Have you ever wondered if eye cancer can develop? You may not have even heard of it. But, cancer can actually develop inside our eyes and in the areas around them. Although this may sound scary, it is important to be aware of it. Because, if detected early, it is easier to treat. So, today we will talk about eye cancer in a simple way that you can understand.
What exactly is eye cancer?
Simply put, eye cancer is when cells in our eyes divide uncontrollably, rapidly, and form a tumor in one place. Now there are two types of these tumors. Some are just benign tumors , which means they are not cancerous and do not spread to other parts of the body. However, the other type is malignant tumors . Those are a little more dangerous because they can grow and spread to other parts of the body.
The most important thing is that if these eye cancers are detected early and treated, the spread of the cancer can be largely stopped.
What types of eye cancer are there?
Doctors classify eye cancers based on where the cancer starts—whether it's inside the eye, outside the eye, or in the areas around the eye—and the type of cells the cancer starts in. Let's take a look at the main types.
1. Intraocular Melanomas
This is the most common type of eye cancer. You may have heard the word ``Melanoma'' when talking about skin cancer. That ``Melanoma'' is formed from cells called ``Melanocytes''. This ``Intraocular Melanoma'' is a cancer that develops inside the eye from those ``Melanocytes'' cells. Most of the time, these develop in the middle part of the eye, that is, in the layer called the uvea . Therefore, these are also called uveal melanomas . There are several main types under this:
- Iris Melanoma: This develops in the part of the eye that gives color to the iris . It may look like a new, gradually growing black spot on the colored part of your eye. These are usually slow-growing.
- Ciliary Body Melanoma: This develops in the ciliary body , a part of the eye that controls the lens of our eye when we look at things that are close to us and things that are far away. This is located behind the iris.
- Choroidal Melanoma: This develops in the choroid, the layer that supplies blood to the retina and the front of the eye at the back of the eye. It is in the choroid that most eye melanomas develop.
Sometimes melanoma can also develop in the thin membrane that covers the front of the eyeball, the conjunctiva . These are called conjunctival melanomas . These are very rare, and like uveal melanoma, they can spread and be more serious.
2. Eyelid and Orbital Cancer
These cancers develop in the tissues near the eyeball. Orbital cancers develop in the eye socket, where the muscles and nerves that move the eyeball are located. Adnexal cancers develop in tissues that support the eye, such as the eyelids and tear glands. These are classified according to the type of cell from which the cancer develops. The most common types are:
- Squamous Cell Carcinoma: Develops from the squamous cells on the surface of the skin.
- Basal Cell Carcinoma: Develops from the basal cells at the top of the skin.
- Rhabdomyosarcoma: Forms within muscle tissue.
3. Retinoblastoma
This is a cancer that starts in the retina at the back of the eye. It is most often seen in children under the age of five.
4. Intraocular Lymphoma
This is a very rare type of B-cell lymphoma . It develops in white blood cells called lymphocytes . It is most common in people over the age of 50 and in people with weakened immune systems. Many people with this type of eye cancer also have a condition called Primary Central Nervous System Lymphoma (PCNSL) . This is a cancer that affects various parts of the central nervous system, such as the brain and spinal cord.
How common is this eye cancer? What is the most common type?
Eye cancer is actually extremely rare . For example, in the United States, only about 3,400 cases are reported each year. However, it is more common for cancer to spread to the eye when it starts elsewhere in the body. However, because these are not cancers that start in the eye, doctors do not classify them as eye cancer.
The most common type of eye cancer is intraocular melanoma , which most often develops in the choroid, a structure in the middle of the eye.
What are the symptoms of eye cancer?
In most cases, a tumor may not cause any symptoms until it starts to interfere with the function of the eye. However, do not assume that you have eye cancer just because you have the symptoms listed below. Many non-cancerous eye diseases can also cause these symptoms. Therefore, you should definitely see a doctor to find out for sure.
The most common symptom of eye cancer is painless vision loss . In addition, these vision problems can also be symptoms of eye cancer:
- Blurry vision.
- Vision loss - partial or total.
- Seeing flashes of light, squiggly lines or spots (floaters).
Other features:
- A bulging eye.
- Persistent eye redness and itching (Eye irritation that doesn't improve).
- A dark spot in your iris that gets bigger.
- A growing lump on your eyelid or in your eyeball.
- Changes in your eyeball's positioning in the socket and how it moves.
What might be the first symptoms?
Many people only find out they have eye cancer when they go for an eye exam, when an ophthalmologist or optometrist sees something unusual while examining their eyes. For example, if you see enlarged blood vessels inside the eye, or if you see a black spot, it could be a sign of eye cancer or another eye disease. To know for sure, more tests are needed.
Why does this eye cancer occur?
