Consumer Safety Watch Advises That New Research Has Shown That Ovarian Cancer Begins in the Fallopian Tubes

These studies potentially give researchers hope for developing better detection and prevention methods and highlights the alarming reality that far too little is known about ovarian cancer.

Two studies published last fall have confirmed that ovarian cancer actually starts in the fallopian tubes.

According to Alan Christopher, a consumer safety advocate from Consumer Safety Watch, "Ovarian cancer kills 14,000 women in the United States alone annually and women often are not diagnosed until they are at an advanced stage - Stage III or IV." 

Ovarian cancer, dubbed a 'silent killer,' kills 14,000 women in the United States alone annually and women often are not diagnosed until they are at an advanced stage.

Alan Christopher, Consumer Safety Advocate

In most cases, ovarian cancer is not detected during routine pelvic exams, unless the doctor notes that the ovary is enlarged. The sooner ovarian cancer is found and treated, the better a woman's chance for survival.

Two recent studies have confirmed previous claims that the deadly disease actually starts in the fallopian tubes. According to Christopher, "this may also play a part in the alleged link between perineal use of talcum powder and increase rates of ovarian cancer since the talcum particles are known to migrate up the fallopian tube and could act as an irritant in the region."

The researchers found that most of the genetic alterations seen in ovarian tumors in these patients were present in lesions that had formed years earlier in their fallopian tubes. This finding is important, they wrote, because it could potentially help to enable earlier detection of the disease. Currently, about 70 percent of women with high-grade serous ovarian carcinoma (HGSOC) are diagnosed with advanced-stage disease.

The two studies identifying the fallopian tube as the source of the cancer were six days apart in October, shedding some light on the disease that doctors know very little about compared to other cancers. Both studies looked at HGSOC, the most frequent type of ovarian cancer with only 15 percent of those diagnosed surviving beyond five years. They also both concluded that a high percentage of ovarian cancer cases start in the fallopian tubes.

Ron Drapkin, an associate professor of pathology in obstetrics and gynecology at the University of Pennsylvania, has been studying ovarian cancer for nearly two decades. "It’s been about 10 years since the first research came out about ovarian cancer starting in the fallopian tube," he told Daily Mail Online. He said these two studies were "the last nails in the coffin."

"Before 2006 or 2007, no one had thoroughly looked in the fallopian tubes, so researchers kind of just stumbled upon all of the precursors to ovarian cancer," he said. "Since then we’ve been trying to understand what makes the fallopian tubes susceptible to the cancer."

Dr. Drapkin was one of the lead researchers of one of the studies published in the fall that looked at the fallopian tube from a genomic perspective.

About 80 percent of ovarian cancer cases are diagnosed in the advanced stages of the disease. "It’s diagnosed so late because of where it’s located - in the pelvis," Dr. Drapkin said. "The pelvis is like a bowl, so a tumor there can grow quite large before it actually becomes noticeable."

The first symptoms to arise with ovarian cancer are gastrointestinal because tumors can start to press upward. When a patient complains of gastrointestinal discomfort, doctors are more likely to focus on diet change and other causes than suggest an ovarian cancer screening. Dr. Drapkin said it’s usually not until after a patient endures persistent gastrointestinal symptoms that they will receive a screening that reveals the cancer.

"One of the things I tell women is that nobody knows your body as well as you do. If you feel something isn’t right, something’s probably not right."

The study looked at the relationships between tumors in five patients, isolating early precursor lesions in 37 samples. They used genetic profiling techniques to look for changes in the genetic material and patterns between the samples and patients.

"We already basically knew that ovarian cancer began in the fallopian tube, but this study gave us the genomic evidence to support that idea," Dr. Drapkin said. There is a chance that a small number of cases start in somewhere other than the fallopian tube, but there has been no concrete evidence as to where that may be, according to Dr. Drapkin.

The other study by researchers at the Perlmutter Cancer Center at NYU Langone Health in New York City looked at ovarian cancer tumor tissue samples from 96 women and compared them to samples from a group of healthy women. The study concluded that the cancerous cells were most similar to fallopian tissue.

"There are two new early-detection methods in the works right now that are heavily based on our findings," he said. One is a scope that travels up into the fallopian tubes to collect cells for testing. Another is a test similar to a pap smear that could take cells from the uterus and detect changes coming down from the fallopian tubes.

"This method is based on the menstrual cycle and the idea that everything flows through the same path, so by testing downstream from the fallopian tubes we could detect potential signs."

The findings are also being applied to prevention, specifically in women who have the BRCA1 or BRCA2 gene mutation associated with breast and ovarian cancer. Women with BRCA mutations are given the option to remove their ovaries in order to prevent developing cancer. Knowing that the cancer begins in the fallopian tube means that the tubes could be removed as well.

There are studies in the works to see if removing the fallopian tubes at a younger age and saving the ovary removal until closer to the natural time of menopause would still be effective for prevention.

Source: Consumer Safety Watch