Fri. Aug 5th, 2022
    Retinoblastoma retinal cancer

    Retinal Cancer

    The retina is the transparent, light-sensitive membrane at the back of the eye. Retinal cancers usually start in the choroid, a dense vascular layer that nourishes the retina. The choroid is located between the retina and the sclera (outer, white envelope of the eye). As the vascularization of the retina depends on the choroid, an alteration of the latter by a retinal cancer process can affect vision.

    Choroidal melanoma

    Choroidal melanoma is a cancer that originates from cells that produce choroidal pigment (melanocytes).

    It is the most common eye cancer. It is more common in people with white skin. It occurs most frequently between the ages of 55 and 60.

    Symptoms

    At the initial stage, visual acuity is most often normal. Later, it can blur vision or cause retinal detachment, with symptoms like flashes, or a veil or curtain across the visual field, or a sudden increase or change in floaters (objects that appear to move at across the field of vision). Melanomas, especially large ones, can spread into the eye socket or spread through blood (metastasis) to other parts of the body and can be fatal.

    Diagnostic

    Clinical eye examination
    Other tests
    Early diagnosis of choroidal melanoma is important because smaller tumors are easier to treat.

    Diagnosis is made with an ophthalmoscope and tests including ultrasound, fluorescein angiography, and serial photography.

    Treatment

    For small tumours, laser, radiotherapy or implant
    For large tumours, removal of the eye
    If the melanoma is small, laser treatment, radiation, or injection of a radioactive substance can preserve visual acuity and save the eye.

    When the cancer is large, the eye must be removed.

    Choroidal metastases

    Choroidal metastases are cancerous tumors originating from other parts of the body and spreading to the eye. Because of its rich vascularization, the choroid is often the site of metastases from other organs. In women, the main cause is breast cancer. In men, lung and prostate cancer are more frequently involved.

    Symptoms

    Often, choroidal metastases do not cause symptoms when they are not in the advanced stage. Symptoms, when they do appear, are often loss of visual acuity or symptoms of retinal detachment such as floaters, flashes of light, blurred vision and haze in the field of vision. Vision loss can vary from mild to severe.

    Diagnostic

    Clinical eye examination

    • Usually ultrasound
    • Biopsy
    • Sometimes the diagnosis of choroidal metastases is made by ophthalmoscope during a routine ophthalmological examination. The diagnosis is confirmed by ultrasound.

    Confirmation of the diagnosis can be made by removing, with a fine needle, a small piece of the tumor which will be examined under a microscope (biopsy).

    Treatment

    Chemotherapy and/or radiotherapy

    Chemotherapy or radiotherapy, or both at the same time, are the usual treatments for this type of choroidal metastases and depend on the type of primary cancer.

    Retinoblastoma

    Retinoblastoma is a malignant tumor of the retina, rare (one child in 15 to 20,000 would be affected) and of genetic origin, usually appearing before the age of 5 years.

    Symptoms

    Two known signs indicate a risk of retinoblastoma in a person:

    – leukocoria (whitish reflection of the pupil, appearing – at a certain angle, and sometimes highlighted in photos taken with a flash)
    – a strabismus.

    The diagnosis of retinoblastoma is made by an ophthalmologist. This carries out a fundus examination with dilation of the pupil and, in the event of suspicion of retinoblastoma, refers the child to a specialized center which will carry out a new dilated fundus examination and an examination of the retina, the more often under general anesthesia.

    The ophthalmological examination can be supplemented by MRI and ocular ultrasound. In the event of a very large tumour, retinal or optic nerve invasion, the search for distant metastases may be necessary.

    Treatment

    The management of retinoblastoma has been the subject of recommendations published by the Canadian Retinoblastoma Society.

    The treatments are either surgery with sometimes surgical removal of the eye, chemotherapy (cisplatin, etoposide and vincristine), diode laser, thermo-chemotherapy, cryotherapy, radiotherapy or photocoagulation.

    Enucleation is often the only option in non-diffuse forms in developing countries. The anatomopathologic examination of the eye makes it possible to see whether the tumor has remained intraocular.


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    Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.


    Sources: PinterPandai, Harvard University, Associated Retina Consultants

    Main photo credit: Morleyj / Wikimedia Commons (Public Domain)
    Author: Morleyj

    Main photo description: Retinoblastoma (retinal cancer) retina scan before and after chemotherapy.