Fallopian Tube Cancer Triad

　　First, Etiology

　　The etiology is not completely clear. Patients are often accompanied by chronic salpingitis, and there are reports that the disease coexists with tuberculous salpingitis, and there are also cases after tubal ligation.

　　Second, Pathogenesis

　　The pathological changes of primary fallopian tube cancer are as follows:

　　1. The local fallopian tube epithelium is completely replaced by cancer tissue.

　　2. The cancer tissue is confined to the fallopian tube, and the muscular layer of the fallopian tube, the lymphatic vessels of the fallopian tube mesentery, and the serous membrane of the fallopian tube are less invaded. Even if there is invasion, it is less severe than the mucosa. Most of the cancer tissue in primary fallopian tube cancer stays in the submucosal layer and protrudes into the lumen, and it takes a relatively long time to invade the muscular layer. While the metastatic fallopian tube cancer can be found in the muscular wall lesions in the early stage.

　　3. Although the cancer cells do not have cilia, their structure is similar to that of the fallopian tube epithelium.

　　4. There are no cancer foci in the endometrium and ovary. If a cancer focus appears, it is very small in size, and the histological examination can show that the cancer focus is consistent with the metastasis from the fallopian tube.

　　5. In the early stage of primary fallopian tube cancer, the transition form from normal epithelium to cancerous epithelium can be found at the site of canceration.

　　The bilateral fallopian tube cancer is primary or secondary: Both fallopian tube cancers originate from the paramesonephric duct (accessory mesonephric duct), and under the same carcinogenic factors, cancer can occur simultaneously, therefore, bilateral fallopian tube cancer should be considered as primary fallopian tube cancer.

　　Is the fallopian tube adenocarcinoma combined with endometrial adenocarcinoma primary or secondary? ① If both lesions are early and there is no possibility of metastasis, both should be considered primary; ② The metastatic lesion is focal invasion of the endometrium into the stroma or superficial, there is often pressure on the surrounding tissues, without transition morphology.

　　Adhesions of surrounding tissues lead to hydrosalpinx and hematosis of the fallopian tube.

　　1. Causing hydrosalpinx of the fallopian tube:After the ostium and isthmus of the fallopian tube are sealed by inflammatory adhesion, the inflammatory secretions cannot be discharged, and the pus in the lumen accumulates more and more, forming a larger sausagelike mass. Infection after full-term delivery and postpartum infection are common causes of this kind of inflammation, and high fever and lower abdominal pain are typical symptoms of the disease, often dominated by the latter. A few patients have a slower formation process of abscess, and the patient may not have fever, the number of peripheral blood leukocytes may be normal, and the erythrocyte sedimentation rate is often increased.

　　2. Hydrosalpinx of the fallopian tube.

　　In clinical practice, it often manifests as vaginal discharge, abdominal pain, pelvic mass, which is called the triad of fallopian tube cancer.

　　1. Vaginal discharge or bleeding:Vaginal discharge is the most common symptom of fallopian tube cancer, but the nature of the discharge varies, from more to less. The discharge is serous yellow water, and sometimes it is bloody. This is the exudate produced during the growth process of the tumor. Generally, there is no smell. When there is necrosis or invasion of blood vessels in fallopian tube cancer, vaginal bleeding may occur.

　　2. Lower abdominal pain:It often occurs on the affected side, presenting as dull pain, which gradually intensifies and becomes cramping colic after a period of time. If watery or bloody fluid is discharged from the vagina, the pain will subside later. The possible mechanism is that during the development of the tumor, the lumen and ostium are blocked by the tumor, the contents of the fallopian tube accumulate more, the internal pressure rises, which causes an increase in the peristalsis of the fallopian tube, in order to overcome the obstruction and expel the effusion.

　　3. Abdominal mass:Some patients can palpate a mass in the lower abdomen themselves, and a mass can be palpated during gynecological examination. The mass can be the cancer itself, or it can be complications such as hydrosalpinx or uterine fibroids, etc. The mass is small, 3 to 4 cm in size, and large ones reach the navel, presenting as solid or cystic-solid, most of which are smooth in surface, limited in movement or fixed.

　　Four, other manifestations of fallopian tube cancer

　　1. Ascites:It is less common for fallopian tube cancer to be accompanied by ascites. The way of spread of fallopian tube cancer is similar to that of ovarian cancer, but there are fewer cases with ascites, which may be related to the fact that the growth of fallopian tube cancer usually starts from the lumen, while ovarian cancer occurs on the surface of the ovary.

　　2. Exudative hydrosalpinx:Latzko described the symptoms of the patients in 1915 - pain relief, disappearance of the mass, accompanied by a large amount of vaginal discharge. When the lumen is blocked by the tumor, the secretion accumulates to a certain extent, the internal pressure increases, which can suddenly cause a large amount of vaginal discharge. As the lumen pressure decreases, the pain in the abdomen is relieved, the mass shrinks, and this change process is regarded as a characteristic of fallopian tube cancer.

　　3. Infertility:Patients with 1/3 to 1/2 fallopian tube cancer have a history of primary or secondary infertility. The malignancy is very high.

　　1, Early detection, early treatment, and close follow-up.

　　2, Prognosis

　　The prognosis is generally poor, the cure rate is below 25%, and there is no effective preventive method. Garlic can reduce the incidence of female tubal cancer. The malignancy of tubal cancer is high. Factors affecting prognosis include: the duration of symptoms, clinical stage, pathological grade. Poor prognosis for patients with bilateral tubal lesions, and poor prognosis for patients without adjuvant treatment. Due to the improvement of diagnostic and treatment techniques in recent years, the 5-year survival rate of tubal cancer, which is difficult to diagnose early, has reached about 40%.

