Eye Cancer: Symptoms, Therapy, and Treatment, as well as Various Tumors in the Eye (Types of Eye Tumors)

The main anatomical areas of the eye where malignant eye tumors can develop are:

• the eyelids,
  
• the surface of the eye, such as the conjunctiva,
  
• the retina, and
  
• the choroid.

Below, we present the most dangerous forms of eye cancer (eye tumors):

• Basal cell carcinoma of the eyelid (eyelid tumor)
• Conjunctival carcinoma
• Retinoblastoma
• Melanomas of the choroid, the iris, and the conjunctiva

Most growths on the eyelid are benign. This was recently confirmed by an analysis of more than 5,000 eyelid tumors conducted by the University Eye Clinic in Lausanne. However, detecting a malignant growth is all the more important. Malignant tumors are, in fact, easily treatable if they are not yet too large.

In one respect, basal cell carcinoma is completely atypical for a malignant tumor: it very rarely metastasizes. If not detected or treated in time, however, it can invade the surrounding tissue—even bone. This may require extensive plastic surgery.

Prevalence of Eyelid Tumors

Basal cell carcinoma is by far the most common malignant eyelid tumor, accounting for approximately 90 percent of cases. It is becoming increasingly common: numerous epidemiological studies point to a rapid increase in the number of cases in some countries. Exposure to sunlight is considered a major risk factor.

Sunlight is considered a major risk factor for the development of basal cell carcinomas.

This eye tumor appears as a raised nodule. It often has a crater-like depression in the center, which may sometimes bleed or form a scab. In more than 40 percent of cases, basal cell carcinoma occurs on the lower eyelid. In 12 percent of cases, it occurs on the upper eyelid, and in the remaining cases, it occurs at the inner or outer corner of the eyelid.

Basal cell carcinoma—which, incidentally, is the most common malignant skin tumor of all—primarily affects older people over the age of 60. Individuals with fair skin are particularly at risk.

 

Treatment of Eyelid Tumors

The most commonly used form of treatment for this type of eye tumor is surgical excision. In microscopically guided surgery (Mohs surgery), the specialist examines tissue samples under a microscope. In very rare cases involving complex initial findings, this is done while the patient is still on the operating table. If the margins of the incisions are not free of tumor cells, the procedure is extended until the margins are tumor-free.

In a cohort of 385 basal cell carcinoma patients, 92 percent remained recurrence-free after more than 12 years of follow-up. In rare cases, a basal cell carcinoma is also treated with cryotherapy, i.e., the local application of cold. This treatment may be used, for example, in older patients for whom extensive surgery appears too risky. The overall prognosis for this eye tumor is good.

 

Conjunctival Carcinoma

Sun exposure is also a major risk factor for conjunctival carcinoma. It can begin inconspicuously as a whitish elevation on the conjunctiva, possibly accompanied by quite noticeable blood vessels. The danger of conjunctival carcinoma is that it does not present with a typical appearance and looks relatively mild in the early stages. It also causes hardly any subjective symptoms. Treatment for this type of eye tumor consists of surgical removal. Depending on the extent of the tumor, follow-up radiation therapy or local treatment with the cytostatic drug mitomycin C may be necessary.

Retinoblastoma, which arises from pathologically altered, immature retinal cells, is the most common eye tumor in children.

It occurs in approximately one in every 10,000 to 20,000 births and almost always manifests before the age of 3. In just over one-third of children, this eye tumor is bilateral: both eyes are affected by the tumor. The cause is a genetic predisposition or a mutation during the embryonic development of the retina. If there are cases of retinoblastoma in a family, couples planning to have children should seek genetic counseling. After birth, an ophthalmologist should examine the baby at an early stage.

By http://visualsonline.cancer.gov/details.cfm?imageid=2418, Public Domain, Link

Symptoms of Retinoblastoma

Since the child is too young to express any symptoms, it is often only the parents who notice the problem: the pupillary reflex when the eye is exposed to light (for example, in a photo taken with a flash) is not red, but white. Retinoblastoma is light in color. It usually grows inward toward the vitreous humor after the tumor has detached from the retina.

It is also possible for the tumor to grow out of the eye, into the optic nerve, and thus toward the brain. Another sign of retinoblastoma may be a squint. In this case, it is a deviation of the affected eye, which is practically blind.

Treatment of Retinoblastoma

Until quite recently, enucleation—the removal of the eyeball—was the standard treatment for retinoblastoma. Advances in chemotherapy and radiation therapy now make it possible in most cases to save the patient’s life and preserve the eye—even if the eye is usually severely impaired or blind.

If the eye tumor is not too large, a radiation source can be sutured onto the sclera from the outside, directly over the tumor. This “plaque” remains in place for several months, destroying the tumor cells and causing the retinoblastoma to shrink. In specialized centers, proton radiation therapy (administered from outside the eye) may also be performed.

Chemotherapy drugs can be delivered to the eye tumor via the artery leading into the eye (“chemosurgery”). After successful treatment, children must undergo regular follow-up examinations over the next few years. This allows for the timely detection of a possible recurrence.

Overall, the prognosis for this type of eye tumor is much better today than it was just a few years ago: a study from Singapore published in late 2012 reported a 5-year survival rate of 97 percent for unilateral retinoblastoma.

Melanomas originate from pigment-containing cells called melanocytes. They occur in various layers of the eye. Choroidal melanoma, which affects the layer of blood vessels located beneath the retina, is the most common malignant tumor of the interior of the eye. It occurs in about one in every 2,500 people.

Symptoms, Diagnosis, and Treatment of Choroidal Melanoma

Unfortunately, it rarely causes any subjective symptoms. As a result, the affected person does not notice anything until the eye tumor has already grown quite large and is impairing vision. During ophthalmoscopy—an examination of the back of the eye with a dilated pupil—the ophthalmologist observes a deep, dark protrusion. This protrusion detaches the retina and grows into the vitreous humor.

Choroidal melanoma is a life-threatening condition: between 30 and 50 percent of those affected die from liver or lung metastases. It must be distinguished from benign findings on the fundus with pigmentation through an ultrasound examination and fluorescein angiography.

Similar to retinoblastoma, radiation therapy can often prevent the need for eye removal. Surgical removal (resection) is also often possible for this type of eye tumor.

Symptoms, Diagnosis, and Treatment of Iris Melanoma

When melanoma occurs in the iris, it is usually detected early and accurately. Even at this location, the affected person typically experiences few subjective symptoms. A glance in the mirror may lead to the discovery of the lesion. The ophthalmic surgeon can usually resect this eye tumor effectively.

Symptoms, Diagnosis, and Treatment of Conjunctival Melanoma

The conjunctiva is the layer of the eye on which melanomas are actually easy to spot and identify: as dark nodules against the background of the white sclera. However, distinguishing them from other forms of pigment deposits in this transparent layer is not entirely straightforward.

In conjunctival melanosis, melanin-containing cells stain large areas of the conjunctiva dark brown. In Caucasians, this is considered a potential precursor to melanoma. In Africans, however, melanosis is harmless.

Early removal is also the treatment of choice for conjunctival melanoma. Unfortunately, conjunctival melanomas metastasize early, usually first to the lymph nodes in the head and neck region.

The term “eye cancer” encompasses various types of eye tumors, including benign and malignant tumors that can develop on the eye. Early diagnosis and treatment are crucial, as symptoms of eye cancer often do not appear until late in the disease’s progression and should be recognized as early as possible. The most important signs of eye cancer include visual disturbances or visible changes, which is why it is essential to consult an ophthalmologist if eye cancer is suspected.

The causes of eye cancer are varied, and genetic factors and other risk factors may play a role. Certain factors increase the risk of eye cancer, even though the exact causes have not yet been fully elucidated. Eye cancer is a rare disease; however, it is important to know that it can occur in both adults and children. Retinoblastoma and choroidal melanoma, in particular, are well-known examples of different types of eye cancer.

Treatment for eye cancer is determined on a case-by-case basis depending on the type and location of the tumor. Treatment for retinoblastoma differs significantly from that for choroidal melanoma; in the case of choroidal melanoma, a targeted approach is usually taken to stop the tumor’s growth and prevent its spread. In some cases, removal of the tumor is necessary; in advanced cases, the eye may even need to be removed to prevent metastasis.

Tumors in and around the eye can progress differently depending on their type. Symptoms of eye cancer can vary depending on the type, which is why symptoms must always be evaluated on a case-by-case basis. Depending on the type, treatment is specifically targeted at the tumor to ensure successful treatment.

More information on eye cancer shows that early evaluation by an ophthalmologist is crucial, as detecting eye cancer early significantly improves the prognosis. This is especially true for rare forms of eye cancer, where symptoms often do not become apparent until late in the disease. Taking these symptoms seriously is crucial to preventing the tumor from spreading before it forms metastases or continues to grow within the eye.