Like other cancers, eye cancer develops when cells divide and multiply uncontrollably, eventually forming a tumor . These tumors can break off and spread to lymph nodes and the blood. The cancer cells can then travel through the blood and lymphatic system to other parts of the body and form new tumors. When this happens, doctors say the cancer has "spread" or metastasized . This means that the disease has become more serious.
Scientists are still researching how normal, healthy cells become cancer cells.
Who is at higher risk of developing eye cancer?
Researchers have found several factors that increase the risk of developing eye cancer:
- Age: Most eye cancers are diagnosed in people over the age of 50. However, a type called ``Retinoblastoma`` that develops in children under the age of 5 is different.
- Skin color: If you are white and have fair skin, you are more likely to develop eye cancer.
- Eye color: People with light-colored eyes, such as blue and green, are more likely to develop cataracts than those with dark-colored eyes, such as brown.
- Inherited conditions: People with dysplastic nevus syndrome , a hereditary condition that causes many abnormal moles to form on the body, are at increased risk of developing some eye cancers. A condition called BAP1 tumor predisposition syndrome may also increase the risk of developing several cancers, including uveal melanoma.
- Sun exposure and tanning: There is some evidence that exposure to UV rays from the sun or tanning beds may increase the risk of developing intraocular melanoma. More research is needed to know for sure.
How is eye cancer diagnosed?
Eye cancer is diagnosed by an ophthalmologist or an ocular oncologist . Before determining whether it is cancer, various tests are performed to ensure that there are no other common eye diseases.
1. Eye Exam
In this, the doctor will carefully examine your eye and check for signs of cancer. They will look for things like black spots and enlarged blood vessels. They will check to see if the eyeball is moving properly. They will use special instruments to clearly see the structures inside the eye.
- Ophthalmoscope: This is a handheld instrument that has a light and several lenses. It can be used to view structures at the back of the eyeball, such as the retina.
- Slit Lamp: This is a table-top device that has a light and a special lens system, similar to a microscope. It allows you to see the front and back of your eyeball very clearly.
2. Imaging tests
In most cases, the information obtained from an eye exam and these imaging tests is enough to diagnose eye cancer. The most common imaging tests are:
- Ultrasound: This uses sound waves to take pictures of the inside of the eyeball. Ultrasound can show how big the tumor is and where it is located. This is especially useful for detecting intraocular melanoma.
- Fluorescein Angiography: In this, the doctor injects a special dye into your blood vessels. The dye makes the blood vessels clearly visible during imaging. After the dye reaches the blood vessels inside the eye, a special camera is used to watch the blood flow inside the eye.
If there is a suspicion that the cancer has spread, further imaging tests may be done. Tests that are done to see if the cancer has spread beyond the eye include:
- Ultrasound
- Chest X-ray
- CT scan
- MRI
- PET scan
3. Biopsy
In a biopsy , the doctor takes a small piece of tissue from the tumor and tests it for cancer cells. While most eye cancers can be detected with an eye exam and imaging, a biopsy can provide information about genetic changes in the cancer cells, such as genetic mutations. This information can be used to determine things like how severe the cancer is and whether you are a good candidate for certain treatments.
- Fine Needle Aspiration Biopsy: A very thin needle is used to remove a small amount of fluid from inside the eye to check for cancer cells.
- Incisional Biopsy: A portion of the tumor is removed and examined.
- Excisional Biopsy: The entire tumor is removed and examined.
How is cancer staging determined?
Staging helps determine how severe the cancer is and what stage it is in. This information is used to plan treatment and give an idea of the prognosis. There are two staging systems commonly used for eye cancer:
1. American Joint Committee on Cancer (AJCC) TNM staging system
Doctors determine the stage of cancer by looking at several factors:
- T (Tumor): The size of the tumor and whether it has spread to other parts of the eye.
- N (Nodes): Whether the tumor has spread to the lymph nodes in the ear and neck.
- M (Metastasis): Whether the cancer has spread to other organs (most often the liver).
Taking all these factors together, eye cancer is given a stage ranging from I (least serious) to IV (most serious).
2. Collaborative Ocular Melanoma Study (COMS) staging system
Another commonly used method is to determine the stage based on the size of the tumor. Size is often used to determine the most appropriate treatment. The measurement is taken in millimeters (mm).
- Small: Between 1 mm and 2.5 mm in height, between 5 mm and 16 mm in width.
- Medium: Between 2.5 mm and 10 mm in height, 16 mm or less in width.
- Large: More than 10 millimeters in height, more than 16 millimeters in width.
What other tests will be done?
If your doctor suspects that the cancer has spread, they may order an imaging scan of the liver. This is because eye cancer that spreads beyond the eye is most likely to spread to the liver.
What are the treatments for eye cancer?
Sometimes, if the tumor is slow-growing or the diagnosis is uncertain, your doctor may recommend that you wait a while before starting treatment. This is especially true if the risks of treatment outweigh the risks of not doing so. For example, if there is a risk of vision loss in the area being treated.
1. Radiation Therapy
This is a commonly used treatment for eye cancer.
- Brachytherapy: Or internal radiation therapy. This is most commonly used for eye melanoma. In this, the doctor places a small disc-like device near the tumor. It emits radiation and kills the cancer cells.
- External Beam Radiation Therapy (EBRT): In this, radiation is delivered to the tumor using a machine that does not touch your body. There are techniques like stereotactic surgery . In this, high doses of radiation are delivered to the tumor in one treatment session. Proton beam radiation therapy is another option. This is a newer radiation therapy. It can deliver high doses of radiation to the tumor with great precision. However, it is not available everywhere because of the high cost of maintaining the equipment.
2. Surgery
Surgery is a commonly used treatment, especially for small tumors where the cancer has not spread beyond the eyeball.
- Iridectomy: This involves removing part of the iris. This is often used for small melanomas.
- Iridocyclectomy: This involves removing part of the iris and ciliary body. This is also commonly used for small melanomas.
- Transscleral Resection: Melanoma in the choroid or ciliary body is removed.
- Enucleation: The eyeball is completely removed. This surgery is done when there is a large tumor or when treatment fails to save your vision. After that, a prosthetic eyeball is inserted into your other eye. Your medical team will help you fit the artificial eye exactly, with the same appearance and movement as your own eye.
- Orbital Exenteration: The entire eyeball and some of the tissue around it are removed. Your doctor may recommend this surgery if the cancer has spread to the structures around the eyeball. Like enucleation, this is followed by an artificial eyeball.
3. Laser Therapy
Laser treatments use heat to destroy eye cancer. The most common method is called transpupillary thermotherapy (TTT) . In this, infrared light is used to deliver concentrated heat to the tumor, destroying cancer cells. It can be used alone or after brachytherapy to prevent the cancer from coming back.
4. Immunotherapy
Immunotherapy works by helping your immune system recognize and destroy cancer cells. In some cases, an immunotherapy drug called Tebentafusp is used to treat uveal melanoma. Immunotherapy is often used when the cancer has spread or cannot be removed with surgery.
5. Targeted Therapy
Targeted therapy uses drugs to target specific weaknesses in cancer cells and destroy them. If your cancer cells have a BRAF gene mutation , you may be eligible for targeted therapy. Although this mutation is currently most commonly seen in skin melanoma, this treatment may also be beneficial for people with eye melanoma.
6. Chemotherapy
Chemotherapy is not a common treatment for eye cancer. However, your doctor may recommend chemotherapy if your cancer is not responding to other treatments or if it has spread to other areas.
What are the possible side effects of treatment?
Side effects depend on the type of treatment your doctor recommends. Because these treatments target the eyes, there may be changes in your vision. The most important risk is partial or complete loss of vision. These risks depend on several factors that you should discuss with your doctor.
Can eye cancer be prevented?
There is no way to completely prevent eye cancer. However, if you know you are at high risk for developing eye cancer, regular eye exams can help detect the disease early and increase your chances of recovery. For example, if you have a condition like `(BAP1 tumor predisposition syndrome)`, it is a good idea to have your eyes checked regularly. If someone in your family has `(Retinoblastoma)` and you have a child, it is wise to have that child's eyes checked regularly for cancer.
Can eye cancer be cured? What is the cure rate?
The outcome of your treatment, or prognosis, depends on many factors. The size of the tumor, its location, and how far it has spread. For example, brachytherapy can kill up to 95% of small to medium-sized intraocular melanomas. It may not cure eye cancer completely. However, it can control its growth inside the eyeball.
Ask your doctor about the chances of recovery, depending on your specific type of eye cancer.
Intraocular melanoma, the most common type of eye cancer, has a very good survival rate if it is detected and treated while it is still inside the eyeball. However, if the cancer has spread to other organs, the survival rate is not as good. Fortunately, most cancers are detected and treated before they spread.
Important questions to ask your doctor
You can ask questions like these:
- What type of eye cancer do I have?
- What stage is my cancer in?
- What treatment options do you recommend?
- What are the possible side effects of treatment?
- Will I be able to keep my vision after treatment?
- What are the chances that my cancer will be completely cured with treatment?
Finally, an important message
When you are diagnosed with eye cancer, what it means depends on many factors, including the type of cancer you have, where it is in your eye, and whether it has spread. For the most common types of eye cancer, early detection is essential for successful treatment. That's why regular eye exams are so important. Since many eye cancers don't show symptoms in the early stages, seeing something unusual during an eye exam is usually the first sign of eye cancer. So, follow your eye doctor's advice about how often you should have your eyes checked to identify any vision problems or other conditions that may affect your eyes. Don't panic, be informed, and take the necessary steps.
` Eye Cancer, Eye Cancer, Eye Cancer, Cancer Symptoms, Cancer Treatment, Melanoma, Retinoblastoma
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