Primary carcinoma of the fallopian tube: a 20-year literature review.

Case series and important case reports of primary fallopian tube carcinoma published in the English literature from 1973 to 1992 are reviewed. Meta-analysis revealed a mean age of presentation of 56.7 years, with a nulliparity rate of 27.5 per cent and a mean parity of 1.7. Abnormal vaginal bleeding and discharge, and pelvic pain are the most common presenting symptoms. Despite developments in cytology, transvaginal ultrasound, and tumor markers, most cases remain undiagnosed preoperatively. In addition to direct intraperitoneal spread, early lymphatic spread is now recognized as a frequent cause of treatment failure. FIGO has recently released a staging classification for fallopian tube malignancy incorporating detailed surgical staging, which should allow uniformity and comparison between future series. Treatment regimes are empirically based on therapy for epithelial ovarian malignancy, but none have been subjected to controlled trials. Recent case series support extensive debulking surgery and adjuvant platinum-based combination chemotherapy for optimizing prognosis, although results from radiotherapy and hormonal therapy are largely disappointing. Promise is expressed in tumor markers and "second-look" laparotomy for monitoring disease response and planning management.