Specialised Treatments (click on the link for images): Cavernous hemangioma of orbit, Lacrimal gland tumors, Optic nerve glioma, meningioma, etc

Common ocular cancers: Choroidal melanoma - It arises from the pigmented cells of the choroid of the eye and is not a tumor that started somewhere else and spread to the eye. A choroidal melanoma is malignant, meaning that the cancer may metastasize and eventually spread to other parts of the body. Because choroidal melanoma is intraocular and not usually visible, patients with this disease often do not recognize its presence until the tumor grows to a size that impairs vision by obstruction, retinal detachment, hemorrhage, or other complication. Pain is unusual, except with large tumors. Periodic retinal examination through a dilated pupil is the best means of early detection.

Treatment - Treatment recommendations for choroidal melanoma usually are based on the size of the tumor. Small suspicious melanomas usually are closely watched for evidence of growth before treatment is recommended. Medium-sized tumors may be treated with either radioactive plaque therapy or enucleation (removal) of the eye. Large-size tumors usually are best treated by enucleation. This is because the amount of radiation required to treat the tumor is too much for the eye to tolerate.

Choroidal hemangioma: A hemangioma is a tumor comprised of blood vessels and can grow within the choroid, the blood vessel layer beneath the retina. Choroidal hemangiomas are not cancers and never metastasize. However, if the hemangioma is located in the area of central vision of the eye it can leak fluid that causes a retinal detachment and visual function may be affected.

Treatment - Many choroidal hemangiomas can be safely monitored by your eye doctor without the need of further treatment. Photographs can be used to document evidence of growth or leakage and the need for treatment. Treatment options may include laser photocoagulation to decrease the amount of fluid leakage or low doses of external beam radiation therapy.

Choroidal Metastasis: Metastatic cancers that appear in the eye usually come from a primary cancer of the breast in women and the lungs in men. Other, less common, sites of origin include the prostate, kidneys, thyroid, and the gastrointestinal tract. Blood cell tumors (lymphomas and leukemia) also can spread to the eye. The care of patients with metastasis to the eye should be coordinated between the eye cancer specialist, medical oncologist, and radiation oncologist.

Treatment - Treatment options may include chemotherapy, external beam radiation therapy, or, more rarely, enucleation.

Choroidal Nevus: Like a raised freckle on the skin, a nevus can occur inside the eye. And, like a skin nevus, a choroidal freckle can become malignant, so should be closely monitored. A choroidal nevus should be examined by an ophthalmologist every four to six months to check if the pigmentation or size of the nevus has changed.

Treatment - In most cases, the only treatment recommended is close observation and monitoring by an ocular oncologist.

Conjunctival Tumors: Conjunctival tumors are malignant cancers that grow on the outer surface of the eye. The most common types of conjunctival tumors are squamous cell carcinoma, malignant melanoma, and lymphoma. Squamous cell carcinomas rarely metastasize, but can invade the area around the eye into the orbit and sinuses. Malignant melanomas can start as a nevus (freckle) or can arise as newly formed pigmentation. Lymphoma of the eye can be a sign of systemic lymphoma or be confined to the conjunctiva.

Treatment - Both squamous cell carcinomas and malignant conjunctival melanomas should be removed. Small tumors can be completely removed surgically. In other instances, cryotherapy (freezing therapy) may be necessary or chemotherapy eye drops may be used to treat the entire surface of the eye.

Eyelid Tumors : Tumors of the eyelid may be benign cysts, inflammation, or malignant skin cancers. The most common type of eyelid cancer is basal cell carcinoma. Other common eyelid cancers include squamous cell carcinoma and sebaceous gland carcinoma. Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. A simple biopsy can determine if an eyelid tumor is malignant.

Treatment - Malignant tumors are completely removed and the eyelid is repaired using plastic surgery techniques. This usually results in a complete cure of the eyelid cancer. Additional cryotherapy (freezing-therapy) and radiation therapy sometimes is required after surgery.

Iris Tumors: Tumors can grow within and behind the iris. Though many iris tumors are cysts or a nevus, malignant melanomas can occur in this area. Most pigmented iris tumors do not grow. They are photographed and monitored with a special slit lamp and high frequency ultrasound to establish a baseline for future comparisons. When an iris tumor is documented to grow, treatment is recommended.

Treatment - Most small iris melanomas can be surgically removed. Radiation plaque therapy or enucleation may be considered for larger iris tumors.

Lymphoma/Leukemia: Lymphoma tumors can appear in the eyelid tissue, tear ducts and the eye itself. In most patients with large cell non-Hodgkin's lymphoma, the disease is confined to the eye and central nervous system. In these patients, symptoms appear in the eye an average of two years before they are seen elsewhere.

Treatment - Treatment may include external beam radiation, chemotherapy, or both (chemoradiation) to the central nervous system.

Orbital Tumors: Tumors and inflammations can occur behind the eye. These tumors often push the eye forward causing a bulging of the eye called proptosis. The most common causes of proptosis are thyroid eye disease and lymphoid tumors. Other tumors include hemangiomas (blood vessel tumors), lacrimal (tear) gland tumors, and growths that extend from the sinuses into the orbit. Though CT scans, MRI's and ultrasounds help in determining the probable diagnosis, most orbital tumors are diagnosed by a biopsy.

Treatment - When possible, orbital tumors are totally removed. If they cannot be removed or if removal will cause too much damage to other important structures around the eye, a piece of tumor may be removed and sent for evaluation. If a tumor cannot be removed during surgery, most orbital tumors can be treated with external beam radiation therapy. Orbital lymphomas are usually biopsied. After a complete work-up by an oncologist, treatment with radiation therapy is usually indicated. Chemotherapy may be needed if the lymphoma is found to involve other areas of the body.


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