Malignant tumors can also form in the eye. In young children, retinoblastoma is one of the most common eye tumors, and adults struggle with the malignant tumor choroidal melanoma. The symptoms, as well as possible therapies, depend on the type of cancer. In the early stages, both tumors can be almost completely removed with adapted treatment – however, if left untreated, they will lead to the patient’s death.
What is retinoblastoma?
Retinoblastoma is one of the mutation-related malignant retinal tumors. Young children (of both sexes) are particularly affected by the malignant tumor. With early detection and treatment, the chances of cure are about 97 percent.
Causes
Almost half of all diseases are hereditary. Usually, a damaged allele (expression of a particular gene on a chromosome) is inherited; however, these people are heterozygous (mixed-hereditary) with respect to a mutation of the retinoblastoma gene. If such a gene is damaged, it loses the ability to regenerate, which can lead to uncontrolled growth of retinal cells.
Symptoms, complaints, and signs
Symptoms of eye cancer depend on the type, size, and location of the tumor. Often, tumors go unnoticed for a long time until the first symptoms appear. Only in the case of the so-called retinoblastoma can there be early signs of disease. A typical symptom here is a whitish glow of the pupil when the eye is examined with an ophthalmoscope. Since retinoblastoma is a congenital hereditary disease, this symptom, known as leukocoria, can occur even in newborns. Sometimes the affected eye is blind at the same time. Furthermore, a so-called strabismus (squint) also appears as a common symptom. In rarer cases, there may be reddened eyes, inflammation in the orbit, glaucoma, iris discoloration, or unilateral pupil dilatation. Another malignant eye tumor, choroidal melanoma, initially causes no symptoms. It is often discovered by chance. However, in later stages of the disease, there may be significant limitations in visual performance due to retinal detachment. Furthermore, changes in the mole on the choroid can be detected during examinations. As with all melanomas, metastases occur in various organs. The corresponding symptoms depend on the organ affected. However, there are no preferred target organs for metastases. Another type of eye cancer, basal cell carcinoma of the eyelid, is characterized by mottled nodules that are sometimes crusted and bleed.
Diagnosis and progression
Retinoblastoma is most commonly diagnosed by specular examination of the back of the eye (ophthalmoscopy) or on the basis of the amaurotic cat’s eye. Blood analyses of the affected patient can be used to determine whether it is a familial form of retinoblastoma. If diagnosed early, the chances of cure are very high and vision should return to its original state. If left untreated, the tumor will lead to death.
Complications
The risk of complications in people who have eye cancer depends largely on the development of the tumor. Decisive factors here are its size, the parts of the eye affected, and the formation of daughter tumors. For this reason, early detection and treatment are important. In most cases, eye cancer can then be treated successfully without damaging the eyesight. If left untreated, however, the disease leads to death. Complications occur, among other things, when the retinoblastoma grows into the retina. Then various symptoms, such as a retinal detachment, can occur, which progressively worsen vision. At a certain degree, the doctor decides against the forms of therapy that do not damage the vision and for a surgical intervention. In this case, the entire eye is removed. In any case, however, even with other forms of therapy, permanent damage to the eye can occur. It becomes particularly dangerous if the tumor develops daughter tumors, so-called metastases. This happens when the cancerous tumor grows into the blood vessels of the eye and spreads there via the bloodstream. In this case, the liver and bones are most frequently affected.In addition to treatment of the eye, other therapeutic measures must be taken, such as chemotherapy, which has much more aggressive side effects.
Treatment and therapy
Treatment of retinoblastoma depends on the stage of the disease. Smaller tumors can be treated by radiation therapy. If the retinoblastoma is in an advanced stage, the eyeball must be removed (enucleation). After successful surgery, this is replaced by an ocular prosthesis.
Prevention
The disease of retinoblastoma can hardly be prevented, because the spontaneous mutations cannot be prevented. If eye cancers already run in the family, it is advisable for children to go for screening examinations at regular intervals.
Choroidal melanoma
What is uveal melanoma?
Choroidal melanoma is the most common malignant tumor in the eye, occurring in 1:100,000. The blackish-brown tumor consists of melanin-containing (pigment-containing) cells, which is usually not detected until advanced stages.
Causes
Various studies on the eye have shown that the metastatic disease is mainly related to genetic predispositions. This involves the loss of a chromosome 3, also called monosomy 3. Other causes are not yet known – some speculation is along the lines that UV radiation, as well as a low pigment count, promotes the disease in the eye.
Diagnosis and course
A retinal examination is performed for diagnosis, followed by a tentative diagnosis. The height and extent of the tumor is determined by ultrasonography. Benign changes, such as cysts, can thus be delineated. In addition, visualization of the blood vessels in the choroid (fluorescence angiography) also provides initial indications of choroidal melanoma. Often, choroidal melanomas are only detected during routine eye examinations. Prior to this, there are often severe changes in the visual performance of the affected patient. This is generally caused by retinal detachment.
Treatment and therapy
If the tumor is not too large, treatment is by local irradiation (brachytherapy). This involves sewing a radioactive platelet onto the affected eye and leaving it in place for a few days. If the tumor has already passed a certain stage, it is irradiated with protons (teletherapy). If this treatment has no effect or if the choroidal melanoma is already too large, the only remaining option is surgical removal of the eyeball (enucleation). Due to the stable envelope of the eye, called the sclera, the chances of cure for this form of eye cancer are quite high.
Outlook and prognosis
If eye cancer is diagnosed and treated early, the patient has a good chance of recovery. Complete recovery is possible if the tumor in the eye is small and there has been no spread of cancer cells in the organism. Early removal of the diseased tissue in the eye increases the prospects of preservation of the usual vision and complete regeneration. With up to 95%, eye cancer is cured without further complications if therapy is started early with the current medical possibilities. If the tumor disease is in an advanced stage, the prospects of complete freedom from symptoms decrease. Eye cancer is often successfully treated and cured even at a later stage of the disease, but permanent impairment of vision may occur. In particularly severe cases, the diseased eye may go blind without an option for change. If the diagnosed eye cancer remains untreated over a long period of time despite severe impairments, the tumor continues to grow unceasingly. In parallel, the risk of a fatal course of the disease increases. The cancer cells can be transported from the original site to other places of the organism via the vessels and blood vessels. There they also have the ability to spread. Metastases form and new forms of cancer develop. These significantly reduce the prospect of a cure.
Prevention
Prevention of uveal melanoma, as with retinoblastoma, is very difficult. The eye cancer can be prevented mainly by preventive examinations at regular intervals. Due to the good chances of cure, this is also strongly recommended.In particular, people who have a family history of such tumors should have regular checkups with an ophthalmologist.
Follow-up care
Appropriate follow-up examinations are of great importance in the case of eye cancer. Immediately after surviving the disease, regular examinations should take place at short intervals to see if the cancer may return. The earlier a return of the disease is detected, the better the chances for a complete and timely recovery. However, if the affected person forgoes such follow-up examinations, then an unnecessary risk is thereby accepted. This type of cancer can spread throughout the body within a very short time. Only with regular examinations can an early return of the disease be detected and treated accordingly. Even several months or years after surviving the disease, these follow-up examinations should be adhered to. Affected individuals who have survived this form of cancer are always at increased risk. To counteract this danger, an appropriate doctor should be visited regularly. An eye cancer disease can even recur many years after supposed recovery. Those who wish to avoid this risk should not forego appropriate follow-up care. In extreme cases, strictly adhered to aftercare can even be life-saving. Therefore, this type of examination should by no means be put on the back burner. The shorter the intervals between examinations, the lower the risk of recurrence.
What you can do yourself
When eye cancer is suspected, a doctor must first be consulted. The measures that patients can take themselves to promote recovery depend on the type and severity of the cancer. If the tumor is detected early, a few radiation treatments are often sufficient to destroy it completely. The patient should take it easy during this time and also follow the doctor’s instructions. Typically, a diet is also followed. In most cases, there is a decreased appetite, which is why nutritional supplements as well as high-calorie foods must be taken. This, along with regular hydration, ensures that deficiency symptoms do not occur during the strenuous radiation therapy. If visual disturbances or other complications occur, the responsible physician must be informed immediately. The medication may have to be changed or the therapy may not be effective. In any case, close consultation with the doctor is necessary during treatment so that the therapy can be regularly adjusted to the patient’s state of health and the stage of the disease. Cancer often also affects the mental state of the patient. Therefore, in addition to medical treatment, psychological therapy should also be sought. If desired, the therapist can also establish contact with other sufferers or refer the patient to a self-help group.