New information presented at the recent American Association for Cancer Research meeting in San Diego suggests that the serous type of epithelial ovarian cancer may arise from the fallopian tubes, not the ovaries. If true, this would revolutionize how we think about screening and diagnosis. Treatment is already basically the same, so that would not be affected as much.

Researchers at Dana Farber in Boston studied a group of women at very high familial risk for developing ovarian cancer. These women had their fallopian tubes and ovaries removed in an attempt to prevent ovarian cancer. The researchers observed that when early cancerous growths were found, they were located in the fallopian tube rather than on the ovarian surface. Even more interesting was that most of these early cancerous areas were found at the end of the tube, called the fimbria, which actually sweeps across the surface of the ovary. Almost all women in this study group who already had ovarian cancer when their ovaries and tubes were removed had early pre-cancerous areas in their fallopian tubes.

The theory is that early cancerous growths start in the fallopian tube, cancer cells break away and, while the fallopian tube sweeps across the ovary, these cancer cells are deposited on the ovarian surface where they start to grow. This theory has some merit since ovarian cancer does start on the surface, not from within. Of course, it is only a theory but it is very provocative since the fallopian tube is more accessible than the ovary by insertion of tiny fiberoptic endoscopes through the vagina and the uterus. Although this technology is not widespread, one can see the possibility of evaluating the fallopian tube just like we currently do when screening for colon cancer by using colonoscopy.