Swollen lymph node leads to fallopian tube cancer diagnosis
Case unusual as aggressive cancer in left tube affected nodes in right groin
In a rare case, a woman in China was found to have fallopian tube cancer in her left tube that had spread to lymph nodes on the right side of her groin, scientists report.
The 47-year-old woman, who first sought care because of a swollen lymph node, was successfully treated with surgery and chemotherapy. Her doctors noted it was highly unusual for this form of gynecological cancer to affect lymph nodes farther away than other nodes, and called for further study.
The report, “High-grade serous cancer of left fallopian tube with right inguinal lymph node enlargement: a case report,” was published in Frontiers in Oncology.
Fallopian tube cancer, like ovarian cancer, often diagnosed in advanced stages
Fallopian tube cancer is a rare cancer that forms in the lining of the tubes that carry eggs from the ovaries to the uterus. In practice, it’s treated as a type of ovarian cancer.
These malignancies usually don’t cause obvious symptoms in early stages, and most aren’t diagnosed until the cancer has advanced and spread. Noticeable symptoms are abdominal discomfort, appetite changes, or pelvic pain.
Ovarian and fallopian tube cancer can spread to nearby lymph nodes, but most often the lymph nodes involved are in the abdomen (para-aortic nodes) and pelvis. Lymph node swelling, or lymphadenopathy, can be an evident symptom.
Lymph nodes in the groin — called inguinal lymph nodes — also can also be affected, but it’s unusual for people to be aware of node involvement at the time their cancer is diagnosed, the scientists wrote.
The woman came to their hospital in Shanghai with an enlarged right inguinal lymph node that had been present for at least two months. She noticed no other symptoms except for occasional and dull abdominal pain.
Analysis of an ultrasound of the node revealed a solid mass, and a biopsy showed signs of a high-grade, or aggressive, cancer that likely had spread from her reproductive system.
Imaging tests confirmed a likely cancerous tumor in the area of the left ovary and fallopian tube, with fluid accumulation in the right inguinal region. Laparoscopy, where a small lighted tube with a camera is inserted into the abdomen, showed a tumor affecting the left fallopian tube and ovary, but no involvement of the para-aortic or pelvic lymph nodes.
Woman’s cancer treated by surgery, followed by chemotherapy
The woman then underwent cancer surgery to remove her uterus, fallopian tubes, ovaries, and omentum — the fatty tissue that surrounds the stomach and intestines — in a procedure called a hysterosalpingo-oophorectomy with omentectomy.
Later examination of the tumor tissue confirmed a high-grade serous cancer in her left ovary and left fallopian tube. Serous means the tumor arose from certain cells in the lining of the ovaries and fallopian tubes.
The tumor did not have mutations in the BRCA1/2 genes, which are sometimes found in this type of cancer. The homologous recombination deficiency (HRD) status of the tumor was positive. HRD positivity reflects that a tumor with difficulties in repairing its own DNA, making it more likely to respond to certain treatments.
In accordance with current guidelines, the woman underwent six cycles of chemotherapy with carboplatin and taxol, with the targeted therapy bevacizumab (sold as Avastin, among other names) added to the final two cycles.
Imaging after four cycles of chemotherapy showed no signs of cancer. Blood levels of CA 125 — a biomarker that’s often high in ovarian and fallopian tube cancer — had been elevated but declined with treatment.
Unusual that lymph nodes opposite to cancer site only ones affected
Exactly how this gynecologic cancer made its way to an inguinal lymph node on the opposite side of the body from the original tumor — without affecting closer tissues — “remains unclear,” the scientists noted.
“The reasons for the left fallopian tube tumor presenting with right inguinal lymph node enlargement and the explanation for lymphatic drainage from the primary tumor to only the right inguinal lymph node require urgent investigation,” they wrote.
They believe the woman’s HRD-positive status may be one relevant factor, but “further research is needed to identify other genetic factors linked to this phenomenon.”
This spread pattern, however, may be associated with a less aggressive disease course, the scientists wrote. Previous research into this type of primary fallopian tube cancer supports a good prognosis, they added, indicating they planned to follow the patient “for a long time.”
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