understand which cancer they actually developed.

Ovarian cancer

There are different types of ovarian cancer and more information can be found on my ovarian cancer page.

By definition, ovarian cancer develops in the ovaries, which are the almond sized and paired female reproductive organs that store eggs and produce hormones. The most common type of ovarian cancer is epithelial ovarian cancer (EOC), which originates in the layer of cells that cover the ovaries and the abdominal cavity. At advanced stages, ovarian cancers can hardly be differentiated from advanced fallopian tube or peritoneal cancers. Under the microscope, these cancers look all the same.

There are also two separate groups of non-epithelial ovarian cancers, which arise not from the outer layer of the ovary but from the inside of the ovary. They are called “Germ cell tumours” and “Sex-cord stromal tumours”. These tumours look distinctly different to epithelial ovarian cancers and are also treated differently.

Ovarian borderline tumours also arise from the ovaries and, while not entirely benign, fail to meet the strict criteria of cancer. They have a distinct appearance under the microscope. Their treatment is surgery; chemotherapy is not effective.

Fallopian Tube Cancer

Recent research suggests that some of the cancers we considered "ovarian" cancers in the past, fact may actually arise in the fallopian tubes. In premenopausal women, the fallopian tubes carry the fertilised egg from the ovary to the uterus (womb). Ligation of the fallopian tubes is a widely-performed contraception method. The fallopian tubes do not produce any hormones.

The risk factors for fallopian tube cancer are similar to those for ovarian cancer. It is most frequently in women with BRCA1 or BRCA2 and post-menopausal women, and in women with a history of breast cancer. Women who had a hysterectomy or women who had their tubes and ovaries removed previously have a much lower risk of developing ovarian or fallopian tube cancer.  

Primary Peritoneal Cancer

Peritoneal cancer develops in the peritoneum, the sheet of tissue that covers the inner surface of the abdomen and pelvis, including the organs, such as bowel, bladder, stomach and liver. The peritoneum produces a fluid which covers your organs making them slick, stopping your organs from sticking together. It is a very rare cancer and found mostly in women. Peritoneal cancer can occur anywhere in the abdominal space, and you can have peritoneal cancer even if your ovaries have been removed. It affects the surface of organs contained inside the peritoneum.

Peritoneal cancer develops in a similar way to epithelial ovarian cancer or fallopian tube cancer. This is because the lining of the abdomen and the ovary are similar types of tissue. The symptoms are generally vague including appetite loss, weight gain, feeling unwell and pain in the stomach area. It is not known what causes peritoneal cancer.

Treatment

Although these cancer types differ in origin and other factors, ovarian, fallopian tube and peritoneal cancers are often treated the same. Treatment usually involves a combination of surgery and chemotherapy. A gynaecological oncologist would be the best person to advise on the treatment of these cancers.

My recommendation:

Prevention is far more effective than the treatment of ovarian, fallopian tube or peritoneal cancer. Women who consider a hysterectomy should be offered to have their fallopian tubes removed if there are premenopausal; it will have no impact on the hormonal situation because fallopian tubes don’t produce hormones. Postmenopausal women who need a hysterectomy should be offered to have their fallopian tubes and the ovaries removed at the time of their hysterectomy. Removing ovaries will not change the menopausal status any more.

Typically, a hysterectomy is best done through a laparoscopic surgical approach because the entire procedure can be done in minimally invasive ways with the lowest risk of complications and the highest chance to recover quickly within days. By contrast, only one in 10 women can have their fallopian tubes removed with a vaginal hysterectomy. An open hysterectomy should be avoided because of a much higher risk of surgical complications.

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