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UC Davis Comprehensive Cancer Center

UC Davis Comprehensive Cancer Center

Eye Cancer

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Dr. Park and eye cancer patient, Michael Bone 

Park receives Joan Oettinger Memorial Award  

Susanna Soon-Chun Park, professor of ophthalmology, is the recipient of the 2011 Joan Oettinger Memorial Award for her cutting-edge research into the use of radiotherapy as a treatment for ocular melanoma and other eye conditions.

New Patient Support

New patient support 

Peer navigator program provides one-to-one peer support  

This special program matches newly-diagnosed cancer patients with cancer survivors.

Related Resources

eye cancer cellCancers of the eye can be divided into those covering the surface of the eye and those occurring internally. Most external tumors are relatively benign and slow growing and can be treated by superficial excision. Internal eye tumors, usually involving the retina and choroid, are more serious and often call for radiation and other therapy in addition to surgery. The most common internal eye cancers include intraocular melanoma in adults and retinoblastoma in children. Both of cancers can spread to other organs and can be fatal. Sometimes, cancers from other parts of the body (e.g. breast or lung cancer) can spread to the eye and cause a secondary tumor.

Eye cancer treatment frequently requires the collaboration among specialists from multiple different medical disciplines. The ophthalmologist plays a central role in the diagnosis and management of eye tumors but may work with medical and radiation oncologists to provide the appropriate evaluation and treatment, as needed.

Research efforts are under way at UC Davis to evaluate the use of radiation therapy for internal cancers of the eye and to increase knowledge of the effects of other cancers upon the eye.

Clinical Trials at UC Davis Comprehensive Cancer Center
UC Davis Comprehensive Cancer Center has a large clinical trials network. The close collaboration among our doctors and our research scientists means that new drugs and treatments developed in the laboratory can quickly move to the clinic, offering our patients immediate access to the latest therapies.

Risk Factors

Retinoblastoma is a relatively uncommon tumor of childhood that arises in the retina and accounts for about 3% of the cancers occurring in children younger than 15 years. There are tumors that occur in heritable (40%) and non-heritable (60%) forms. Heritable disease is the only known cause.

Risk factors for intraocular melanoma include:

  • Older age
  • Being white
  • Having a fair complexion (light skin) or green or blue eyes
  • Being able to tan

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Signs and Symptoms

Retinoblastoma:

  • Pupil of the eye appears white instead of red when light shines into it. This may be seen in flash photographs of the child.
  • Eyes appear to be looking in different directions.
  • Pain or redness in the eye.

Intraocular melanoma may not cause any early symptoms.  It is sometimes found during a routine eye exam when the doctor dilates the pupil and looks into the eye. The following symptoms may be caused by intraocular melanoma or by other conditions. A doctor should be consulted if any of these problems occur:

  • A dark spot on the iris.
  • Blurred vision.
  • A change in the shape of the pupil.
  • A change in vision.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Diagnosis

Tests that examine the retina may be used to detect (find) and diagnose retinoblastoma. 

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken. The doctor will ask if there is a family history of retinoblastoma.
  • Eye exam with dilated pupil: An exam of the eye in which the pupil is dilated (opened wider) with medicated eyedrops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is examined with a light. Depending on the age of the child, this exam may be done under anesthesia.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the eye, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the eye. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Retinoblastoma is usually diagnosed without a biopsy (removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer). Clinical laboratory service is now becoming more available in some centers for performing genetic testing of relatives of retinoblastoma patients to determine risk of hereditary susceptibility to the disease.

Tests that examine the eye may be used to help detect (find) and diagnose intraocular melanoma.

  • Eye exam with dilated pupil: An examination of the eye in which the pupil is dilated (enlarged) with medicated eyedrops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is examined using an instrument that produces a narrow beam of light. This is sometimes called a slit-lamp exam. The doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
  • Indirect ophthalmoscopy: An examination of the inside of the back of the eye using a small magnifying lens and a light.
  • Ultrasound exam of the eye: A procedure in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye. The picture, called a sonogram, shows on the screen of the ultrasound monitor.
  • Transillumination of the globe and iris: An examination of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid.
  • Fluorescein angiography: A procedure to look at blood vessels and the flow of blood inside the eye. An orange fluorescent dye (fluorescein) is injected into a blood vessel in the arm. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to detect any blockage or leakage.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Treatment

There are six types of standard treatment for retinoblastoma:

  • Enucleation
    Enucleation is surgery to remove the eye and part of the optic nerve.  The eye will be checked with a microscope to see if there are any signs that the cancer is likely to spread to other parts of the body. This is done if the tumor is large and there or no chance that vision can be saved. The patient will be fitted for an artificial eye after this surgery. Close follow-up is needed for 2 years or more to check for recurrence in the area around the eye.
  • Radiation therapy
    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, plaques, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Methods of radiation therapy used to treat retinoblastoma include the following:
    • Intensity-modulated radiation therapy (IMRT): A type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of radiation therapy causes less damage to healthy tissue near the tumor.
    • Stereotactic radiation therapy: Radiation therapy that uses a rigid head frame attached to the skull to aim high-dose radiation beams directly at the tumors, causing less damage to nearby healthy tissue. It is also called stereotactic external-beam radiation and stereotaxic radiation therapy.
    • Proton beam radiation therapy: Radiation therapy that uses protons made by a special machine. A proton is a type of high-energy radiation that is different from an x-ray.
    • Plaque radiotherapy: Radioactive seeds are attached to one side of a disk, called a plaque, and placed directly on the outside wall of the eye near the tumor. The side of the plaque with the seeds on it faces the eyeball, aiming radiation at the tumor. The plaque helps protect other nearby tissue from the radiation.

  • Cryotherapy
    Cryotherapy is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryosurgery.
  • Photocoagulation
    Photocoagulation is a procedure that uses laser light to destroy blood vessels to the tumor, causing the tumor cells to die. Photocoagulation may be used to treat small tumors. This is also called light coagulation.
  • Thermotherapy
    Thermotherapy is the use of heat to destroy cancer cells. Thermotherapy may be given using a laser beam aimed through the dilated pupil or onto the outside of the eyeball, or using ultrasound, microwaves, or infrared radiation (light that cannot be seen but can be felt as heat).
  • Chemotherapy
    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ (such as the eye), or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

     

Treatment of ocular melanoma

  • Radiation Therapy
    Radiation therapy is the most common treatment for eye melanoma since the patient does not require removal of the eye. Studies have shown no difference in patient survival regardless of whether the melanoma is treated with radiation or eye removal surgery.
  • Surgery
    The surgical option for treatment eye melanoma is eye removal (enucleation). This is the simplest and most definitive treatment for eye melanoma, but this is reserved usually for patients with poor vision and large tumors. If the tumor has extended outside the eyeball into the surrounding tissue, removal of the surrounding tissues in the eye socket also will be performed (exenteration). Surgery is also an option for small melanomas involving the iris.
  • Surveillance
    Continued surveillance for signs of extraocular metastasis of ocular melanoma is needed even with successful eye treatment since patients are at risk for metastasis. This can be done by a medical oncologist or ocular oncologist.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Your Team

Jeffrey J. Caspar, M.D.
Residency Program Director
Professor of Clinical Ophthalmology & Vision Science
Cataract and Refractive Surgery

Nandini Gandhi, M.D.
Assistant Professor of Ophthalmology & Vision Science
Pediatric Ophthalmology

John L. Keltner, M.D.
Professor of Ophthalmology, Neurology, and Neurosurgery
Neuro-Ophthalmology
Director of Research & Faculty Development

Khizer Khaderi, M.D.
Assistant Professor of Ophthalmology & Vision Science
Neuro-ophthalmology

Esther S. Kim, M.D.
Associate Professor of Ophthalmology & Vision Science
Director of Comprehensive Service

Jennifer Li, M.D.
Assistant Professor of Ophthalmology & Vision Science
Corneal Disease and Surgery

Mark J. Mannis, M.D.
Professor and Chair of Ophthalmology & Vision Science
Corneal Disease and Surgery

Lawrence S. Morse, M.D., Ph.D.
Professor of Ophthalmology & Vision Science
Vitreo-Retinal Disease and Surgery
Director of the Vitreo-Retinal Service

Mary A. O'Hara, M.D.
Professor of Ophthalmology & Vision Science

Susanna S. Park, M.D., Ph.D.
Professor of Ophthalmology & Vision Science
Vitreo-Retinal Disease and Surgery

Ivan R. Schwab, M.D.
Professor of Clinical Ophthalmology & Vision Science
Corneal Disease and Surgery
Director of Cornea & External Disease Service

Support

UC Davis Comprehensive Cancer Center is dedicated to caring for the whole patient.  We offer: