Ocular Oncology

Conjunctival Tumors

Conjunctival tumors may first appear as a pink or brown bump on the eye. Depending on the specific type it is, conjunctival tumors have a relatively low incidence of metastasis, but it is vitally important that it be caught early so as to prevent it from invading the orbit and progressing into malignant melanoma. Surgery to remove the tumor is the treatment of choice for most conjunctival tumors although the patient may need additional treatment with cryotherapy (a freezing technique) and surgery on the sclera and epithelium. Patients with certain conjunctival tumors may require chemotherapy as well.

Eyelid Tumors

Eyelid tumors are not uncommon and can be benign or malignant. Most often, they can be observed by the naked eye and anyone who has an unusual bump or nodule on the eyelid should see their ophthalmologist for a more thorough examination. Treatment for eyelid tumors depends on the type and size of the tumor, as well as whether it is malignant. Simple benign tumors may be surgically removed while malignant tumors may require surgery, chemotherapy, radiation or some combination of treatment strategies.

Choroid

The importance of routine eye examinations cannot be understated. That is because it is often during a regular eye exam that serious conditions such as malignant melanoma of the choroid is discovered. This condition usually affects older adults and is a type of cancer that is related to skin cancer (melanoma). Only one eye is affected and it usually is detected in the choroid, the ciliary body or sometimes the iris. If malignant melanoma is suspected, you will probably have to undergo a fluorescein angiography study and echography (ultrasound) of the eye. These tests and others will help to stage the cancer. Based on that information, your ocular oncologist will make recommendations regarding your treatment. The important factors that affect outcome include the size and location of the tumor. For patients who have small tumors that have stayed in one location (localized), malignant melanoma is usually curable and they have a good chance of preserving their vision. For patients with larger tumors that have spread, a number of treatments are available, including enucleation (removal of the eye), laser photocoagulation, plaque radiotherapy and transpupillary thermotherapy, chemotherapy and immunotherapy (use of a vaccine to stimulate the person’s own immune response to the tumor), among others.

Orbital Tumors

In children, orbital tumors tend to be benign (non-cancerous) although one form of rare orbital tumor rhabdomyosarcoma, is a malignant and more serious form of this type of tumor. In adults, orbital tumors may affect the lacrimal system, or may be associated with entangled blood vessels (cavernous hemangiomas) or nerve fibers (neurilemoma). It could also be a manifestation of lymphoma or metastatic tumor. Many treatment methods are available for orbital tumors, including removal of the entire tumor either through the eyelid or conjunctiva, incisional biopsy (removal of a portion of the tumor and adjacent tissue), chemotherapy, radiation and immunotherapy (a type of vaccine to promote an immune response against the tumor). If the tumor is advanced, orbital exenteration (removal of the eye and contents of the orbit) may be necessary.

Retina

Retinoblastoma, a malignant tumor that grows in the retina can destroy a child’s vision and may be fatal. Affecting children of all races, boys and girls equally, retinoblastoma occurs in one or both eyes, usually in the first year or two of life. The most common sign is a change in the color of the pupil, which can appear white in reflected light. This phenomenon is referred to as a cat’s eye reflex (Leucocoria). Sometimes the affected eye will cross or turn outward. Retinoblastoma can be hereditary and is more likely to develop in children with a family history of the disease. With early diagnosis, retinoblastoma treatment is remarkably effective. More than 90% of children survive and many eyes are saved with a combination of chemotherapy, radiation therapy, and heat, freezing, or laser treatments. In severe cases, the affected eye is removed. If a child has had retinoblastoma there is an increased chance for a second cancer to develop. Children with retinoblastoma should have regular examinations by an ocular ophthalmologist and a pediatric oncologist.