　　Tubal cancer triple syndrome mainly relies on auxiliary examinations, such as tumor marker examination, diagnostic curettage, vaginal desquamation cell examination, laparoscopy, ultrasound, CT, and other examinations, and histopathological examination.

　　First, diet taboos

　　1,主要以半流食为主, eat easily digestible food, reduce the burden on the gastrointestinal tract.

　　2, A balanced diet, high in protein, high in vitamins, low in fat and salt, avoid spicy and刺激性 food, sweet and greasy food, barbecue, pickled food, etc.

　　3, Eat on time and in the right amount, and have a reasonable diet.

　　4, It is advisable to choose foods that are beneficial for the physiological cyclical regulation of ovarian function, such as abalone, cuttlefish, octopus, black-bone chicken, quail, sea cucumber, shark fin, pigeon egg, bird's nest, etc.

　　5, It is advisable to eat more foods with the effect of invigorating the spleen and eliminating dampness, such as yam, dolichos lablab, coix seed, black fungus, broad bean, lotus seed, mung bean, adzuki bean, walnuts, celery, etc.

　　6, Yellow vaginal discharge and blood-stained leukorrhea are due to damp-heat, it is advisable to drink more soup and light diet, eat more fresh vegetables: celery, winter melon, amaranth, watermelon, mung bean, water chestnut, seaweed, mung bean, black fungus, etc.

　　7, Swelling and pain patients: Pork kidney, sea rye fish, myrica, hawthorn, orange cake, walnut, hickory, chestnut, etc.

　　8, Bleeding patients: Lotus root, sheep's blood, shepherd's purse, mushrooms, rock shiitake, persimmon cake, malan head, garlic, snails, conch, sea cucumber, etc.

　　9, Infected patients: Eel, Warty clam, sesame, celery, buckwheat, Brassica chinensis, toon, snake meat, adzuki bean, mung bean, old wheat, carp, etc.

　　Second, therapeutic diet recipes

　　1, Dioscorea Oppositapollen Porridge:Dioscorea Oppositapollen is decocted in water, the dregs are removed and the juice is taken, then added with glutinous rice and red dates to cook porridge, which can promote diuresis and swelling, and is especially suitable for patients with tubal cancer triple syndrome in the late stage with ascites.

　　2, Vegetable Quail Egg:First, boil quail eggs, peel them, slice carrots, aloe vera, mushrooms, and green peppers, then stir-fry them with the eggs and season to taste. It can improve chronic anemia in patients with tubal cancer triple syndrome.

　　3, Coix Seed Lotus Seed Red Date Porridge:Coix Seed should be dried and ground into powder, lotus seeds and red dates are cooked in a pot with water, then the Coix Seed powder is added and cooked together, seasoned with brown sugar, and cooked to a porridge-like consistency. It has the effects of replenishing qi and nourishing blood, and invigorating the spleen and eliminating dampness.

　　4, Polygonum Multiflorum and Raw Rehmannia Chicken Soup:Radix Polygonum Multiflorum, raw Rehmannia and black chicken are cooked in a clay pot or sand pot until tender, then season with sauce and eat. This recipe can nourish yin and blood, and is especially suitable for patients with tubal cancer triple syndrome who have symptoms such as emaciation, vaginal bleeding, and yin deficiency and blood deficiency.

　　5, Five Flowers Diuretic Tea:Jinhuahua, Gehua, Juhua, Danhua, Huaimi, Muhua each 15 grams, together with Tuifuling and Shanyiren each 30 grams, and 6 grams of Gancao boiled, strained and taken out the juice, which can be sweetened with rock sugar, can be made into tea. It can clear heat and detoxify, promote diuresis and anticancer, suitable for patients with the triad of fallopian tube cancer with increased leukorrhea.

　　The Western medical treatment method for the triad of fallopian tube cancer is mainly surgical treatment, supplemented by radiotherapy and chemotherapy.

　　First, Surgical Treatment

　　1, Stage I:Extraperitoneal total hysterectomy, bilateral adnexectomy and omentectomy.

　　2, Stage II and above:Try to resect to the point where there is no gross residual tumor, and even part of the involved organs may need to be resected.

　　Cannot be resected to the point where there is no gross residual tumor: perform tumor resection, and selectively perform paraaortic lymph node biopsy or pelvic and paraaortic lymph node dissection.

　　3, Precautions

　　(1) Explore and perform surgical staging after the operation begins, and take biopsies of suspicious areas: find tumor cells in ascites, and withdraw peritoneal lavage fluid when there is no ascites.

　　(2) Block the blood vessels in the fallopian tube area as soon as possible.

　　(3) Appropriate chemotherapy drugs should be placed in the peritoneal cavity before closing the abdomen.

　　Second, Radiotherapy

　　It is mostly used for patients without residual tumor in the upper abdomen after surgery, only with small residual tumor in the pelvis.

　　Patients with ascites can also apply radioactive phosphorus placement in the abdominal cavity.

　　Contraindications: Patients with serious complications and dysfunction of the heart, liver, lungs, kidneys and other organs. Patients with advanced fallopian tube cancer are in a state of exhaustion and cannot tolerate surgery.

　　Anesthesia methods: epidural anesthesia or lumbar anesthesia, general anesthesia can be performed for those who do not cooperate.

　　Third, Chemotherapy

　　Can be used as palliative treatment for advanced cases and adjuvant treatment after surgery.

　　Effective drugs: Stilbamate, Melfalan, Doxorubicin, Cisplatin, Fluorouracil, Cyclophosphamide, Taxol, etc.

　　Most commonly used chemotherapy regimen:

　　1, DDP plus Taxol regimen:Repeat for III, IV stage ovarian cancer every 21 days.

　　2, CP regimen:Repeat cyclophosphamide every 28 days.

　　3, CAP regimen:Repeat cyclophosphamide every 21-28 days.